Health Cloud: The New Payer Data Model

Health Cloud: The New Payer Data Model

Built on the world’s #1 CRM platform, Salesforce’s Health Cloud solution is quickly becoming the new payer data model. Why? It offers a complete view of members in a single dashboard, driving productivity for service agents and clinical professionals. Simply put, the insurance market is recognizing the urgency that it needs to adapt to today’s smart, data-driven marketplace.

Salesforce® first introduced Health Cloud in 2016 to transform the way healthcare and life sciences organizations connect with patients. In 2019, Salesforce continues to expand the power of Health Cloud with features specifically built for the health insurance industry. This allows companies to engage with both members and providers in smarter and more efficient ways. Here’s how it’s done, including examples of “better outcomes.”

Transforming Business Operations

Health Cloud transforms business operations with an insurance-specific data model that simplifies the integration of systems of record — including benefits, claims, and authorizations — into one place. This drives more productivity for service agents and clinical professionals. With all member information in a single dashboard, payers are able to work faster and smarter. In addition, they better understand each member’s needs. And that includes whether they are in the call center or in the place of service, and from any device.

The Better Outcome: A payer today often needs to log into multiple systems to research different aspects of a member’s claim for an upcoming procedure. With Health Cloud, they can now see all of the member’s prior authorization and information about the procedure in one place. That allows payers to serve both members and providers quickly and efficiently.

Better Streamlined Workflows

Healthcare requests — that might include prior authorizations, admissions, and appeals — can be now be streamlined through guided, collaborative, and measurable workflows directly within Health Cloud. Agents, clinical professionals, and medical directors are able to deliver more personalized and appropriate care in a more cost-effective way.

The Better Outcome: A provider previously treated a member who needed surgery had to submit a prior authorization request to the payer. Often times that meant the provider had limited visibility into its processing. Now, with Health Cloud, the provider and member have the ability to easily view the progression and status of the request. That reduces any stumbling blocks or delays. Once a care request is approved, tasks are triggered automatically for case management based on the diagnosis or service code within Health Cloud.

Strengthen Member Engagement

With Health Cloud, payers can create customizable, interactive and highly personalized digital journeys for members, helping develop stronger relationships by overcoming barriers to care and increasing access to clinical and support services. Members can easily access their insurance plans, receive care alerts via their mobile device and connect with clinical professionals and care managers using email or text messages.

The Better Outcome: A case manager can proactively engage a member to arrange home care, rehab, and follow up hospital visits related to their procedure or service through the member’s preferred form of communication. Doing so advances their goal of driving optimal member outcomes.

Payer Educational Opportunity

Ad Victoriam Health Cloud Webinar

Ad Victoriam recently presented a webinar for payers, “Connecting Data to Transform Payer-Member Relationships,” during which attendees learned:

  • How connected member data can enhance your sales potential and member satisfaction.
  • Ways a modern system user interface can decrease training times and enhance the agent experience – increasing employee engagement.
  • How to invigorate marketing when data is no longer siloed.

Watch the free webinar here.

Interested in learning more about how Salesforce Health Cloud can transform your business operations and increase member engagement? Contact Ad Victoriam’s Health Cloud consultants quickly by filling out the form below or click here.

 

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Connect Care with Salesforce Health Cloud

ConnectCare with Salesforce Health Cloud

For the past decade, hospitals and physicians have been transitioning from paper-based to electronic health records (EHR) to connect care. They have done this to expedite the exchange of patient information, with the hope that it will also, somehow, optimize patient revenue streams.

In that time, more than 95 percent of hospitals and nearly 90 percent of office-based physicians have adopted an EHR system, according to the Healthcare Information and Management Systems Society (HIMSS).

Disparate to Interoperability

According to HIMSS’ own analytics, the average hospital has affiliated providers using 16 EHR systems — and many of those are provided by a different vendor. So, with so many disparate systems, interoperability — getting computerized systems and software applications to connect, exchange, and interpret EHR data — is a top priority for the industry.

Connecting these technologies requires seamless integration. In the past couple of years, Salesforce® has made a specific point to build this kind of interoperability within its industry-focused product, Salesforce Health Cloud. Since its inception, this system has been API-based and MuleSoft® technology is integrated to boost its power. The single goal of these capabilities is to streamline the use of Salesforce within the healthcare industry.

Why consider Salesforce Health Cloud to Connect Care?

With Salesforce Health Cloud, caregivers can now focus on patient relationships, not records. Here’s just some of what Health Cloud can do to deliver smart patient care:

  • Easily browse tasks and review all patient conversations. You have the ability to see patients with a clear priority of tasks that need attention. And you do all from the “Today” page.
  • Using “Patient Profiles,” caregivers get a panoramic view of their patients, with rich, contextual EMR data, plus the ability to review a collaborative care timeline for a complete patient history view.
  • Wearable device data is integrated directly into Health Cloud. This makes relevant patient data – such as glucose levels and sleep data – at the ready.
  • View the patients’ professional and personal care networks from a caregiver “team map.” You can then immediately share information with a primary care physician without ever leaving the patient profile. A physician on the patient’s care team can then respond quickly using any device.
  • Using Salesforce Communities, caregivers can communicate easily with patients. Send secure messages, pre- and post-visit surveys, and appointment reminders to their mobile devices. And using SOS with a two-way video chat, patients can ask questions and describe symptoms in real-time.

Looking to transform your hospital or private medical practice’s disparate technology into an interoperable solution that will not only optimize your revenue streams but enhance your interaction with you? Ad Victoriam’s Salesforce Healthcare Consultants can identify your needs and implement a long-term scalable solution custom-fit to your specific needs. Connect with us now, here, or fill out the brief form below.

And if you happen to be a payer interested in learning how Salesforce’s Health Cloud can unlock and connect your data in one coordinated view, watch this recent Ad Victoriam webinar.

 

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