9 Salesforce Clouds Healthcare Payers Should Be Using

The competition for Medicare recipients and employer groups is increasing. The ability to effectively market and shorten the sales cycle time, broker sales, and automate quotes is becoming critical. Payers that quickly transform these critical business processes with effective digital transformation become more competitive. More competition demands more efficient operations. How does your business stack up?

Today Health Care payers often face many of these challenges :

  • Increased competition for medicare recipients and employer groups causing lost sales
  • Manual inefficient operations causing poor member experience
  • Siloed data systems between sales, enrollment, services, claims, and care management causing disconnected member experiences
  • Transactional care versus value-based care, causing poor provider engagement

As a healthcare payer, how can you combat these challenges? Salesforce offers nine Clouds to accelerate the healthcare payers digital transformation journey and improve their competitive position, member and provider experiences, and differentiate their brand while improving their services.

9 Salesforce Clouds for healthcare payers:

  • Marketing Cloud (B2C) — Payers can market their insurance plans directly to the consumers (patients)
  • Marketing Cloud Account Engagement – AKA Pardot (B2B) — Payers can market their insurance plans directly to businesses, employer groups and labor groups
  • Sales Cloud -— Payers can sell their insurance plans to businesses, employer groups and labor groups
  • Revenue Cloud — Payers can use “Configure Price Quote” (CPQ), “Billing”, and “Renewals” to build a true “Quote to Cash” digital experience for their customers
  • Service Cloud — Payers can provide true world class call center service to their customers (patients) and businesses in the omni channel of their choice
  • Experience Cloud — Payers need portals for customer and partner self service to provide a true digital experience while providing cost reductions through self service.
  • Customer 360 (C360) Platform — The Sales Cloud, Service Cloud, Revenue Cloud sit on top of the C360  Platform, and the Marketing Cloud experience cloud connects to the C360 Platform. As does the Integration Cloud for other integration needs.
  • Health Cloud — Payers have to connect with Providers to authorize health care and pay providers. Health Cloud is a Patient Engagement Cloud that sits on top of the Service Cloud and Sales Cloud, which in turn sits on top of the C360 Platform.
  • Salesforce Connect — This allows the Heath Cloud to see Claim data in the Payer Systems

Let’s dive a little deeper into what the Clouds can do for your business:

1.Marketing Cloud (B2C)
Imagine if you could build and foster member relationships that last? That type of customer-centric thinking can help you reimagine your digital transformation and customer engagement processes.

Most consumers really know very little about the details of their health insurance, and certainly do not look forward to selecting a health plan. Imagine your competitive advantage if you could deliver personalized, relevant, and timely information to your customers? How would that improve their experience? Imagine being able to enhance your customers’ experience across email, mobile, text, social, advertising and websites? Could you build loyalty and drive advocacy? With Marketing Cloud, you can do all of this, and more.

2. Marketing Cloud Account Engagement — AKA Pardot (B2B)

What if you could close more deals with intelligent lead nurturing? Think about what is possible if you could: 

  • Send your emails at scale based on day and time.
  • Use user content interactions to maximize their engagement.
  • Send personalized messages with dynamic content.
  • Leverage your prospects activity and engagement score with updated lead grading to get a detailed view of their engagement.

Best of all? All of this activity in Marketing Cloud Account Engagement is continuously integrated with your Sales Cloud in real time, allowing your sales team to focus on the best qualified leads.

3. Sales Cloud
Increase the productivity of your sales team, by having the worlds best customer relationship management (CRM) working for them. What if you could?:

  • Keep track of prospect activity, customer interactions, and automate the redundant tasks and admin work. 
  • Integrate with your email, calendar and work on the go with your mobile device. 

Sales Cloud can Manage Accounts, Contacts, Leads, Opportunity, Quotes, Collaborative Forecasts, Dashboards, Reports, and Approvals.

4. Revenue Cloud
Accelerate negotiation of sales of your insurance products. With Revenue Cloud, you can:

  • Build compliant solutions, route pricing for rapid approvals, and make documenting the terms of agreements easy. 
  • Define business rules and automatically validate that you are playing by the rules. 
  • Protect your margins across all of your channels. 
  • Accelerate cash collection with a flexible billing engine, and support most charge types, sales orders or payment schedules with ease.
  • Keep your insurance pricing up to date and consolidate product and pricebooks.
  • Allow per account pricing or standard pricing; Couple this with document generation and eSignature for a digital transformation of your revenue cycle.

5. Service Cloud
Your buyers and patients have increased service experience expectations. Why not consider the world’s number one call service platform? Take advantage of:

  • Optimizing your case management by using omni-channel to route cases automatically to the agent with the best skill set to solve them. 
  • Tracking customers insurance, and buyer assets, support history, and more, in one place for a complete view of their activity. 
  • Logging notes instantly on calls, and managing calls on a console without touching the phone. 
  • Get a 360-degree view of each customer by connecting data across departments and external systems so your agents are fully informed.
  • Use automation and templates to drive agent productivity.
  • Use knowledge management to drive rapid case resolution with recommended solutions and optimized search.
  • Automate your service processes for a consistent buyer and customer experience.

With all the automation available with Service Cloud, it’s time to rethink how you’re running your business.

6. Experience Cloud
Help your buyers and customers find answers themselves. Believe it or not, empowering buyers and customers to find the information they need is more cost effective and improves the customer experience. Consider providing:

  • A storefront for B2B, and B2B2C for buyers and customers for online buying?
  • Account portals for each buyer and customer, where they can access articles, update their accounts, and create and manage their own cases?
  • A partner portal for your broker’s where they can see Leads and Opportunities, and sumit their own Leads and Opportunities so you can extend your sales team?
  • Microsites for events?
  • With Experience Cloud, there are an incredible amount of ways to engage with your buyers and customers.

7. Customer 360 (C360) Platform
The C360 is the core CRM that many of the other Salesforce Clouds either sit on or connect to. It has all the building blocks like Account, Contacts, Cases, Calendar, Events, Custom Objects, Activities, Tasks, Content, Documents, Ideas, Documents, Reports, Dashboards, Chatter, Identity, Security, Mobile, Workflow, Knowledge, Flow, Apex Code, VisualForce Code, APIs, Salesforce Connect, Identity Connect, Custom Apps (AppExchange), Data Storage, File Storage, Encryption, Masks, Sandboxes, and much more. You can also buy it on its own, and configure your own apps.

8. Health Cloud
Most healthcare organizations still rely on Electronic Health Records (EHR) to manage clinical data. However many EHRs have limitations, as they struggle to integrate clinical and non-clinical information. This leads to a disjointed, disconnected patient experience, and often means that patients do not follow their care plans when there are multiple providers, each with different EHRs. Often as a result insurance utilization can be much higher than it needs to be and positive patient treatment outcomes are more elusive. This also leads to higher insurance premiums for buyers.

Enter the Health Cloud, which focuses on patient engagement. It can connect to multiple EHRs and Claim systems. This allows a patient’s needs and wants to be better managed and improves compliance with care plans, reduces insurance utilization, and ultimately improves outcomes for the patients, and reduces costs. Health Cloud enables providers to access patient data from mobile devices, and hence, engage from anywhere. It improved  record keeping accuracy, and allows for virtual appointments. It also reduces mistakes and inaccuracies.

9. Salesforce Connect
Salesforce Connect provides seamless integration of data across system boundaries your users view, search, and modify data that is stored outside of the Salesforce platform. Such as in Payers claim systems for pre-authorizations, determinants of health, and EHRs for clinical records. For data that needs to persist in the platform there is the Integration Cloud.

Need some help deciding where to start? It’s time to connect with the Redpath healthcare team!

With the rapid evolution of technology, Salesforce solutions are ever-changing and improving features. Contact our team for up-to-date information.

Published On: July 7, 2022

About the Author: Paul Selway

Paul is the president and co-founder of Redpath. He works with prospects and customers to help them imagine their future with a Salesforce solution. He was born in England and hails from the Redpath clan in Scotland.