Medicare Advantage Population Health Solution

Purpose-built to support Medicare Advantage care management, utilization management and population health.

VirtualHealth empowers organizations with significant Medicare Advantage populations to deliver exceptional outcomes and while meeting regulatory requirements. HELIOS® is optimized to manage Medicare Advantage populations, refined by years of experience supporting payors with government programs and complex populations. Where CMS Star Ratings and HEDIS® scores can represent significant risks and opportunities, HELIOS helps guide payors to execute personalized, connected care experiences while maximizing financial indicators, operational efficiencies, and member satisfaction.

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

Medicare Plan Types HELIOS Supports

  • 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

Identify and Meet Medicare Regulatory Requirements

HELIOS 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 and KPIs.

HELIOS is also audited, updated, and optimized throughout the year to ensure it continually meets and exceeds your needs, as well as the requirements of federal and state regulatory bodies.




Key Benefits & Features of HELIOS for Medicare Advantage

One Unified Platform for CM, DM and UM

Fully Configurable, Automated Workflows Integrated with Clinical Guidelines Across Medical, Pharmacy, and LTSS

Streamline Identification of In and Out-of-network Providers

Identify Regulatory Requirements and Configure Tasks to Ensure Compliance

Internal and External Process Configurations - 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 Telehealth 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

Intelligent Automations, Insights and Reporting to Streamline, Improve CM/UM Team Productivity and Decision Making

Front-end Data Integrity Validation

Included RDB (Replicated Database) 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

State-of-the-art LTSS/MLTC Management Capabilities


Effectively Managing Care For Medicare Advantage Populations

Better management of Medicare Advantage members requires both a value-based care mindset and a tech-empowered strategic approach. Download our new white paper to discover how to drive efficient and effective improvements in six critical care areas including.


Discover the Power of HELIOS Solutions

Download our quick product guide to learn about our family of HELIOS healthcare solutions. HELIOS is 90% configurable and supports care management, disease management, care coordination, LTSS, behavioral health, utilization management, and data interoperability – all within one single platform.

Enable the Experiences Your Medicare Advantage Members Want

Today, Medicare Advantage members desire care that is personalized, accessible, and transparent. This means streamlined healthcare experiences that mold to their lifestyle and social factors. Above all, they want to know that quality of care is always the primary objective.

From population health for complex cohorts to integrated management of long-term care and home health, see how HELIOS helps Medicare Advantage plans to provide a comprehensive yet adaptable care management program across the entire care continuum.

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)

What Our Customers Say

We’re excited to bring VirtualHealth’s HELIOS platform to PacificSource. As our organization continues to grow, HELIOS’ ability to scale and match the proactive care we provide our members is vital to the ongoing health of the communities we serve.

Martin Martinez, Vice President of IT-Enterprise Systems

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