Skip To Content
Back to Clients

Connecting Disparate Data and Improving Care with a Member Contact Center

Amida Care is a private, nonprofit community health plan that specializes in providing comprehensive health coverage and coordinated care to Medicaid members with chronic conditions, including HIV/AIDS and behavioral health disorders. They serve 7,000+ members throughout the five boroughs of New York City, including people living with HIV/AIDS; people who are experiencing homelessness, regardless of HIV status; and people of transgender experience, regardless of HIV status.

Download PDF

They understand that people with complex health conditions need access to providers with specialized knowledge, so Amida Care’s vast network features:

  • 175+ HIV-specialist primary care providers (PCPs)
  • 1,700+ general physicians PCPs
  • 9,000+ specialists
  • 5,000+ behavioral health providers
  • 75+ federally qualified and community health centers
  • 30+ hospitals

Integrated care, targeted improvements

As a nonprofit providing services to at-risk members spread across five separate NY communities, Amida Care needed a customer service ecosystem and backend environment that synced up their large amounts of data effortlessly. Unfortunately, their outdated and disparate systems, combined with manual processes, often produced communication gaps that hindered visibility into member and provider activity — limiting access to critical data points and presenting challenges in meeting required compliance and NYC regulatory mandates.

Knowing they needed improved systems and tools to enable their staff, Amida Care partnered with Silverline to implement a solution to help them connect data and build processes to provide an improved foundation of care — with a focus on member services and care management.

An accelerated transformation

In just ten weeks, Silverline deployed a member contact center (based on Silverline’s healthcare accelerator) that was uniquely tailored to meet Amida Care’s needs and business processes. This quick turnaround enabled Amida Care to take advantage of industry best practices and start realizing value sooner.

Silverline’s implementation included preconfigured objects, metadata, and custom code — all of which is fully accessible to Amida Care. During the course of the project, enhancements and adjustments were made to customize the accelerator based on the requirements and associated value indicated by Amida Care.

Creative change management

Unless users are ready to learn, use, and embrace new software solutions, implementation alone will not lead to the desired outcomes and innovations. Fortunately, Amida Care fully embraced change management, ensuring their employees were informed, included, and supportive of the new system.

Change management activities to foster Amida Care’s adoption success were a major focus of their digital transformation initiative. For instance:

  • There was a company-wide contest to name their Salesforce solution
  • They established a Use & Performance Committee to evaluate ongoing feedback and approve implemented enhancements and suggestions
  • Ongoing training was created for new teams, new functionality, and related change impacts
  • They created one-on-one and small group sessions to facilitate moving away from spreadsheets and their legacy systems and onto the new Org — saving time, reducing manual processes, and increasing data accuracy by providing real-time member information

Aside from excitement over process improvement, these change management techniques promoted community within the organization — facilitating user buy-in, rejuvenation through greater and more effective collaboration, and knowledge around the benefits Salesforce would bring to their collective teams, including member services, health services, and provider services.

Realized results

As a result of the implementation, Amida Care is able to meet their strategic initiatives around membership service, care management, and growth through enhanced communications, accurate and reliable data via system integrations, improved member experience, and consolidated reporting and dashboards.

Integrated communications

Amida Care staff now work on a common Salesforce platform across all departments and enjoy full visibility into member information as required by role. With a platform that provides a 360-degree view, staff from all departments can easily access member information, such as enrollment status, demographic information, clinical results, preferences and social determinants, prior calls, visits, communications, appointments, and other inquiries.

This new process increased administrative efficiencies and made it easier to serve members faster and more effectively. Amida Care has a unique model of care for their members, created by integrating care across providers and specialists, based on unique patient needs. Silverline’s tailored solution enables that model to flourish.

All member touchpoints, including call center communication, are tracked in Salesforce. This includes external third-party partners who provide member services after hours and in emergency situations. It also enables them to manage touch points with their provider teams. This allows Amida Care field staff to be out serving members one on one with an up-to-date look into each member’s care history; they can also add real-time information into the patient care portal while working in the local community.

Executives and management now have a strategic and holistic view of membership, growth, and care management metrics — along with insight into member touch points, case management, and assignment tracking with providers, pharmacies, or clinical partners, and more.

Meeting compliance and regulation standards

There is also a newly defined process flow for member orientation. This process ensures that Amida Care adheres to regulation compliance, that the information they gather is secure, and that appropriate care is facilitated up front with any immediate needs a member may have.

Amida Care experienced a 30% increase in completed new member orientations, meeting compliance in accordance with regulations.

A specialized Amida Care member services team handles appeals and complaint management. With Salesforce, all communications surrounding these claims are now tracked digitally, and customized tools allow staff to tailor responses and letters to those complaints more efficiently. This has increased Amida Care’s ability to improve their compliance percentage in keeping with certain state and federal mandated regulations.

Improving lead generation, member participation

Silverline helped Amida Care further realize member growth goals and member participation through website and process improvements. For instance, a newly created form ports member leads directly from the Amida Care website into Salesforce for assignment, follow-up, and tracking.

Incentivized member programs like Healthy Rewards and Live Your Life Undetected, as well as assessment completion tracking, were once managed through multiple spreadsheets saved in different locations. Now, those manual processes and spreadsheets have been replaced with automated Salesforce functionality.

My Amida Care Community Portal

Silverline also worked with Amida Care to craft a personal digital member community, accessible to their members on both computer and mobile devices.

The app, called My Amida Care, provides many self-service features that enable members to personally manage their Amida Care plan, schedule appointments and services, and communicate directly with the Amida Care Member Services team.

Using My Amida Care, members can:

  • Access Amida Care ID Card & Request a New ID Card
  • View Member Incentive progress in programs like Live Your Life Undetected, and Healthy Rewards
  • Access Member Resources: Plan/Services Information & Forms
  • View Frequently Asked Questions
  • Update Personal Profile Information, like addresses and phone numbers
  • Send Requests to Member Services, and view current and previous communications

Continued success

Following the initial implementation, Amida Care entered into a Navigator (i.e., Managed Services) engagement with Silverline’s Client Services.

With Silverline’s ongoing process improvements, Amida Care has all but eliminated paper forms, which were being used frequently with members, and driven efforts to lower the amount of time that members spend on calls because of the now immediate access to member data. Amida Care now uses multiple integrations that allow them to leverage data within other platforms to provide not only the best member experience, but also Salesforce user experience for their staff — with access to data at their fingertips.

Through multiple phases and iterations, Silverline developed and implemented new processes to streamline and automate previously manual tasks across multiple departments. These improvements let Amida Care focus more on the member experience, and less on basic administrative duties.

Our continued partnership in ongoing platform enhancements and integrations, along with improved process efficiencies, has enabled Amida Care staff and providers to better leverage member data and communication tools across their entire organization.

Ready to see real results? We can help.

Get in Touch

We don't support Internet Explorer

Please use Chrome, Safari, Firefox, or Edge to view this site.