Medicare Advantage Population Health Solution

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

Supporting today’s Medicare Advantage members means enabling payers to offer connected care experiences while identifying and meeting regulatory requirements. HELIOS® is built to serve Medicare Advantage populations, and refined by years of experience supporting payers with government programs and complex populations. Where CMS Star Ratings and HEDIS® scores can represent significant risks and opportunities, HELIOS helps guide payers to execute personalized, connected care experiences, and meet regulatory requirements while maximizing financial return, 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.

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

single unified platform icon

One Unified Platform for CM, DM and UM

fully configurable automated workflows icon

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

streamline identification of in and out-of-network providers icon

Streamline Identification of In and Out-of-network Providers

identify regulatory requirements icon

Identify Regulatory Requirements and Configure Tasks to Ensure Compliance

internal and external process configurations icon

Internal and External Process Configurations - Authorizations, Appeals, Grievances & More

user friendly authorization management icon

User-friendly Authorization Management, Full-lifecycle Available

auditing and reporting metrics icon

Auditing and Reporting Metrics for Internal or External Reviews and Audits

disease management clinical workflows icon

Disease Management Clinical Workflows That Follow Industry-standard Regulations

built-in suite of member engagement tools icon

Built-in Suite of Member Engagement and Telehealth Communication Tools for Improved Outcomes and Transparency

real-time 360-degree view of members icon

Real-time 360-degree View of Members and Their Utilized Benefits and Services to Provide More Efficient, Personalized Care

identify and solve for SDOH icon

Identify and Solve for Varying SDOHs with AI-powered Insights, Integrated Community Resources and Telehealth

seamless communication icon

Seamless Communication for More Accurate Care, Claims Payments and Coverage Insights

end-to-end visibility icon

End-to-end Visibility for Optimizing High-quality, Cost-effective Care Delivery Models

intelligent automations icon

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

front-end data integrity icon

Front-end Data Integrity Validation

included rdb icon

Included RDB (Replicated Database) to Help Create Customized Reports for Audits and Other Internal/External Needs

enables easy collaboration icon

Enables Easy Collaboration Across Care Teams, Utilization Review Teams and Disease Management Teams

built-in industry standards icon

Built-in Industry-standard, Evidence-based Behavioral Health Screening Tools and Care Plan content for a Collaborative, Interdisciplinary Care Team Approach

assessments and screenings icon

Assessments and Screenings That Auto Populate to the Care Plan, Auto-generate Workflows and Tasks


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

Enable the Experiences Your Medicare Advantage Members Want

Today’s Medicare Advantage members want care that’s accessible, personalize, 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.

From population health for complex cohorts to being fully integrated for long-term care and home health, see how HELIOS help Medicare Advantage plans provie an adaptable Medicare care management program with value-based care expereinces 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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