Salesforce Health Cloud for Payers: What an Integrated Platform Offers Insurers

If you’ve worked in the healthcare field, known anyone in the industry or even been to a doctor’s office lately,

4 min. read

If you’ve worked in the healthcare field, known anyone in the industry or even been to a doctor’s office lately, you probably have some idea of the daily game of tug-of-war that’s played out between provider, payer and patient. Any given prescription can result in a multitude of phone calls between the three parties to ensure the order is sent to the payer, authorized and reimbursed.

Within that triangle, payers must navigate contradictory hurdles simultaneously. They must offset rising specialty drug costs and a convoluted (yet uncertain) regulatory landscape while offering their members a higher-quality, more efficient experience. Failure here could result in lower enrollment.

While technology can’t solve all of these problems, Salesforce is betting that its new Health Cloud for Payers can alleviate many pain points — not just for insurance companies, but across the healthcare landscape. The CRM giant unveiled the solution (launching in October 2018) at its annual conference, Dreamforce, showcasing what the product suite can do for payers in the healthcare space.

And while Salesforce built many core aspects of the solution — care planning, utilization and authorization management, etc. — explicitly for payers or the broader healthcare market, Salesforce veterans watching the product demo surely noticed that much of its functionality was built on existing platform features, adapted to the business needs of a payer. It showed that Salesforce isn’t reinventing the wheel to release an unproven product into the market. Instead, Salesforce Health Cloud for Payers relies on tried and true features to deliver an integrated experience in these 5 ways:

5 Ways Salesforce Health Cloud for Payers Drives an Integrated Healthcare Experience

1. Bringing payers, providers and patients into one community

The Dreamforce keynote on healthcare and life sciences (HLS) was quick to highlight the value of Community Cloud to payers. The demo showed how they can build a modified Salesforce customer community, in which their members can find resources, join forums and even collaborate on tasks assigned by their care coordinator. These portals can be mobile-friendly, too, to give their members access anywhere, from any device. In an age where patients demand a more personalized experience and better services, this sort of connected approach can be a significant differentiator for insurers.

It also demonstrated how similar technology can integrate the third corner of the triangle: Providers. By granting community access to in-network physicians, payers can let doctors create service requests for their patients directly in the Salesforce platform. No more contentious phone calls back and forth. Rely less on hand-written scripts (in MD chicken-scratch, no less). Managing these requests and all communication about them within a single platform can streamline this process for the benefit of all parties involved.

2. Integrating disparate data systems for a 360-degree member view

Healthcare patients often list disjointed experiences as a common pain point with their insurance providers. Usually, this is a product of the disconnected technology systems payers deal with — claims data, clinical information from provider EHRs and more. But with Health Cloud for Payers, businesses can leverage Mulesoft integration solutions and the soon-to-be-released Salesforce Customer 360 feature to connect member data from multiple systems and Salesforce clouds (more on that later).

The end result is a unified platform where any payer-side employee — claims processor, customer service rep, you name it — can access the member information they need to get the job done. Test results, claims, authorizations, care plans — it’s all stored in the same place to allow for a more connected, streamlined member experience.

3. Building personalized journeys for every member

With the two solutions mentioned above, a payer can already offer an integrated, streamlined and inviting platform to their members. But both of them are centered on inbound activities — what a member experiences when they call in or log onto a portal. To build engagement, payers also need a personalized outbound strategy as well.

Enter Marketing Cloud, where a business can design detailed customer journeys individualized to each member. They can receive different texts and emails depending on their care plans, comorbidities, previous engagement or any other useful information. Combining this sort of outbound strategy with a welcoming suite of inbound resources can help any payer drive deep, meaningful relationships with their membership base. When that happens, members become more active in their care, outcomes improve and enrollment numbers climb. Everyone wins.

4. Collecting patient feedback to stay responsive

If a payer implements the first three solutions on this list, they’re already doing a lot right. But there are always ways to improve, and the landscape changes constantly. So it’s crucial to collect member feedback to assess performance and identify issues as soon as they pop up.

As shown in the Dreamforce HLS keynote, the wealth of survey solutions on the Salesforce AppExchange can help any business do just that. With the right tool, a company can include branded and user-friendly surveys in their outbound strategy, making it easy to track engagement.

5. Bonus: What could Einstein do for payers?

One other tool that could have an impact on healthcare payer technology: Salesforce Einstein. This AI functionality has helped teams across industry and role — sales, traditional customer service, marketing — and could have widespread potential when paired with Health Cloud for Payers too. Possible use cases include identifying high-risk members in need of a touchpoint and automatic prioritization of service requests, but they certainly don’t end there. Any time a payer needs the power of AI to flag important information based on past data trends, that’s where Einstein can help.

Leveraging pre-existing Health Cloud functionality and the latest capabilities of the broader Salesforce platform, Salesforce Health Cloud for Payers showcases how far the platform can go in transforming the entire healthcare industry — not just the provider’s world.

Want to learn more about Salesforce solutions for healthcare? Check this out.