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Boost Member Health and Wellness Engagement

Learning Objectives

After completing this unit, you’ll be able to:
  • Explain how Health Cloud supports self-service with Provider Search.
  • Describe how assessments and surveys can be used to tailor member service.

Find a Doctor

Time is money. So, to save time is to save money. Imagine if you could cut down the time it takes to connect a member with a provider by half. Imagine if you could reduce call center costs because agents don’t have to address every query raised by members.

Across the industry, payers are working with providers to create a value-based care system that improves outcome, while keeping referrals inside the network. With Health Cloud’s Provider Search, payers empower members to connect to the right provider based on cost, preference, and their insurance plans.

The traditional approach depends on extracting data from the CRM system into a data warehouse for enabling Provider Search. But Health Cloud gives you Provider Search on top of your CRM data for internal users and members via Communities. The result is lower implementation costs, a smooth care process, and increased call deflection.

Provider Search lets members look for providers via customizable fields such as specialty, facility name, maximum distance, and whether they’re taking new patients. The search returns results with providers who meet any of these criteria. They’re also sorted by distance from the member, and include a map.

Provider Search in Community. Two options are selected to filter search.

Two providers listed on the left. On the right, is the location of the first result on a map.

Provider Cards show key information for each provider. Members can view accreditations, awards, board certifications, National Provider Identifier (NPI) number, services provided, and the payer network with which the provider is associated. With a complete view of the provider, members can easily locate and connect with their provider.

Consider Charles Green, who has acute lower back pain. Instead of phoning the call center agent, Charles uses Provider Search in his Health Cloud console. He can find a provider near him who specializes in Orthopedics and is covered by his insurance company. This saves time for the member and reduces costs for the payer.

Know Your Patient

To serve a member better, it helps if a care provider knows their member’s story. With Assessments and Surveys case managers can collect actionable data about the member’s preferences, earlier outcomes, family relationship, and social determinants of health. This provides a glimpse into the life of a member beyond their immediate health needs.

Let’s look at Paul Nunez who was recently discharged from the hospital after a hip surgery. As part of the continuation of care at home, his care coordinator, Ravi, has assigned a caregiver who is fluent in Spanish. Before the surgery, Ravi had asked Paul to take part in an assessment where Paul had to answer a series of questions about his personal preferences.

From the results of the assessment, Ravi found out that Paul preferred communicating in Spanish. Ravi knows that the recovery from surgery requires a lot of trust between the patient and his caregiver. It can be distressing for the patient if they cannot fully communicate what they need. By assigning a caregiver with whom Paul can easily communicate, Ravi makes sure Paul is fully supported on his road to recovery.

A survey invitation for Charles titled Member Preference.

Assessment and Surveys allow case managers to create easy-to-use, customizable forms to collect information about a member. They can add questions to collect the data about the patient such as healthcare preferences. They can also use this to extract data from previously completed surveys, and monitor survey responses to gain insights about the member’s preferences and healthcare choices. Assessments enable case managers to help members stay on top of health goals and show gaps where they’re likely to fall behind.

Creating a survey with a question, description of the question, and multiple choice options.

Another way to know more about a member is by pulling data from electronic health records which are integrated into Health Cloud. Using the clinical data model, case managers can access up-to-date information about patient demographics, hospital admission, discharge, and transfer information, clinic appointments, and allergies. 

Importing this data into the Health Cloud data model allows case managers to do all sorts of real-time analytics with Einstein and Risk Stratification. Einstein provides critical insights and analysis of the patient population. Risk Stratification uses embedded dashboards to connect with the Health Cloud risk-scoring tables to identify and manage patients who are at risk. Together they help case managers offer preemptive care as case managers can identify high-risk members and enroll them in care programs and wellness journeys.

But how do care programs help drive customer satisfaction? Care programs ensure continuity of care, which in turn leads to customer loyalty and increased trust. Aimed at preventive care rather than treating an illness, care programs save money by reducing emergency room visits and expensive readmissions. According to a report by Salesforce partner Silverline, almost half of the survey respondents noted fewer medical errors and better outcomes as the biggest benefits of value-based care programs. As a result, care programs enjoy high customer success.

A care program called GoodHealth Care Program for pain management of arthritis.

Now back to Charles Green, who used Provider Search to find a provider for his acute lower back pain. Using Surveys, Assessments, and Charles’s electronic health records, the care manager collects information about Charles’s case history, medical preferences, and previous survey results. The care manager analyzes the data and decides that Charles is a good fit for GoodHealth’s value-based care program for early intervention for arthritis. GoodHealth is recruiting patients who have a case history like Charles’s for a new back pain relief medication. The care manager gets Charles’s consent to enroll him in a GoodHealth Pharma’s pain management care program. It includes education on pain management and a series of exercises that Charles can do at home.

With Provider Search, Assessments, Surveys, and electronic health records on a unified platform, care management expands beyond immediate health concerns. Care managers can offer end-to-end care for their members beyond the clinic and the hospital.

Resources