Medicaid Population Health Solution

Purpose-built to support high-quality, proactive care with appropriate cost controls and state-by-state regulatory compliance.

Medicaid payers have to deliver care that’s unique to their program requirements, processes, and rules for care and utilization management. With experience across multiple state programs and for some of the largest Medicaid payers with complex care needs, VirtualHealth’s HELIOS® solution provides unparalleled flexibility, automations and tools to enable high-quality care for vulnerable populations across the country.

12+ Million

Managed lives through HELIOS

Up to 93%

Increase in care team efficiency

Up to 92%

Care team productivity gains

37 Million

Total interactions in HELIOS

Medicaid Solution Features

Single Unified Platform For CM, DM, Population Health & UM

Whole-Person Views

Comprehensive Population Analytics & Reporting

SDOH Data & Analysis Integrations

Health Equity and SDOH Resources and Tools

Smart Targeted Assessments For Social And Behavioral Health

Population & Cohort Level Analysis Capabilities

Configurable, Automated Workflows

Advanced Population Stratification & Risk Scoring

Real-Time Data Feeds & Task/Case Assignments

Automated Care Plan Recommendations

Advanced Utilization Management with Automated Prior Authorization

Integrations with Leading SDOH, UM & Quality Analytics Partners

Mobile Application for Care Management in the Field

Pre-Built & Customizable Quality Reporting Dashboards

Behavioral Health, Home Health & LTSS Features, Customizations

Disease & Chronic Care Management Tools for Higher Complexity Populations

Proven Leaders In Medicaid Care Management

For years, HELIOS has been a leading choice platform for all kinds of organizations and a driving innovator in the field. Independent research and head-to-head comparisons confirm that HELIOS is the leader among medical management platforms servicing Medicaid clients.

Managed Care

Our platform empowers the automation of all facets of managed care – from program referrals to real-time task lists to upstream quality reports. The result? Better outcomes at lower costs.

Comprehensive LTSS Support

We support the most complex LTSS programs across the country, from assessment to authorization to service planning to EVV and reconciliation. All are completely configurable and fully compliant.

Delivering For Dual Eligibles

We have extensive experience with dual enrollees in both Medicaid and Medicare, from managing coordination of benefits to disenrollment/re-enrollment processing to specialized tracking.

Home Health Care

We were the first medical management platform to partner directly and integrate fully with home care and EVV vendors. From provider selection to capturing rich data at the point of care, we give you the tools to succeed.

Secure, Validated, Trusted

HELIOS is the HITRUST certified cloud platform for care, disease, utilization and population health management. Absolute commitment to information security underpins our proven track record in supporting the world's largest healthcare organizations.



Strategies To Unlock Medicaid Population Health

Delivering equitable, cost-effective, and value-based care experiences to Medicaid beneficiaries can be challenging, especially for those moving from fee-for-service (FFS) to managed care. In this white paper, we provide five managed care strategies that are easy to execute for payers looking to simplify the delivery of care, provide equitable access, and reduce costs.

What HELIOS Solutions Do You Need for Medicaid?

From population health to complex cohorts, to being fully integrated for long-term care and home health, HELIOS helps Medicaid plans optimize utilization management and deliver value-based care experiences across the entire care continuum in this quick overview.

Not sure what HELIOS solutions you need? Take this quick assessment to find out. Afterward, we’ll send you quick demo videos and information on the solutions you selected.

Customize Your HELIOS Platform

The power of HELIOS is in it’s singular design. Answer seven short questions to find out which HELIOS solutions are a good fit for your population health needs.

Step 1 of 8

What populations is your organization interested in managing (select all that apply)

What populations is your organization interested in managing (select all that apply)(Required)