member-centric care

How to build member-centric care in the payer industry

by Jayneel Patel

The healthcare payer industry is evolving. With telehealth and remote care, members have increasingly high expectations for personalized experiences. Traditionally, the payer industry has always looked at members in population, demographics, and segmentation to perform statistical analysis and risk assessment. However, member experience and loyalty are now driving the payer industry, and member loyalty is driven by the care that each member gets. Patient-centered services are correlated with reduced costs for facilities and improved overall health. Trends like these mean the industry is expected to shift its attention from the population to individuals in order to provide better care and services. Although each symptom may be the same, every care is different. Hence, to earn member loyalty, payers must provide a member-centric experience. In this blog, I will share the solution to transitioning from the population mindset to individualized care.

If individualized care is so important, why has providing individualized care been so difficult until now?

Providing individualized care sounds great if you are the individual getting the care, but for a payer, it is a complex business problem to solve. When shifting to individualized care, the following are some critical questions to consider. 

 

How do you provide individualized care for hundreds if not thousands of members?

Providing individualized care means developing a comprehensive care team, providing the ability to track each individual need, catering to that need, and monitoring health improvements. The overhead alone of building such an ecosystem with end-point solutions could make the program quite costly under legacy systems.

How do you measure program performance in individualized care?

In an industry that thrives on running statistical analysis on populations to measure performance, payers have found it difficult to accurately measure the program performance in which each member’s care needs are different.

How do you ensure not only the members are happy but also the providers who are providing care?

Providing highly personalized experience and individualized care, if not orchestrated closely and continuously, could add a significant level of organizational work on the providers and the care team. This could ultimately negatively affect the quality of care and hence increase the cost of the program.

 

So how can Salesforce Health Cloud help solve the challenges in individualized care and make providing a personalized experience a reality? Below, let’s take a look at five major components of personalized care that are key to building member-centric care management.

 

Risk stratification

Proactively identify high-risk members with intelligent risk stratification and assign them to personalized care programs to control their conditions. The Salesforce solution integrates seamlessly and securely with systems relevant and important for patient care such as clinical data, lab results, referrals and approvals, and medical device service to name a few. The intelligent risk stratification is capable of incorporating multiple factors when calculating risks, which helps provide more personalized care for the members. 

 

Automation and intelligent recommendations

When the care team serves many members at the same time, all with varying levels of needs, a solution from Salesforce Health Cloud can help automate and identify the care necessary in the level of priority. A single care dashboard called the Today Page allows the care team to know the number of members they care for, the number of new members added to their care that week, and the care-related tasks for the day. With the use of automation and intelligence, the system streamlines the orchestration of care, leaving the care team to worry about the only thing that truly matters – providing care to their members. 

 

Care network

Easily reference each member’s care team and manage relationships across household members, care plans, and providers. When it comes to care, we know it’s not just provided by one but rather by many. Salesforce Health Cloud includes a household map that allows the care team to understand the circle of care that each member receives and to customize the care journey accordingly. 

 

Omnichannel

Through omnichannel communication, the care team can make relevant information available to the members in the form the members would like. When thinking through thoughtful design for healthcare, it becomes necessary to conduct communication and interaction through platforms that are portable and easily accessible. Salesforce Communities, when integrated with Salesforce Health Cloud, answers this need by offering a personalized experience and a flexible way to interact with the care team. Members can report on issues and progress in real-time instead of waiting to connect with their provider in their next appointment. Such real-time interactions further reduce the wait time and improve the quality and timeliness of care.

 

Collaboration

Focus less on reporting status and more on collaboration. With Salesforce, let the platform do the work of building informative reports to measure your key performance indicators (KPIs) and instead allow the care team to focus on the member’s health timeline and the care journey. Manage your care network through a care hierarchy and coordinate daily care tasks all through a single platform. Get real-time feedback from the members and engage in member interaction through the digital member portal. 

 

The payer industry can no longer provide care through generic programs designed through statistical analysis. Members are playing a strong role in shaping tomorrow’s care management and require real-time interaction, digital experience, and personalized care. Providing member-centric service is absolutely essential for the payer industry’s survival. Through Salesforce Health Cloud, we can deliver next-gen care experiences without increasing overhead costs or compromising on the quality of care. 

 

Jayneel Patel

Jayneel is VP, Healthcare & Life Sciences, here at Simplus. With a Ph.D. in engineering and MBA from Duke and over 15 years of experience, Jayneel designs and delivers empathy-driven innovative solutions in healthcare. He has developed digital strategies to reduce risk, increase visibility, and improve patient and member satisfaction. His passion is to enable better care through technology.

[email protected]

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