3 Ways Payers are Transforming Healthcare with Salesforce Communities

The unique role of payers in the healthcare space — as the chief players concerned with cost and financing —

5 min. read

The unique role of payers in the healthcare space — as the chief players concerned with cost and financing — has understandably led to some friction between them and other parts of the industry. They occasionally butt heads with providers as the two parties try to curb rising costs while still providing high-quality care. With members, too, this tension may arise at times when payers have to play the role of gatekeeper: stepping up and saying “no” when a cheaper option will lead to comparable outcomes.

This dynamic is changing for the better, though. A recent survey of both payers and providers found that a majority “strongly agree” that the two parties must collaborate to be profitable and deliver better outcomes. And some of the biggest health plans are actively working to promote better relationships with providers — these payers include Anthem, Optima and UnitedHealthcare. Similarly, in a survey of 100 health payer leaders, 84 percent noted that an improved member experience was their top priority for 2019.

Better healthcare collaboration certainly won’t happen overnight, but many factors drive this trend forward — technology serves as a major one. Each year, major payers unveil new tech solutions designed to streamline the member experience, connect better with providers and otherwise improve the authorization and care processes for all involved.

Specifically, countless payers have turned to Salesforce Community Cloud to help with these efforts. By connecting Health Cloud for Payers with an externally facing Salesforce community, these organizations are significantly increasing their engagement with other arms of the industry. For those in the health insurance world, here are 3 specific ways your organization can leverage a Salesforce community to transform your relationship with members and providers.

3 Ways Payers Are Leveraging Salesforce Communities to Transform Healthcare

1. Providing members with self-service health and benefits resources

One of the biggest evolutions in the payers’ world has been their growing role as an overall health advocate and guide. As health plans have better understood the connection between the availability of member health resources and lower healthcare costs, we’ve seen the growth of health apps like Rally (UnitedHealthcare’s gamified wellness app for members) and discounts for gym memberships.

In this vein, the expectation for a payer to provide health resources for its members has grown — it’s no longer a nice-to-have. A Salesforce community can help here. One of its core benefits? Member self-service. Your organization can use it to publish knowledge articles to your external site and create discussion groups for your members, allowing them to quickly find answers to their health questions, information about their plan benefits and nearby providers. This technology is a win-win for your organization and your members — they get the answers they need faster, and their reduced call volume frees your teams to focus on other efforts.

What’s more, this functionality can integrate seamlessly with your other service channels. As shown in the Dreamforce 2018 healthcare keynote, your company can embed your community with click-to-dial, web chat and other communication functionality — allowing members to quickly reach your support agents if they can’t find the answers they need. In all, it helps provide a more comprehensive member experience and establish your organization as a trusted health guide.


2. Enabling interactive care plan coordination with patients and their caregivers

Patients are increasingly looking to their health plans for care coordination services. As they interact with more and more MDs in various specialties, they see the payer as the single point of connection for providing overarching healthcare guidance. In fact, a 2017 survey of health plan members found that care plan coordination was the #1 factor influencing their satisfaction with their insurance, but only 25 percent of respondents said their payer offered the service.

A Health Cloud community can help here, too. Member care plans represent a core component of this technology, and this solution allows your care coordinators to assign multiple people to a member’s care team, whether they’re a benefits manager inside your organization, the actual member or an external caregiver like a PCP or family member. From there, members and caregivers can use your community to engage with the care plan — via desktop or mobile — so they can understand their outstanding tasks and track progress. Members specifically can use this technology for much more, whether it involves viewing their entire care timeline, adjusting their upcoming appointments or managing their claims. This sort of interactive workspace allows payer, providers and members to collaborate seamlessly and lets the individual members take more control over their own care.

3. Building a cooperative authorization process for providers

Another use case for Salesforce communities addresses a common pain point between providers and payers that I referenced above: care authorization. The back-and-forth between these two parties will never be perfect, but the right community setup can take a lot of heartburn out of the situation.

You can build your authorization process right into Salesforce and expose parts of it to providers through a portal, letting them quickly log care requests and route them to the right utilization management resource. Then, that resource can automatically compare that request with all the other patient data they need — because it’s all in the same platform — and respond appropriately. From there, all status updates about the request can be instantly communicated back to the provider and even the patient, and your teams can collaborate on coverage options with the provider via Chatter, keeping all communication within the Salesforce platform instead of requiring multiple phone calls back and forth. Ultimately, this kind of solution can reduce much of the tension around care authorization, to the benefit of everyone involved.

These certainly don’t represent the only ways your organization can use Salesforce communities to provide a more interactive care experience, but they offer common use cases that have already helped many large payers drive value for their members. Interested in discussing how this technology could look for your organization? Send us a message. One of our healthcare experts would be happy to talk with you about what Salesforce could mean for your healthcare organization.