Press Kit - HeliosComp.com

Press Kit
Sparked by the merger of Progressive Medical
and PMSI, Helios has provided solutions for
workers’ compensation and auto no-fault cost
containment for nearly 40 years. Our proven,
integrated solutions include:
Pharmacy Benefit Management (PBM)
Ancillary Services
Settlement Solutions
The systemic combination of these three
programs creates a synergy of information that
results in more control, better outcomes, stronger
compliance, a healthier patient, and a healthy
bottom line.
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About Us
Helios is bringing the focus of workers’ compensation and auto no-fault Pharmacy Benefit Management, Ancillary, and
Settlement Solutions back to where it belongs—the injured person. We provide our services from first fill to settlement with a
passion, focus, and intensity on delivering value beyond just the transactional savings for which we excel.
Our products and services enable better decisions and achieve better outcomes. They get injured people the right medications,
products, services, and settlements at the right time. They reduce program costs by avoiding payments for medications and
services that should not be paid, pairing robust analytics with veteran clinical expertise, and leveraging our operational flexibility.
All of this leads to brighter insights, greater savings, and fewer claims.
Website: www.HeliosComp.com
Media inquiries:
Colleen Stoker
| Twitter: @HeliosComp
|
|
LinkedIn: https://www.LinkedIn.com/company/helioscomp
colleen.stoker@helioscomp.com
|
614.212.8210
Headquarters
Florida
Ohio
Utah
6410 Poplar Ave., Suite 800
Memphis, TN 38119
175 Kelsey Lane
Tampa, FL 33619
250 Progressive Way
Westerville, OH 43082
706 West Price River Dr.
Price, UT 84501
4225 Lake Park Blvd., Suite 300
Salt Lake City, UT 84120
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PMSI acquired
Tmesys® to
create first
wholly-owned
workers’
compensation
retail pharmacy
network.
PMSI founded.
1982
1986
1996
1999
2003
PMSI acquired
Health Advocates™,
Inc., a leader
in Medicare SetAsides.
PMSI published first
Annual Drug Trends
Report.
2006
2007
2009
Progressive
Solutions and
PMSI merge.
2011
2012
2013
PMI and SRPS joined to form
Progressive Solutions.
1976
PMI launched Ventrix™ ancillary
provider ranking system.
PMI introduced
first retail drug card.
Progressive Medical (PMI) founded.
StoneRiver Pharmacy Solutions (SRPS) founded.
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PMSI launched
MyWorkComp™
mobile app.
PMI launched
IFX, first claims
management
portal.
PMI introduced
first injury-specific
formularies.
2014
Helios
launched
into the
market.
COMPANY VITALS
XX
Industry-leading provider of customized, innovative, and clinically-focused solutions for workers’ compensation and auto
no-fault Pharmacy Benefit Management (PBM), Ancillary services, and Settlement Solutions.
XX
Most experienced workers’ compensation-specific program in the market, managing more than 7 million prescriptions
annually.
XX
Serve more than 1,000 clients, including many of the country’s largest insurers and third party administrators (TPAs).
XX
More than 1,400 employees across the country in six office locations: Memphis, TN (Headquarters); Tampa, FL; Westerville,
OH; Salt Lake City, UT and Price, UT.
XX
Three business units supported by integrated account management, clinical, informatics, technology, marketing, and
government affairs functions.
XX
Industry’s only wholly owned, directly-contracted retail pharmacy network, Tmesys®, which includes nearly 70,000
pharmacy locations nationwide.
XX
Only fully integrated Medicare Set-Aside (MSA) and PBM vendor.
XX
In-house clinical management tools and solutions provide targeted clinical analysis, intervention programs, formulary
management, thought leadership, and continuing education services.
XX
Award-winning, patent-pending analytics.
XX
Recognized leadership and advocacy in Government Affairs.
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At Helios, we have a passion
for doing what’s right, for our
clients, the injured person,
and the industry. That is why
we are always looking for
brighter solutions to meet
the challenges in the workers’
compensation and auto
no-fault industries.
This passion inspires us to
reshape the way things are
done into the way things
should be done. And, of
course, to never stop working
toward even better solutions.
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INSIGHTFUL SOLUTIONS
Pharmacy Benefit Management
The Right Medication at the Right Time
Helios Pharmacy Benefit Management is laser-focused on doing the right thing. This intensity has sparked innovations that
increase cost control by decreasing the personal impact of an injury. Our services:
XX
Make filling a prescription easier through a directly-contracted network that includes nearly all of the nation’s pharmacies
XX
Capture more prescriptions “in-network,” achieving up to 98% retail network penetration and reducing administrative
burden in the process
XX
Ensure the injured person receives the right medication at the right time with veteran clinical expertise
XX
Mitigate potential high-risk, high-cost situations
XX
Excel with advanced technology and reporting, and patent-pending, advanced analytic insight
We have built our carefully crafted, deliberately synchronized program on a strong foundation: a fully redundant, secure
technology and service platform. On top of this, we overlay injury-specific Medication Plans and formularies, drug utilization
review criteria, and client-specific business rules. These criteria feed our proprietary electronic adjudication platform, keeping
data and communication flowing between pharmacy to payer, lighting the way forward to better outcomes.
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INSIGHTFUL SOLUTIONS
Ancillary Products and Services
Quality Care Coordination Secures the Right Path
The right Ancillary services can be as important to quality care as the right prescription. Our comprehensive Ancillary services
are easily navigated and provide a vast network of carefully-vetted, quality providers. We carefully investigate each provider
candidate before adding them to our network. This attention to detail makes certain that high-quality, professional services
are cost-effective and readily available, regardless of location or complexity of needs.
Our program includes:
8
XX
Medical Equipment and Supplies
XX
Home Health Care and Infusion Therapy
XX
High Exposure Claim Services
XX
Comprehensive Coordination of Care, 24/7/365
XX
Translation Services in over 120 Languages
XX
Nationwide Transportation Services
XX
Catastrophic Care
XX
Physical Medicine
XX
Diagnostic Services
XX
Inpatient Negotiations
INSIGHTFUL SOLUTIONS
Settlement Solutions
Integrated Medical, Pharmacy, and Claims Knowledge Achieves the Right Settlement
Helios Settlement Solutions has been called best-in-class, and for good reason. When you use Helios for both PBM and
Settlement Solutions, you’ll maximize overall savings. Helios has been at the forefront of compliance for both the Medicare
Secondary Payer (MSP) Act, and Section 111 of the Medicare, Medicaid, and SCHIP Extension Act (MMSEA) of 2007.
Our programs mitigate potential barriers to settlement, facilitating interventions that pave the way to settlement. We focus
on both the cost and use of medical services and pharmaceuticals throughout the claim lifecycle to ensure compliance and
transition to settled claim. We help you achieve accurate and cost-effective compliance, resulting in timely and appropriate
care for the injured party.
Our MSP compliance programs include:
XX
Medicare Set-Aside (MSA) Allocations
XX
MSA Fund Management
XX
Clinical Cost Containment Solutions
XX
Claim Forecasting
XX
Mandatory Insurer Reporting
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Brighter Solutions.
Better Outcomes.
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LEADERSHIP
Emry Sisson
John Bencivenga
David Farmer
Thomas (Tommy) Young
Mike Brandenburg
Barry Jarnigan
Brett Drexelius
Jay Krueger
Tron Emptage, RPh
Andrew Lewis
Co Chief Executive Officer
Co Chief Executive Officer
Chief Legal Officer
Executive VP of Operations
Chief Sales Officer
Chief Clinical Officer
Chief Financial Officer
Eileen Auen
Executive Chairman
Chief Marketing Officer
Executive VP of Strategy
Executive VP of Human Resources
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SUBJECT MATTER EXPERTS
Brian Allen
As vice president of government affairs,
Brian Allen serves as an advocate for
both payers and injured workers alike.
He monitors legislative and regulatory
issues around the country in an effort to
influence positive change in the workers’
compensation industry. With more than
20 years of experience in government
relations, Brian delivers valuable insight
on current and pending legislation, case
law, jurisdictional and federal regulations,
and other topics that affect injured worker
outcomes.
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Joe Anderson
Jessica Bartell
As the director of analytics, Joe Anderson
researches ways to utilize data to develop
new services for our clients. These
innovative programs utilize historical
pharmacy data to predict which injured
workers will have long-term pharmacy
spend, or long-term complications with
prescription drug use or addiction issues.
As vice president of provider relations,
Jessica Bartell manages the development
of the company’s medical equipment,
health services, ancillary, and specialty
services provider network. In her role,
Jessica negotiates contracts and pricing
schedules with vendors to get the best
possible pricing solutions for our clients.
Additionally, she oversees two large
ancillary customer contracts working
to ensure their service and contractual
obligations are met.
SUBJECT MATTER EXPERTS
Tron Emptage, RPh
As chief clinical officer, Tron Emptage
oversees our comprehensive suite of
clinical programs designed to help
payers gain more control over medical
costs to achieve better outcomes for
injured workers. Tron leverages two
decades of pharmacy and managed
care experience in developing and
managing key program components,
such as medication plans and formularies,
utilization reviews, physician outreach,
clinical intervention, and pharmacist
and nursing support. The use of these
programs by our customers ensures
injured workers receive the right
therapy at the right time.
Kelli Falter
As the manager of provider relations, Kelli
Falter manages and develops our ancillary
provider network, ensuring that injured
workers receive adequate coverage and
a high quality of care and product at the
best price.
Matthew Foster, PharmD
As clinical pharmacy manager,
Dr. Matthew Foster oversees our
clinical services production team
that is responsible for all of the
prescriber intervention services
that help ensure the right medications
are being utilized at the right time.
He also works closely with our clinical
liaisons and design teams to provide
enhanced and new clinical services
for Helios clients.
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SUBJECT MATTER EXPERTS
Rafael Gonzalez, Esq.
As vice president of strategic solutions for
settlement, Rafael Gonzalez serves as a
thought leader on all aspects of Medicare
and Medicaid compliance issues,
including Mandatory Insurer Reporting,
Conditional Payment Resolution,
Medicare Set-Aside Allocations, CMS
approval, and professional administration.
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Jeff Gurtcheff
As the vice president and general
manager for settlement, Jeff Gurtcheff
is responsible for clinical cost mitigation
programs for settlement purposes,
Medicare Set-Aside allocations,
conditional payments, MMSEA Section
111 Reporting, structured settlement
services, and post settlement programs,
to include professional administration.
Jeff’s team is comprised of pharmacists,
registered nurses and life care planners,
attorneys, and seasoned claims
professionals that work diligently to
protect our client’s assets and be
compliant with Medicare’s Secondary
Payer requirements.
Robert Hall, M.D.
As corporate medical director, Dr. Robert
Hall advises our customers and employees
on evidence-based clinical and rehabilitation
guidelines that optimize our pharmacy,
home health, and durable medical
equipment programs to promote better
outcomes and earlier return-to-work for
injured workers. He also offers counsel on
our processes and procedures to identify
and reduce prescription medication misuse
and abuse.
SUBJECT MATTER EXPERTS
Brooke Mueller, PharmD
As a senior clinical pharmacist,
Dr. Brooke Mueller manages the
Drug Testing and Monitoring (DTM)
service provided by Helios. In this
role, Brooke provides training and
direction to the pharmacists in
assessing inconsistent drug test
results, and providing communication
to the prescriber regarding
recommendations on how they
should follow up with the results
to the claimant.
Kevin Tribout
As executive director of government
affairs, Kevin Tribout spearheads our
client education, communication, and
compliance programs on the latest
legislative and regulatory initiatives.
He reviews the impact of legislative
and regulatory issues, ensures
compliance across all business units,
and acts as a direct liaison to state
legislators and regulators on behalf of
the company. Kevin also assists the
Settlement division with influencing
changes in the CMS Medicare Set-Aside
allocation processes at the federal level.
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