The term “payvider” isn’t new. It’s part of the inspiration behind our HELIOS platform – to enable and support value-based partnerships between payers and providers. But in recent years, the desire of health systems to become involved in risk management has increased.
A survey in 2021 found that nearly 60% of health systems aimed to become payviders by getting into risk-based Medicare Advantage payment models by 2022. It also found that these systems were looking to diversify their risk-based payment strategies by opting for:
– Commercial employer-based risk contracts
– Medicare payment models
– Managed Medicaid
– Direct-to-employer partnerships
Fortunately, for payviders, HELIOS is uniquely designed to support not only value-based care models as well as utilization management.
HELIOS Enables and Supports Value-Based Partnerships Between Payers + Providers
The recent increase in the payvider movement is due to three trending objectives shared by payers and providers. These trends are the trio of ingredients to a successful payer and provider partnership.
1. An increased focus and emphasis on value-based care to improve overall health system care.
A shift away from profits to people has finally prioritized quality of care over quantity. This concept encourages incentivizing providers to provide high-quality care that a patient needs, versus a higher number of treatments. Essentially, this effort is designed to deliver the right care, at the right time, to the right patients.
HELIOS is a HITRUST-certified cloud platform for care, disease, utilization, and population health management. It was built specifically for value-based care models (in fact it was the first to be designed purposefully for this) and operates to support framework models such as the Institute for Healthcare Improvement’s Quadruple Aim concept.
For payviders, HELIOS offers a single, integrated, user-friendly platform for care management and coordination, disease management, utilization management, population health management, home health, behavioral health, and more. With Medicare and Medicaid populations wanting more whole-person care and personalized options, HELIOS enables this omnichannel delivery of care with its desktop and mobile (HELIOSgo) options, as well as its built-in telehealth tool (HELIOSvisit) and texting feature (HELIOStext).
With 360-degree patient views, numerous integrations and 90% configurability, HELIOS provides payviders with broad spectrum visibility across the entirety of the healthcare continuum while also providing the ability to focus in on unique member needs.
This enables unparalleled collaboration, coordination, and care delivery across every member touch point. It also helps deliver care team efficiencies (up to 93%) and productivity gains (up to 92%). For payviders who value delivering high-quality care to members without costly inefficiencies or waste, HELIOS provides a singular solution to do this, with the added benefit of reducing staff burnout and simplifying payviders’ tech stacks.
2. Delivering high-quality, cost-effective healthcare that provides better health outcomes and patient experiences, helps reduce financial risk and increase profitability.
Payers and providers have similar goals today. They want to provide better care and personalized experiences to members while reducing waste and risk.
Part of what supports this effort is the consolidation and interoperability of data in one place so payers and providers can share it. HELIOS helps support payvider partnerships by acting as a single platform both sides can use to see the same real-time data in one place.
And because payers and providers essentially share risks and rewards when it comes to care and outcomes, the integration of utilization management and care management in HELIOS can further improve the quality and cost-effectiveness of care. HELIOSum unifies providers, care managers and UM teams in a single, easy-to-use platform. With it, payviders can achieve:
Faster and more efficient authorizations
– Streamlined utilization reviews, appeals, and grievances
– Efficient data management, with no duplication of effort across teams
– Reduced risk of human error (and less stress for staff!)
– Significant cost savings
– Higher plan satisfaction ratings
– Happier, healthier members
– Care Gap closure
Integrations with community partners like Healthwise, findhelp, and UniteUs, also enable HELIOS to comprehensively support payvider efforts to address social determinants of health (SDOH) that may be preventing members from accessing or receiving cost-effective, quality care. This is especially important for payers with population health management needs in rural areas, or with members with lower socio-economic status.
HELIOS can help identify and connect members to resources for SDOH such as health literacy, transportation, food insecurity, and access to care. [See how NC INCK leveraged HELIOS to develop a real-world model to address SDOH challenges here.]
3. Continued expansion of Medicare and Medicaid models that reduce costs and improve care quality and health outcomes for beneficiaries
From day one, VirtualHealth has been focused on the idea of value-based care and quality as an incentive. In the last few years, the Centers for Medicaid and Medicare Services (CMS) has been aggressively shifting to managed care as its preferred model and encouraging Medicare and Medicaid payers to do so.
A recent example of CMS efforts to push value-based care includes new prior authorization standards in response to the Improving Seniors’ Timely Access to Care Act of 2021. HELIOS recently partnered with Edifecs to help support payviders to comply with new CMS standards.
Additionally, HELIOS data interoperability abilities help payviders with the HL7® FHIR® (Fast Healthcare Interoperability Resources 1) standard.
View strategies for care managers and payviders to help support Medicare and Medicare Advantage populations here. This free whitepaper offers care management and tech-empowered strategies payviders can employ to improve care quality, efficiency and health outcomes.