Salesforce Announces Health Cloud for Payers, Transforming Business Operations and Member Engagement for Insurers

Salesforce, the global leader in CRM, announced Health Cloud for Payers, a complete solution designed specifically for the health insurance industry. Every payer, such as insurance carriers and health plan sponsors, will be able to use Health Cloud to get a complete view of their members and provide more personalized experiences, helping to improve member outcomes and contain medical costs.

• Built on the world’s #1 CRM platform, the new Salesforce Health Cloud solution will give every health payer a complete view of members in a single dashboard, driving productivity for service agents and clinical professionals
• Payers will be able to create customizable, interactive and highly personalized connected experiences to improve member outcomes and satisfaction

Healthcare payers are facing a highly competitive market where both members and providers expect connected and personalized experiences. As more healthcare costs shift to the member, payers must respond to the growing consumer demand for better services or risk lower enrollment. The stakes are high, as 80 percent of customers say the experience a company provides is as important as its products and services.

In addition, inefficiencies across member operations and siloed systems hinder a payer’s ability to get a single view of each member, which is the foundation for providing personalized care management and effective provider collaboration. Finally, members often struggle to understand their benefits and care plans, while at the same time expect more modern ways to connect with their insurers.

“Payers around the world are no longer just competing against one another, they’re being compared to any company providing a convenient user experience that builds loyalty,” said Dr. Joshua Newman, Chief Medical Officer, Salesforce.

Dr. Joshua added, “With Health Cloud for Payers, Salesforce is providing a solution that makes it easier for insurance companies to streamline workflows and connect with both members and providers in more effective ways.”

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Introducing Health Cloud for Payers

In 2016, Salesforce introduced Health Cloud to transform the way healthcare and life sciences organizations connect with patients. Today, the company is expanding the power of Health Cloud with new features specifically built for the health insurance industry that will allow these companies to engage with members and providers in smarter and more efficient ways:

A New Payer Data Model

Health Cloud will include an insurance-specific data model that simplifies the integration of systems of record—including benefits, claims, and authorizations—into one place, driving more productivity for service agents and clinical professionals. With all member information in a single dashboard, payers will be able to work faster and smarter, and better understand member needs—whether they are in the call center or in the place of service, from any device.
For example, 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 will be able see all of the member’s prior authorizations and information about the procedure in one place, allowing them to service members and providers quickly and efficiently.

More Powerful Utilization Management

Care requests—including prior authorizations, admissions, and appeals—will be streamlined through guided, collaborative and measurable workflows directly within Health Cloud. Insurance agents, clinical professionals, and medical directors will be able to deliver more personalized and appropriate care in the most cost-effective setting. This enables payers to improve member outcomes and contain medical costs.

For example, previously, a provider treating a member who needed surgery has to submit a prior authorization request to the payer and often has limited visibility into its processing. Now, with Health Cloud, the provider and member will be able to easily view the progression and status of the request, reducing friction and delays. Once a care request is approved, tasks are automatically triggered for case management based on the diagnosis or service code within Health Cloud.

Stronger Member Engagement

With Health Cloud, payers will be able to 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 will be able to easily access their insurance plans, receive care alerts via their mobile device and connect with clinical professionals and care managers on any channel like email and text message.

For example, 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, advancing their goal of driving optimal member outcomes.

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Salesforce’s Partner Ecosystem Brings More Capabilities to Health Cloud for Payers

Salesforce continues to build a comprehensive ecosystem of partners that extend the power of Health Cloud. According to a recent IDC² study, Salesforce and its ecosystem of customers and partners will create more than 244,000 jobs and enable more than $68 billion in new business in healthcare worldwide by 2022. Health Cloud for Payers will leverage solutions from Salesforce’s ecosystem of partners in the AppExchange, the world’s leading enterprise cloud marketplace, to deliver an integrated care platform across providers, payers and community services:

• Leading clinical care partners like Geneia and MCG provide risk analytics and clinical guidelines.
• Virsys12, Vlocity and Zipari have built solutions to better manage provider, broker and member relationships.
• Leading engagement companies have integrated their educational tools for member engagement, including Elsevier, Healthwise and myStrength.
• Global system integrators, including Accenture, Deloitte and PwC, are leveraging new Health Cloud for Payer functionality to enhance their existing Payer Fullforce Solutions.

“Managing complex relationships and being able to have a single view of a member is now table stakes for all insurance payers, and those who don’t are at risk of falling behind in this incredibly competitive market,” said Rita Sharma, VP of Product Management, Salesforce. “Health Cloud for Payers provides the technology that connects members and providers in a way that powers the enormously important relationships with each other and themselves.”

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Executive Comments

• “Payers need to address the market demand to offer clinical programs that meet people where they are based on their health and social risks, care gaps, preferences and needs. This requires a significant breadth of integrated capabilities,” said Heather Lavoie, Chief Strategy Officer, Geneia. “By leveraging Health Cloud for Payers and integrated ecosystem partners like Geneia, payers can take advantage of features in one solution and one underlying data set that would otherwise have required more than 50 different vendor integrations. As a solution for clinical programs, this is a complete game changer, enabling payers to exceed the expectations of their customers.”
• “As health plans look to provide a broad set of member care services, Health Cloud provides members with a rich unified experience throughout their journey,” said John Argenziano, Partner, PwC. “Utilizing Health Cloud’s plan and provider data model, health plans can accelerate time to market, improve its members’ health and increase member loyalty.”
• “Rapidly shifting consumer market experiences are changing the way patients view their healthcare and forcing healthcare payers to fundamentally rethink member engagement,” said Denis Pombriant, Founder, Beagle Research. “The new capabilities of Salesforce Health Cloud enable payers to break down data silos and drive more meaningful member interactions.”

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