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How Salesforce Improves 4 Key Member Services Interactions 

By Matthew McCrea 02.10.22
Reading time: 4 minutes

Calling a health insurance company’s member services number can often get a bad rap. Push 1 for a new card. Push 2 for an explanation of benefits. Push 3 to speak with a representative. Push 4 if you want to lose your sanity.

In an instant access world, people have become used to having anything they need with a click of a button. Those elevated expectations have carried over to healthcare. Being efficient and effective is no longer enough, and members are holding payers to a high standard of service. 

Silverline helps organizations meet that higher standard with Salesforce technology, with a team of healthcare experts who understand member services needs and how technology can satisfy them.

Four member services interactions enhanced by Salesforce Health Cloud

There has been a shift in the approach to interacting with members. Member services interactions are no longer transactional and cold, and more about using these connection points as an opportunity to be a relationship builder. 

Each and every interaction between a member and member services needs to provide value. These are four key areas that every payer should evaluate to ensure they are creating personalized and productive relationships among members at every stage.

1. Elevate member inquiries with 360-degree insights

There are a number of reasons that a member may be contacting member services. It could be to look for a doctor, order a new ID card, or to gain a better understanding of their benefits. They are seeking information, assistance, and problem solving all in one. 

Salesforce Health Cloud brings a full 360-degree view of each member to the member services center. It provides insights into where the member has been, where they are now, and where they are going next in their healthcare journey. This information allows each member services agent to personalize their responses to member inquiries with recommendations and answers that are tailored to the individual. 

Let’s use a member with an injured knee as an example. Instead of providing a random specialist, a member services agent can take a look at Salesforce Health Cloud and provide a custom suggestion. This may be a knee doctor that is within a certain distance of the member’s home or workplace. The rep can then take the proactive and productive step of recommending a physical therapist because they know that will most likely be the member’s next need.

2. Upgrade appeals and grievances for a smoother health journey

There are often occasions where either the member or the provider doesn’t understand a health decision that has been made, and this leads to the appeals and grievances process. Healthcare plans are based on many rules and regulations. These can be helpful for payers to make decisions on a large scale, but they can sometimes falter at the individual member level. 

As part of the appeals and grievance process, members will typically reach out to member services for clarity around issues such as making sure a treatment was medically necessary or if a medicine should have been covered. Salesforce Health Cloud comes to the rescue again by providing a complete picture of the member so that member services can intelligibly share the necessary information with the member. They have the context of the member’s health history and can immediately get up to speed and best guide them.

3. Advance engagement with members who have gone dark

Now let’s go to the dark side of member engagement. We’re talking about the ‘dark members’ who have little to no interaction with their health plan. About 40% of members at any one time are considered dark members. Like an unopened birthday gift, they take their great coverage and just let it sit there.

These members who are trying to manage their healthcare in the dark present a problem to member services. They are left searching in a black hole for any piece of information to actively engage with these members. The years pass, and suddenly, a dark member will pop up out of nowhere with a catastrophic event requiring immediate medical attention. The member must dust off their ID card while the payer raises their eyebrows at the high claims cost. 

Many of these dark member issues could be prevented if the payer had the opportunity to intervene earlier to help manage the situation. For example, the dark member may be making unhealthy lifestyle choices that results in weight gain, which in turn leads to cardiovascular health problems. This could have possibly been avoided by conducting outreach with the dark member sooner, such as with Salesforce Health Cloud’s built-in messaging functionality.

4. Enhance wellness engagement to prevent future problems

Going for an annual physical, drinking enough water, counting steps — these are all critical elements of our overall wellbeing. Yet many members need some motivation to set these activities in motion. By promoting better wellness, member services can help to thwart off costly medical issues or long-term chronic conditions. This could be in the form of recommending a nutritionist for better eating or reminding a member that coverage of home exercise equipment is included in their plan. 

Salesforce Health Cloud connects the disparate information on members from various data silos. This allows member services agents to better support the wellness of the member they are interacting with. For example, being able to glean insights from the appeals and grievances system and the clinical management system gives member services the capability to personalize their guidance rather than following a general, impersonal script.

Make every member services interaction count

Member interactions are not limited to the traditional phone call. Member services agents are now expected to be available on other channels, such as a website, live chat, mobile app, or email. Salesforce Health Cloud helps make those omnichannel interactions possible by creating unique member profiles that include communication preferences.

Salesforce Health Cloud is an easy-to-use, intuitive platform that is pre-configured for the healthcare industry. It is designed to gather a member’s information into one logical, accessible, and streamlined view. The integrated solution tracks all member interactions over time so that each one keeps building on the next. 

Learn more about how Silverline can help augment every interaction between your members and your member services team.

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