With Care Management & Utilization Management in one platform, payers streamline UM for faster authorizations and more connected care.
VirtualHealth announced the release of a completely redesigned Utilization Management (UM) module within its cloud-based care management solution HELIOS. The newly updated platform fuses powerful automation with a user-friendly Care Management (CM) interface so that UM teams work faster and with fewer errors – and health plan members get a better experience due to faster approvals.
Top Artificial Intelligence Insights: Could Instances of NLP Bias Derail AI?
“We believe CM and UM need to live on one platform, because the future of whole-person care should be connected, yet simple. We designed our module to modernize UM workflows with artificial intelligence and automation so teams can work with a lot more speed and accuracy.”
This represents the latest innovation to HELIOS by VirtualHealth, an industry-leading medical management SaaS company that empowers clients to provide value-based, high-quality care.
“Utilization management typically involves antiquated processes that can contribute to human error and difficulty meeting authorization timelines. And that leads to member dissatisfaction, with long waits for approvals and delays in appeals and grievance resolution,” said Adam Sabloff, CEO of VirtualHealth. “We believe CM and UM need to live on one platform, because the future of whole-person care should be connected, yet simple. We designed our module to modernize UM workflows with artificial intelligence and automation so teams can work with a lot more speed and accuracy.”
Most companies use multiple platforms or rely on electronic health record (EHR) integrations to manage UM activities, such as utilization reviews, claims authorizations, and grievance and appeals tracking. Many homegrown UM systems are notoriously complex, creating inefficiency and lack of coordination among providers and payers. Complex UM workflow can sap time and energy from staff, including on the provider side, which can negatively impact quality of care.
AI ML in Marketing: AI and Big Data Analysis Used to Find Brands’ Emotional Connection
On the other hand, the complete redesign of VirtualHealth’s HELIOSum module transforms the way UM and CM teams work by breaking down silos and serving up all the needed data within the same dynamic platform. Unlike antiquated systems that require duplicate documentation and logging into multiple systems, with HELIOS, information is available in the same platform with just a few clicks, saving time and reducing errors. This allows staff to more quickly secure authorizations for the procedures, treatments, and prescriptions that members need to improve health outcomes, as well as seamlessly navigate appeals and grievances.
“The team at PacificSource is thrilled to be working with VirtualHealth on our next generation Utilization Management system in HELIOS. With this modernized platform, we expect to be able to improve approval timelines and automate many of our manual UM processes, which will help improve the overall member and provider experience as well increase our team’s satisfaction,” says Eric Doolan of Pacific Source.
Through HELIOSum, staff can leverage tools such as auto-approvals, automated member timelines, and automated triage to work more efficiently and with less stress – for example, by eliminating the need to search manually for high-priority claims with tight turnaround times. Health plans must comply with CMS timeline requirements for authorization or risk lost revenue and possible civil monetary penalties.
The platform also includes integrations with best-of-breed partners such as MCG and InterQual so that users can access leading clinical guidelines and third-party electronic authorizations, building confidence in accuracy while saving time.
Read More About ML News : How Machine Learning and First-party Data Work in Harmony for Performance Marketers
[To share your insights with us, please write to sghosh@martechseries.com]
Comments are closed.