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Future-Proof Member Management for Health Insurance Companies

By Cheryl Gibson 08.05.21
Reading time: 3 minutes

In a world where business technology seems to change and age faster than ever, companies typically have two options for enabling new capabilities: modify what they have, or invest in new tools designed for their specific needs. 

Today’s health insurance companies are no exception. As they scale for growth and adapt to digital trends, client management technologies need to be upgraded to help them stay competitive. Many of these companies have successfully leveraged Salesforce Service Cloud and Sales Cloud to drive productivity and deliver strong customer experiences, but there are significant benefits in migrating to Health Cloud. With support and guidance from the experts at Silverline, you can accelerate growth by creating new value, improving operations, empowering personalized care plans, and enhancing provider relations. 

Streamlined Systems, Optimized Operations

Many health insurance companies’ day-to-day operations are bogged down by large, siloed legacy technology solutions. Leveraging the necessary information while navigating through claims management, utilization management (e.g., prior authorizations, referrals, approvals), and care management (e.g., care plans) can become slow and tedious — leading to fatigued employees and frustrated members. That leads to low member satisfaction rates. 

Before Health Cloud was available, many insurance companies implemented Sales and Service Cloud together to gather siloed data and create a single source of truth about each member. But because Sales and Service Cloud weren’t designed specifically for healthcare, they required extensive customizations and configurations to accomplish relevant tasks. 

Health Cloud’s enhanced data model and process capabilities include numerous out-of-the-box features that are designed specifically to streamline insurance company operations. Crucial processes like thorough claims review, administering referrals, and pre-approving treatments are significantly more efficient with Health Cloud. It’s an industry-specific solution designed to improve collaboration and productivity by curating and organizing all the relevant information and step-by-step processes your team needs to make faster, more informed decisions at every touchpoint in the member journey. 

Personalized Care Plans

​​One of the fastest growing priorities for health insurance companies is to create and manage the health of their members through the creation of individualized care plans; thereby improving the health of their members. There is a clear and direct link between healthier members and an improved bottom line, but incentivizing and enabling better health for members at scale is no small task. 

Whether a member has diabetes, a smoking habit, an auto-immune disease, or insufficient access to healthy food, Silverline can help you set up Health Cloud tools in a way that gives your care management team the ability to create and manage highly personalized care plans. These plans not only include traditional medical treatment, but also pay particularly close attention to mental health and social needs as well.  

Building and managing care plans through Health Cloud gives you significant strategic insight into the health and wellness of your member population. Utilizing the collaboration tools built into the Health Cloud platform and their expertise, Silverline can:

  • Guide and enable your care team (e.g., care managers, providers, and caretakers)
  • Integrate with claims systems and electronic health records
  • Help you identify high-risk members
  • Reduce over-consumption of healthcare resources
  • Pursue continued opportunities to improve members’ health

And care plans aren’t the only touchpoint that can be personalized using Health Cloud’s improved 360-degree view of members. Customer service and marketing teams also gain considerably more visibility with data views that empower them to make every customer interaction more informed and rewarding. These improved touch points drive loyalty by making members feel valued as individuals, rather than just a policy number.

The Power of a Provider Portal

One of the most challenging tasks for health insurers is managing ongoing relationships with healthcare providers. Health Cloud collects, curates, and integrates all the information insurers need to collaborate with providers and ensure high quality care. It also makes it possible to build a highly efficient provider portal

With a portal created by Silverline and powered by Health Cloud, providers can:

  • Check claim status
  • Request pre-authorizations
  • Search for and create referrals
  • Collaborate on care plans
  • Manage appeals on a single, integrated platform. 

Not only does this improve productivity and reduce turnaround time by streamlining communications, it can also dramatically improve the experience for your members at a time when they are often under significant stress. Less inquiries into member service teams and faster authorization, referral, and appeal processing drive value for all the parties involved. 

Next Steps

Upgrading to Salesforce Health Cloud is a powerful way to modernize crucial operations and position health insurance companies for growth. But it’s also a significant change with a lot of variables. Silverline’s team of experts have decades of experience with both Salesforce and the health insurance industry—and we’re here to help. Learn more about what migrating to Health Cloud looks like.

Ready to see real results? We can help.

Get in Touch

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