Member Management for Healthcare Payers

March 15, 2023

As a payer, managing members is a critical aspect for healthcare payers. It can be challenging to keep track of member information, claims, and benefits, all while ensuring compliance with industry regulations. According to a survey by Black Book Market Research, 92% of healthcare payers plan to invest in member engagement and communication technologies by 2022.   In this blog, we’ll explore how you manage your members, improve member coordination, and drive better outcomes.

The biggest challenge for healthcare payers when it comes to member engagement is data integration, followed by data privacy and security. Nearly half of healthcare payers (46%) plan to use chatbots and other AI-based technologies to improve member engagement. These findings suggest that healthcare payers are increasingly recognizing the importance of member engagement and communication technologies in their business operations. By investing in these technologies, payers can improve member satisfaction and loyalty, reduce costs, and enhance their overall business performance. 

Member Management for Healthcare Payers
Image Credits “Everest Group

Streamlined member management

Salesforce Health Cloud allows you to consolidate all your member data into a single location, giving you a complete view of each member’s health status, care history, and preferences. With this 360-degree view, you can easily track changes in their health status and quickly identify those who require care. The platform also provides an intuitive interface that allows you to update member records quickly and efficiently.

Improved care coordination

With Health Cloud, you can easily coordinate care across multiple providers and care teams. You can create care plans that outline the necessary steps for each member’s treatment, including appointments, medications, and procedures. You can also share these plans with other members of the care team, ensuring that everyone is on the same page. Health Cloud’s collaborative tools, such as Chatter and Communities, make it easy to communicate with the care team and share information in real-time.

Improved care coordination
Image credits : Salesforce Health Cloud

Enhanced member engagement

Health Cloud helps you engage with your members in a personalized and meaningful way. With the platform’s data analytics capabilities, you can identify high-risk members and proactively reach out to them before their conditions worsen. You can also use the platform to send relevant educational resources and wellness tips to members, encouraging them to take an active role in their health.

Data-driven insights

With Health Cloud’s powerful analytics and reporting tools, you can gain insights into your member population’s health status, utilization patterns, and care outcomes. You can use this data to identify areas for improvement, such as care gaps or high-cost conditions, and take action to address them. Health Cloud’s reporting capabilities also help you track key performance metrics, such as member satisfaction and quality ratings.

Symptom Checker

Symptom checkers are online tools that allow individuals to input their symptoms and receive information on potential diagnoses and treatment options. By providing information on potential diagnoses and treatment options, members a) can make informed decisions about seeking medical attention. b) may be able to avoid unnecessary trips to the emergency room or urgent care facilities, which can be expensive. c) take an active role in their healthcare by providing information on potential diagnoses and treatment options Many healthcare payers have implemented symptom checkers as part of their member engagement strategies to provide value-added services to their members

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In conclusion, Salesforce Health Cloud is an excellent solution for payers looking to improve their member management and care coordination. The platform’s ability to consolidate member data, facilitate care coordination, and drive member engagement, and provide data-driven insights can help payers improve health outcomes, reduce costs, and enhance member satisfaction. To learn more about how Health Cloud can benefit your organization, contact us today.

Dinesh Poduval
Vice President of Marketing
Dinesh oversees the global marketing and communications for CRMIT Solutions. He is responsible for strategic planning and development, branding, market research, and customer service across global markets.

Tags: Health Cloud, Healthcare, Salesforce, Salesforce Health Cloud

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