Purpose Built to Support Medicare Advantage Populations

Supporting today’s Medicare Advantage members means enabling payers to offer connected care experiences that adapt for individual member needs. With HELIOS®, payers can become efficient proactive care providers. By streamlining their Medicare care management operations and leveraging real-time, automated 360° views of members, payers can focus on what matters:
delivering more value to more members.


Enabling the Experiences Medicare Advantage Members Want

Today’s Medicare Advantage members want care that’s accessible, personalized, and transparent. They want simple healthcare experiences that account for their health and lifestyle in real time. And they want to know that their care is the primary objective - always.  

HELIOS® helps Medicare Advantage plans provide a Medicare care management program that’s adaptable, providing value-based care experiences to members efficiently and effectively across the entire care continuum. It streamlines and automates workflows that previously wasted time and resources. It provides a suite of configurable features that give payers end-to-end visibility and care teams a workbench with the information and tools they need to provide the right care, to the right member, at the right time.

Explore HELIOS for Medicare

How HELIOS® Supports Medicare Advantage

HELIOS® supports leading-edge care management, case management, disease management, and utilization management that allows Medicare Advantage and other Medicare health plans to deliver optimized Medicare care experiences for various populations while maximizing financial return and operational efficiency.


Fully configurable, automated workflows integrated with clinical guidelines across medical, pharmacy, and LTSS


Identify regulatory requirements and configure tasks to ensure compliance


Streamline identification of in and out-of-network providers


Configurations available for internal and external processes - authorizations, appeals, grievances & more


User-friendly authorization management, full-lifecycle available


Auditing and reporting metrics for internal or external reviews and audits


Disease management clinical workflows that follow industry-standard regulations


Built-in suite of member engagement and communication tools for improved outcomes and transparency


Real-time 360-degree view of members and their utilized benefits and services to provide more efficient, personalized care


Identify and solve for varying SDOHs with AI-powered insights, integrated community resources and telehealth


Seamless communication for more accurate care, claims payments and coverage insights


End-to-end visibility for optimizing high-quality, cost-effective care delivery models


AI-driven automations, insights and reporting to streamline, improve CM/UM team productivity and decision making


Front-end data integrity validation


Included RDB (replicated data base) to help create customized reports for audits and other internal/external needs


Enables easy collaboration across care teams, utilization review teams and disease management teams


Built-in industry-standard, evidence-based behavioral health screening tools and care plan content for a collaborative, interdisciplinary care team approach


Assessments and screenings that auto populate to the care plan, auto-generate workflows and tasks

Identifying and Meeting Medicare Regulatory Requirements

HELIOS® offers a highly configurable build, AI-driven automations, and powerful data integrations that allow for the management of regulatory requirements. HELIOS® also provides comprehensive data and reporting capabilities that can quickly provide actionable insights or create reports for auditing.

The HELIOS® platform is HIPAA and HITECH compliant, NCQA Prevalidated for Population Health Management, and HITRUST CSF certified. It meets or exceeds all applicable regulatory requirements and empowers you to have the medical management data you need for CMS reporting and audit, as well as NCQA, and other external and internal needs.

We take security very seriously. It’s part of why HELIOS® is audited, updated, and optimized throughout the year. This ensures the platform continually meets and exceeds your needs, as well as the requirements of federal and state regulatory bodies.

NCQA Prevalidated for Population Health Management
HITRUST CSF Certified logo

Driving Member Engagement for Improved Health Outcomes

AI-driven automations and powerful data integrations deliver actionable insights and resources for care managers to help them better engage with members and guide them toward more efficient self-management.

  • Proactive health care capabilities with AI-powered data analysis and automated risk and task notifications 
  • Automated identification of care gaps that empower care teams to proactively engage patients, implement preventive interventions and initiatives and adapt care plans
  • Solve for healthcare inaccessibility issues with integrated community resource tools and partners for food, transportation, and home-health
  • Complete configurability of care plan content including letter generation for care correspondence and educational resources
  • Integrated health education materials and resources that can be tailored to meet the individual needs of each member
  • Robust medication management support including reconciliation and adherence assessment
  • Built-in HIPAA-compliant telemedicine tools HELIOStext and HELIOSvisit for secure member out-bound messages, video conferencing, and file transferal 

Ultimately, HELIOS allows you to provide more proactive care that leads to far fewer avoidable readmissions.

Population Health for Complex Cohorts

Unlike legacy population health tools, our dashboards are embedded directly into workflows, ensuring that insights can be actioned in real-time by the care team. At the same time, we provide administrative reports and drill-downs that support superior population, staff, and compliance management at all levels of your organization. HELIOS® is a workbench for preventive identification, stratification, and intervention while lowering all-important PMPM costs across contracted populations.


Fully Integrated for Long-Term Care and Home Health

We understand that many seniors aging in place require assistance with activities of daily living (ADLs). That is why HELIOS® provides state-of-the-art LTSS/MLTC management capabilities, including advanced assessment, service planning, provider search, authorization, and EVV features. As always, the platform's intelligent automation makes the challenge of managing ADLs for your population easier than ever.

Medicare Plans We Support

Fully Integrated Long-Term Care and Home Health
  • Association for Community Affiliated Plans (ACAP) member plans
  • Medicare / Medicaid
  • Medicare Advantage and Part D plans
  • Medicare Advantage Chronic Care Special Needs Plans (C-SNP)
  • Medicare Advantage Dual-eligible Special Needs Plans (D-SNP)
  • Medicare Institutional Special Needs Plan (I-SNP)
  • SNP Alliance Member Plans
Aging in place

Let Your Members Age in Place, Not Your Technology

From telehealth to connected devices to home care, HELIOS® provides the complete framework for a community-based healthcare ecosystem. We have nearly a decade of experience with these cutting-edge tools. Now, you too can offer your Medicare enrollees the best possible chance of aging at home while enjoying a higher quality of life and care in their golden years.

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