Creating Value for Payers
Payers constantly strive to improve the experience they create for their members by simplifying the interaction between the member and the payer. This can be changes such as communicating with a member in their preferred method — text, phone, web page, live chat, email — or creating a customized care plan that addresses the most urgent health care needs of a member. The Silverline Payer team has helped many health insurance companies identify and implement changes to the way they operate that creates real, measurable value. Our team is comprised of professionals with decades of experience developing and implementing new operational and technological solutions that create this value.
Why Migrate to Salesforce Health Cloud?
The evolution of Salesforce Health Cloud has been tremendous, and when coupled with Silverline’s payer team, Health Cloud creates a foundation to support all areas of a payer organization with capabilities such as:
Create a 360-degree view of a member
With all member information stored in a single “source of the truth” and accessible through a “single pane of glass”, any payer team member is able to view every interaction with a member. This 360-degree view simplifies every type of interaction, whether it is a request for a new membership card, questions about benefits, or viewing information about activities such as the status of a claim or a pre-authorization request.
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Consolidate provider information in one place
With a provider portal, providers can check the status of claims and submit pre-authorizations, referrals, and respond to appeals all in one place, without needing to constantly communicate with payer team members. This improves efficiency and satisfaction for providers, lowers inquiries into the member services team, and increases the timeliness for authorizations, referrals and appeals processing.
Create unique and personalized care plans for each member
Every member has a unique set of health care needs, so crafting a unique care plan is critical for improving the health of every member. With the tools included within Health Cloud, care managers can assess the health of a member, capture social determinants of health, utilize claims experience information, and help the member track and manage their plan of care to address any medical challenge.
Streamline approvals for treatment plans
Health Cloud gives you the ability to capture information about pre-authorizations and manage the workflow. The never-ending back-and-forth with physicians can be drastically reduced, which eliminates the friction in the authorization process and improves the turnaround time for all authorizations.
Give members more control
It’s easy for members to look up their benefits information and monitor claims with a member portal that provides self-service access to their health plan information. Members can submit inquiries, directly communicate life changes, and review a provider directory if they want to change their primary care provider.
Integrate with legacy systems
The ability to include data from a variety of payer legacy systems is simplified with the integration capabilities of Health Cloud. Gathering information from systems such as membership, claims, or utilization management to support the features described above greatly enhances the capabilities of all payer team members. Extending Health Cloud’s capabilities with add-on tools, such as clinical guideline applications offered by popular vendors, also creates more value for payers.
Silverline can help you make the move
Silverline focuses on one thing: helping our payer clients create value with the Salesforce Health Cloud platform. Whether a payer currently uses Salesforce’s suite of products, or is new to Health Cloud, Silverline can assist you with determining the best way to leverage these powerful tools to create valuable new features and functionality that have been unimaginable in the past.
We’ve boiled down the upgrade options into three simple paths to success, depending on each organization’s unique situation. Many existing Salesforce Sales and Service Cloud instances don’t have extensive customizations or technical debt. In those cases, upgrading to Health Cloud in the current org frequently provides the fastest path with little to no disruption for existing users.
Walk through the infographic and let us know which path your organization fits. If you cannot easily answer these questions or you are unsure, reach out below! We’ll help to evaluate your current org to determine the best approach for your situation.
