VH Insights

Why Should Healthcare Payers Consider Integrated Utilization Management Technology
January 10, 2023

Why Should Healthcare Payers Consider Integrated Utilization Management Technology?

Drive faster authorizations, reduce human error and administrative burden, and get higher plan satisfaction ratings 

As value-based care models continue to grow in popularity, healthcare plans and providers should take this opportunity to consider holistically transforming their utilization management (UM) program approach.

Historically, utilization management and care management have been separate disciplines with separate data. This siloed approach can result in higher costs, more administrative effort, slower care delivery, and poor member experiences. HELIOSum, which was recently launched in 2022, simplifies the entire utilization management process.

The Quick Benefits of HELIOSum

A cloud-based solution, HELIOSum unifies providers, care managers, and utilization management teams in the HELIOS platform and provides 360-degree patient views that align care and utilization data together for an integrated and collaborative approach.

With HELIOSum, Medicare, Medicaid, community, and commercial health plans can unlock more efficient, value-based care that improves member outcomes and satisfaction, while also providing the below UM improvements.

  • Faster authorizations
  • Streamlined utilization reviews, appeals, and grievances
  • Efficient data management, with no duplication of effort across teams
  • Reduced risk of human error (and less stress for staff!)
  • Healthier, happier members
  • Higher plan satisfaction ratings

See more ways HELIOSum can help you reimagine how to deliver UM.

A Single Place for Utilization Management and Care Management

HELIOSum is fully integrated within HELIOS so that healthcare organizations support both UM and CM needs in a comprehensive and intuitive manner.

Organizations can build a highly-optimized UM program that uniquely fits their needs, and all teams can access the comprehensive and necessary member information they need in just two or three clicks.

Automated UM to Drive Efficiency, Timeliness, and Accuracy

With HELIOSum, a lot of the burdensome and stressful workload can be alleviated for UM teams. Intelligent workflows, configurable rules engine and automations help teams work faster, and more accurately, and allow for a re-prioritization of time towards patient care.

See below for some of the ways HELIOSum can help drive lower-cost efficiencies:

  1. Prebuilt UM pathways based on industry best practices streamline authorizations and take the guesswork out of the equation for UM team members.
  2. Auto-approvals and auto-determination timelines accelerate authorizations, speeding the delivery of member services.
  3. Design intelligent workflows unique for your organization’s needs without IT support using HELIOS’ configurable rules engine.
  4. Evidence-based clinical guidelines and care decision support through integrations with industry leaders such as Change Healthcare (InterQual) and MCG and/or the ability to leverage internal clinical guidelines and criteria
  5. Automated creation of member timelines speeds up intake and eliminates human error associated with manual data entry.
  6. Automate the triage process to identify high-priority authorizations that require a fast turnaround for improved patient care and satisfaction.
  7. Build real-time dashboards with comprehensive data insights and metrics to track grievances, appeals, approvals, denials, and more.

Save Time and Promote Cross-Team Collaboration

With a platform that integrates UM and care management (CM) activities, team members will no longer jump between systems to access critical member data needed to meet authorization timelines. Instead, they gain a single-member view that pulls in data from across clinical settings and UM services into one place.

That means teams work in collaboration instead of in silos, which cuts back on redundant effort and positions staff to make more informed decisions for members.

Drive Whole-Person Care and Treatment with Real-Time Data Transparency

A platform that aligns UM and CM unlocks more effective care planning through tighter coordination and greater transparency. When care managers have access to a UM-oriented member view alongside the CM view, they can work toward solving UM-related issues in a way that’s best for the member. They can make proactive decisions to help expedite care and optimize outcomes.  

For example, if a care manager has real-time insight into a pending authorization for a surgical procedure, they can immediately begin pre-op support and education. They can engage with the member to guide preparation, tailoring recommendations to the member’s unique picture of health. 

Meanwhile, on the provider side, member data insights from across specialties and UM activities empower higher-value treatment decisions. This can accelerate approval of the recommended treatment, reducing delays in connecting members with medically necessary services. 

Want to learn more about HELIOSum, click here to set up a time to talk with our team.