LTSS Management

Proactive Healthcare for the Long Term

Millions of Americans need long term care. In 2015, state and federal Medicaid spending amounted to more than $113 billion dollars for long-term care services and supports and accounted for over 20% of Medicaid’s total financial obligation. With the industry shift to value-based care, it’s critical to have an efficient, cost-effective solution to address the complex needs of your LTSS population and improve service delivery as the population grows in size and diversity.

Maximize program dollars, improve outcomes, and increase the quality of care through a platform that identifies the appropriate setting and services for every member. HELIOS helps administer LTSS-specific assessments, pre-populated service plans, automated authorizations, real-time compliance and dashboards to monitor members for waiver compliance. The platform appropriately coordinates and integrates Medicare, Medicaid, and dual-eligible benefits.

VirtualHealth Full Platform Configurability
Full Platform Configurability
Configure the platform for specific requirements to remain competitive for state-sponsored contracts without requiring the use of IT resources.
VirtualHealth Streamlined Data Management
Streamlined Data Management
HELIOS pulls data from every available source and tracks members’ individualized needs, including provider visits, approvals, assessments, and service plans. Maximize transparency across the care team, including with UM teams and LTSS managers.
VirtualHealth Increased Efficiency Through Automation
Increased Efficiency through Automation
Automated business rule engines and integrated workflows allow care managers to focus on member interactions and avoid time-consuming tasks through features such as pre-populated service plans and automated tasks.
VirtualHealth Care Management Configurable Reports
Holistic Approach to Member Needs
Configurable whole-person assessments go beyond traditional ADLs to hone in on individualized care needs, while risk stratification algorithms enable effective targeting.
VirtualHealth Integrated Care Coordination
Integrated Care Coordination
HELIOS integrates benefits for Medicare, Medicaid, and dual-eligible members. Improve transitions of care with comprehensive information and communication on a platform accessible to all parties, including third-party vendors.
Full Platform Configurability
Configure the platform for specific requirements to remain competitive for state-sponsored contracts without requiring the use of IT resources.
Streamlined Data Management
HELIOS pulls data from every available source and tracks members’ individualized needs, including provider visits, approvals, assessments, and service plans. Maximize transparency across the care team, including with UM teams and LTSS managers.
Increased Efficiency through Automation
Automated business rule engines and integrated workflows allow care managers to focus on member interactions and avoid time-consuming tasks through features such as pre-populated service plans and automated tasks.
Holistic Approach to Member Needs
Configurable whole-person assessments go beyond traditional ADLs to hone in on individualized care needs, while risk stratification algorithms enable effective targeting.
Integrated Care Coordination
HELIOS integrates benefits for Medicare, Medicaid, and dual-eligible members. Improve transitions of care with comprehensive information and communication on a platform accessible to all parties, including third-party vendors.

A Closer Look

VirtualHealth Meet Juan LTSS
Meet Juan
Juan is an 86 year old male with diabetes and COPD. He uses a wheelchair and requires in-home assistance, but is able to continue living at home with his insurance-provided LTSS benefits. Though Juan’s needs are varied and complex, he is able to enjoy his independence with the right services and supports.
VirtualHealth LTSS Care Team
Juan’s Care Team
Juan has a care team consisting of a care manager, a home health aide, and a visiting nurse. Juan’s home health aide visits his home to assist him with medications and activities of daily living, including bathing and grooming.
VirtualHealth LTSS Real Time Information
Real-Time Information
HELIOS enables Juan’s entire care team to gain insight and transparency into the full spectrum of his complex care needs. In his last visit, the visiting nurse noted that Juan’s ability to self-care has declined and made a note regarding the changes to his condition in Juan’s care plan.
VirtualHeath LTSS Automated Workflows
Automated Workflows
HELIOS’ clinically-based calculations and business rules informed the care manager through an automated workflow that Juan was in need of additional home support, and automatically calculated the increase in hours. The care manager then formally requested an authorization for increased service hours with a few clicks in HELIOS.
VirtualHealth LTSS Intelligent Communication
Intelligent Communication
HELIOS’ auto-approval rules engine with pre-configured parameters resulted in an automatic approval for this additional support and triggered an auto-generated approval letter to both Juan and the home health provider.

In Conclusion

The whole-person view in HELIOS allows for Juan’s care team to fully address his complex needs while appropriately managing service levels and costs. It lets Juan remain independent in his home, enables him to continue seeing the providers he is most comfortable with, and improves his quality of life.