This content is part of the Conference Coverage: Dreamforce 2018 conference highlights and key takeaways

Salesforce Health Cloud for Payers brings CRM to insurance

With its CRM system for payers, Salesforce is targeting a competitive market in which health insurers are fighting for members seeking lower costs and better health outcomes.

With the Salesforce Health Cloud for Payers system, the CRM software giant is targeting an industry plagued by spotty customer service, fragmented data and little coordination in an era of sharply rising healthcare costs.

In other words, Salesforce is going after a sector of the healthcare business -- insurance -- that is badly in need of better customer relations, and the company's heft and CRM expertise may well find a robust market there, according to health IT analysts.

Salesforce announced the system -- a more specialized upgrade of the Salesforce Health Cloud product introduced in 2015 -- in June, but it is not expected to be commercially available until fall 2018.

"I think there are really good reasons to be optimistic on Salesforce's behalf in bringing Health Cloud to payers," said Jeff Cribbs, a research vice president at Gartner focused on healthcare.

Cribbs said Salesforce has recognized that healthcare providers, and particularly payers, are facing a sort of crisis of engagement, in which patients and health plan members have little communication and trust with insurers.

Headshot of Salesforce CMO Josh Newman, M.D.Josh Newman, M.D.

Meanwhile, competition between payers for members seeking lower costs and better service is fiercer than ever.

"Health improvement is at least as much a relationship problem as a clinical problem and, therefore, needs a relationship solution," Cribbs said. "That's a lot easier for a payer to accept. Ever since the HMO era, they knew trust was an issue, [as was] engagement with their members."

Contending with health IT vendors

While the CRM vendor may receive a warm reception among payers, Salesforce has faced stiff competition in the healthcare market from native health IT vendors.

Health improvement is at least as much a relationship problem as a clinical problem, and, therefore, needs a relationship solution.
Jeff CribbsGartner

Such healthcare CRM -- or patient relationship management -- purveyors include, Evariant -- a Salesforce partner -- and HealthGrid. Also, the top electronic health record (EHR) vendors, like Epic, Cerner and AthenaHealth, have evolved ever-more robust patient engagement modules in their EHR platforms.

Meanwhile, since launching the original Salesforce Health Cloud for providers, Salesforce has partnered through its AppExchange marketplace with health IT companies like Geneia and MCG Health to integrate Salesforce technology with clinical and risk analytics systems.

Salesforce sees market opportunity

Josh Newman, M.D., Salesforce's chief medical officer, said Health Cloud for Payers is a response to requests from customers for a CRM system that incorporates data from insurance claims, benefits and authorizations.

Salesforce Health Cloud for Payers was originally conceived of for payer providers, healthcare systems that also are their own insurers, and then was broadened after Salesforce determined that most payers were looking to manage patients better, Newman said.

"Payers are now starting to manage patients and health in the way that comprehensive healthcare organizations or even primary care doctors used to," Newman said. "One of the biggest reasons is they're paying the bill, so it's in their interest to find lower-cost alternatives for care, it's in their best interest to reduce utilization, it's in their best interest to keep people healthy."

Health Cloud for Payers essentially makes insurance and benefits information available to groups of payers, providers and health plan members in a single view rather than having to dig out the data from disconnected sources, Newman said.

Members, for example, can use the system to view their insurance plans, receive care alerts and communicate with insurance customer service people and healthcare providers on their mobile devices.

A central thrust of Health Cloud for Payers is improving payers' marketing, member engagement and customer experience capabilities, Newman said.

Salesforce sees another part of the system, though, as "closer to the clinical realm," as Newman put it.

That doesn't include ordering lab tests and medications, like an EHR does, Newman said, pointing out the Salesforce Health Cloud and the payer version are not meant to play the role of EHRs.

Salesforce and population health

Salesforce Health Cloud is a form of population health, the heavily IT-reliant modern healthcare approach that aims to improve health outcomes for large swaths of patients with expensive-to-treat chronic conditions such as Type 2 diabetes, hypertension and chronic obstructive pulmonary disease.

Population health often deploys predictive analytics to identify which patients are most at risk of becoming sicker or dying.

It also depends heavily on care coordination, or helping caregivers ranging from primary care doctors to care management nurses to communicate with each other to provide the best and least expensive care and track patients' compliance with care plans at home.

That is the area in which Newman said Salesforce Health Cloud for Payers will be most useful.

CRM for care coordination, engagement

Care coordination and member engagement are areas in which payers have traditionally been weak and where a CRM system such as Salesforce Health Cloud could prove effective, said Brian Eastwood, a patient and consumer engagement technology analyst at health IT research firm Chilmark Research.

Eastwood said Salesforce has been fairly successful with its hospital marketing efforts, such as helping to retain patients in big, competitive marketplaces, but has made more limited progress in direct care management and clinical applications.

"It seems like they may have a little bit more to offer in the payer market," Eastwood said. "For outreach and patient management, they're in a good position. Their ability to connect care teams to communicate more effectively about what's happening to a patient -- that could be a differentiator for them."

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