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NEW YORK–(BUSINESS WIRE)–VirtualHealth announced that UPMC Health Plan will leverage its HELIOS care management and care coordination technology solution to coordinate the delivery of person-centered Long-Term Services and Supports (LTSS) under its UPMC Community HealthChoices program.

UPMC Health Plan is one of just three managed care plans providing services under Pennsylvania’s Community HealthChoices (CHC) program, the state’s mandatory managed care program for dual eligible individuals and those with physical disabilities. The CHC program allows managed care organizations to coordinate medical care and LTSS for individuals who qualify for both Medical Assistance (Medicaid) and Medicare or who qualify for Medical Assistance and require nursing facility-level of care.

LTSS is a rapidly growing category of care, encompassing services provided to the elderly and patients with disabilities in the home, community, or facilities such as nursing homes.

“With the complex needs of the 122,000 CHC participants we now serve across Pennsylvania, we look forward to moving to the HELIOS platform to help further improve how we provide comprehensive care to these individuals,” said Brendan Harris, vice president, Community HealthChoices at UPMC Health Plan.

The Congressional Budget Office (CBO) projects an expansion of 18% in LTSS benefits within the next year along with an increase to a projected $100 billion in LTSS Medicaid spending by 2023i. Leveraging HELIOS allows health plans to gain access to a comprehensive care platform specifically designed for value-based care – including the management of complex and critical care populations such as individuals receiving LTSS.

The HELIOS platform is system and solution agnostic for maximum interoperability. Along with automating caseload assignments and care manager task management, HELIOS streamlines the assessment process and helps drive person-centered care planning and authorization processes.

“Forward-looking health plans understand that HELIOS will position them for success through a true whole-person, member-centered approach to care management,” said Adam Sabloff, CEO and Founder of VirtualHealth. “We are honored that UPMC Health Plan plans to utilize HELIOS to enhance its members’ care and experiences in its Community HealthChoices program.”

For more information on HELIOS, click here.

About VirtualHealth

HELIOS by VirtualHealth is the first comprehensive care management platform purpose-built to power the entire ecosystem of value-based care. Utilized by some of the most innovative health plans in the country to manage millions of members, HELIOS streamlines person-centered care with intelligent case and disease management workflows, unmatched data integration, broad-spectrum collaboration, patient engagement, and configurable analytics and reporting. Named one of the fastest growing companies in North America by Deloitte in 2018 and 2019, VirtualHealth empowers healthcare organizations to achieve enhanced outcomes, while maximizing efficiency, improving transparency, and lowering costs. For more information, visit www.virtualhealth.com.

About UPMC Insurance Services

UPMC Insurance Services is owned by UPMC, a world-renowned health care provider and insurer based in Pittsburgh, Pa. UPMC Insurance Services – which includes UPMC Health Plan, WorkPartners, UPMC for Life, UPMC for You, UPMC for Kids, and Community Care Behavioral Health — offers a full range of group health insurance, Medicare, Special Needs, CHIP, Medical Assistance, behavioral health, employee assistance and workers’ compensation products and services to over 3.7 million members and subscribers. For more information, visit www.upmchealthplan.com.

i Congressional Budget Office. “Rising Demand for Long-Term Services and Supports for Elderly People” June 2013. Available at: https://www.cbo.gov/publication/44363.

Contacts

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