HELIOS, VirtualHealth, Harness The Power

Utilization Management, Redefined

HELIOS® UM Delivers:

  • Lower costs with a 360° member view that highlights utilization across the care continuum
  • Maximum efficiency with automated workflows and best-in-class clinical content throughout the review process

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Utilization Management Worthy of HELIOS®
PUTTING MEMBERS FIRST ACROSS THE ENTIRE CARE ECOSYSTEM

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HELIOS® care management has revolutionized healthcare, putting over 7 million members at the center of their respective care ecosystems, improving their outcomes, and helping healthcare organizations reign in costs. VirtualHealth has introduced utilization management capabilities that reflect the game-changing advancements we pioneered in Care Management.

Loaded with leading-edge features, the HELIOS® utilization management suite brings unparalleled efficiency and the intuitive design beloved by our clients. The fully integrated system provides a 360° member and staff view, bringing together our award-winning care management platform and the entire utilization review process. See it in action by scheduling a demo with the form above!

Control the Full Utilization Management Lifecycle
SPEND MORE TIME WITH PATIENTS AND LESS TIME BOUNCING BETWEEN SYSTEMS

The new HELIOS® utilization management capabilities reimagine the end-to-end processes and user journeys to deliver intuitive workflows across intake, routing, assessment, disposition, approval, correspondence, and configurable rules and templates. HELIOS® can be used on a standalone basis to provide the complete workflow for both episodic and chronic service authorization requests or integrate with a third-party system. It supports timely prospective, concurrent, and retrospective reviews to ensure that members get the appropriate care they need, when they need it. 

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Utilization Review Made Easy
LEVERAGING INDUSTRY-LEADING CLINICAL CARE GUIDELINES

Clinical decision support helps organizations perform reviews quickly, efficiently, and supports automated workflows. HELIOS® provides certified real-time integrations with industry-leading content providers such as MCG and Change Healthcare. It also enables clients to incorporate their proprietary medical policies. 

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VirtualHealth’s and MCG’s mutual clients gain access to Cite CareWebQI's rich evidence of care guidelines within the HELIOS® platform for seamless UM workflows and increased efficiency towards whole-person care. The combined solutions offer evidence-based pathways for value-based care and fee-for-service models.


InterQual Connect enables healthcare organizations to benefit from new efficiencies that minimize manual workflows such as paperwork, faxes, and phone calls while maximizing the time available to provide high-quality, person-centered care. The integration gives UM staff access to InterQual Criteria, which supports the secure and speedy exchange of medical review and clinical information required to authorize critical healthcare services.

Seamless Integrations
CAPTURE, ANALYZE, AND NORMALIZE DATA

HELIOS® Utilization Management can ingest data from any source to trigger relevant workflows. It can integrate with EHRs, track member information across third-party vendors, and work with any other client systems for a full-spectrum view of the member.

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Integrate your data into automated workflows to reduce manual work and improve audit outcomes.

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Capture all admission, discharge, and transfer (ADT) data and apply the system rules engine to manage workflows.

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Proactively identify & manage members across the whole care continuum, including during care setting transitions.

State-of-the-Art Rules Engine
DRIVE INTUITIVE WORKFLOWS

The embedded rules engine is supported by an extensive library of configurable clinical rules that enables auto-approvals, distinguishes between authorization types, and supports rule hierarchies. 

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HELIOS® PROVIDES:

Provider Directories Auto-authorizations and a decrease in administrative tasks, eliminating redundant work & allowing staff to better manage caseloads
Enrollment + Attribution Care management program identification & referral from utilization management data
Risk Scoring Turnaround times and member/provider notifications that meet NCQA standards