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Meet Health Cloud for Payers

Learning Objectives

After completing this unit, you’ll be able to:
  • List the benefits of Health Cloud for Payers.
  • Explain the basics of Health Cloud for Payers

Engage with Your Members in a Whole New Way

Health Cloud for Payers is an end-to-end solution for health insurance payers from Salesforce, the world’s #1 CRM. New features help insurers put members and providers at the center of each interaction. And personalized, more efficient member experiences improve outcomes while containing medical costs.

Let’s look at how it works.

Starting with a new payer data model that integrates all relevant records—like benefits, claims, and authorization information—into one place, payers can get a much more comprehensive view of each member. And by using one dashboard for everything, instead of jumping around between multiple systems, payer agents and managers work faster, smarter, and better serve their members.

Improved workflow management streamlines day-to-day tasks. Things like care requests, authorizations, or questions about benefits move faster through the pipeline with better guidance and triggers for next steps. Providers and members can also view the status and progression of their requests, increasing transparency between payers and their members.

Health Cloud for Payers draws on Salesforce’s vast experience helping customers. It also has access to the Salesforce partner ecosystem via AppExchange. Many third-party companies are AppExchange partners and they’ve created healthcare and life sciences apps. These apps help to connect conversations, devices, processes, and healthcare data in a whole new way.

Take a Look

Before Health Cloud for Payers, a service agent logged into multiple systems every day. To answer a member question about an upcoming procedure, for example, agents used different systems to view doctor pre-op recommendations, insurance authorizations, benefit status, and more. Now they see comprehensive information about the member’s procedure in one place, allowing them to service both members and providers quickly and efficiently.

It’s all there in the member record.

Member record for Charles Green showing benefit usage as Low (1), Out-of-pocket expenses as $4,372 of $5,000 (2). Other panes show Web Activity, Member Alerts & Notifications (3), and Next Best Actions (4)

Member service agents see information like benefits usage (1), out-of-pocket expenses (2), and member alerts (3). The guided workflow moves agents through common tasks quickly and efficiently by recommending next best actions (4). Care managers see information about client care plans, assign educators, and make sure that their members are doing well.

Member details show useful information about each member, including when and how they like to be contacted. Past interactions are logged so it’s easy to understand a member’s history. Instead of starting each call from scratch, repeating information the member already knows or has previously shared, the agent or care manager has context and a rich history to consult. Members gain confidence that insurers know what’s going on and are working hard to take care of them.

Agents and care managers can connect to members in many ways. For example, they can sign up to receive alerts on their cell phones, or connect with other professionals via email or text message. So if a member is sent home from the hospital, the care manager receives a discharge notification and can help the member arrange home care and follow up visits. That’s the kind of care that helps members get better fast.

You’ve learned how Health Cloud for Payers can help you take the best care of your members. Now, let’s follow a member services agent named Erica as she uses it to help her first call of the day.