Salesforce Solutions: How Salesforce Can Help Healthcare Providers

Jenna Trott

5 min read | MARCH 10, 2023

You know the feeling well, it begins with a tickle at the base of your throat before evolving into the type of cough that rattles around helplessly in your chest, accompanied by body aches, chills and a raging fever. You’ll likely close your eyes and silently will your sickness to go away while hoping it doesn’t progress into something more serious. Should your sickness result in needing a doctor’s visit or a trip to the hospital, the last thing you should be worrying about is if your insurance provider will accommodate and support your needs. Policyholders have come to anticipate being treated with respect and empathy by knowledgeable professionals who understand their unique healthcare needs. They want their questions answered promptly and their concerns addressed thoroughly, without having to navigate through a complicated web of phone menus or automated responses – particularly when feeling unwell. They expect their medical insurance provider to be transparent about costs and coverage, so they can make informed decisions about their healthcare. Bottomline? Customers want to feel supported and cared for by their provider, knowing that they have a trusted partner in their journey to better health. However, there exists a number of challenges for insurance agencies in 2023, and healthcare agencies are not immune. In addition to rising healthcare costs and surging premiums, agencies must also keep up with changing customer expectations, particularly around convenience, transparency, and personalized service. This requires agencies to invest in new technologies and platforms, as well as reimagining their service delivery models to meet these evolving needs. Adding to these challenges are the pressures of federal and state regulations governing the industry. Navigating this complex regulatory environment requires agencies to devote significant time and resources to compliance, which can be a significant burden. So without further ado, let’s get into how Salesforce can transform quality of service and kickstart efficiency within healthcare organizations.
Centralized Data Management

The average hospital utilizes over 10 disparate Electronic Health Record (EHR) systems. Salesforce is a powerful platform that can help health insurance agencies connect siloed systems and gain a more centralized view of their data. By integrating disparate systems and applications, Salesforce connects every piece of info into a single, secure platform. This integration process is made simpler with tools like Mulesoft Accelerator for Healthcare, which greatly eases the burden on healthcare IT teams. By consolidating all patient data into one cohesive platform, healthcare providers can work more effectively and make more informed decisions, ultimately enabling them to spend more time delivering the highest quality patient care.

Simplified Billing and Claims Processes

The billing and claims process is laborious for health insurance agencies for several reasons with one of the primary being the inherent complexity of the healthcare industry, which involves a multitude of different stakeholders, regulations, and procedures. This complexity leads to a variety of manual tasks that must be completed, such as eligibility verification, claim submission, and payment processing. These tasks are time-consuming and require a great deal of attention to detail, leading to a high potential for errors and delays. Simply by combining siloed systems, this eliminates further inefficiencies and delays, but automation tools offered by Salesforce can further simplify what is a normally tedious process. By automating tasks involved in these processes, like eligibility verification, claims submission, and payment processing, it helps improve the speed and accuracy of the entire billing and claims cycle. Salesforce can also provide real-time visibility into the status of claims, enabling health insurance agencies to quickly identify and resolve any issues that may arise.

Transformed Call-Centers

On any given day, health insurance agencies are tasked with handling a large volume of customer inquiries related to billing, claims, coverage, and other healthcare-related matters. This can make it difficult for agents to keep up with the volume of calls while maintaining quality customer service and ultimately lead to a variety of issues, including: long wait times, dropped calls, and unresolved customer issues. As a result, many agencies are turning to technology solutions like Salesforce to help streamline their call center operations and improve the overall customer experience. Salesforce can offer:

  • A centralized platform for managing customer interactions that enables call center agents to access relevant information at critical points during an interaction
  • Automating routine tasks like call routing and customer data retrieval to free up call center agents’ time to focus on more complex interactions
  • Robust reporting and analytics capabilities makes tracking key metrics like call volumes, wait times, and customer satisfaction scores easy
  • Intelligent insights into customer behavior and preferences enables agents to make more informed recommendations and suggestions during calls

All of this helps to reduce call handling times, improve customer satisfaction, and ultimately, reduce costs.

See also: How Access Global Group worked with Anthem to remedy their current system and help revamp their customer support.

100% Transparency

Transparency is a key factor in building trust and loyalty with policyholders, but for health insurance agencies, it can be a struggle to achieve. As we’ve touched upon, the healthcare industry is notoriously complex, with a maze of regulations and legal requirements that can make it difficult to communicate policy information effectively. With Salesforce, health insurance agencies can revolutionize the way they interact with policyholders and provide them with the transparency they’ve come to expect. By leveraging Salesforce’s powerful data management and analytics capabilities, insurance agencies can offer real-time access to policy details, claims history, and billing information, helping to eliminate confusion and provide a clear and transparent view of their coverage. Moreover, Salesforce provides powerful tools for tracking customer feedback and sentiment, allowing insurance agencies to proactively address concerns before they become critical issues, further supplementing the policyholder experience.

Return on Investment

In the current economic climate, businesses are understandably cautious about their investments, and IT is no exception. However, companies are not completely eliminating this process but are instead shifting their focus to ROI and cost management. Salesforce can help health insurance companies achieve these objectives by offering a range of tools that optimize their operations that aid in cost reduction. With Salesforce’s automation and streamlining capabilities, health insurance companies can reduce manual errors, eliminate redundancies, and improve operational efficiency, leading to significant cost savings. Furthermore, Salesforce’s data management and analytics capabilities allow health insurance companies to identify areas of inefficiency and make data-driven decisions that further reduce costs. With Salesforce’s customer relationship management tools, it enables health insurance companies to personalize interactions with customers, enhancing customer satisfaction and retention, which ultimately leads to increased revenue. By investing in Salesforce, health insurance companies can effectively save money, reduce costs, and improve their bottom line while still investing in IT.

Unique Challenges for Medicare Advantage

As of 2021, approximately 18.4 percent of the U.S. population was covered by Medicare, and trends project that number will continue to increase in the coming years. Medicare is a Value-based healthcare model that focuses on delivering high-quality care to patients while reducing costs. Instead of paying for each service provided to a patient, value-based care incentivizes healthcare providers to achieve better patient outcomes by linking payment to the quality of care provided. Under the value-based care model, healthcare providers are rewarded for achieving positive patient outcomes, such as improved health and reduced hospital readmissions. This encourages providers to focus on preventive care, early intervention, and care coordination to keep patients healthy and out of the hospital.

However, the value-based care model demands that a patient’s entire medical team must be connected and have access to the most detailed and up-to-date information on an individual’s condition. This involves proactively engaging with patients, providing timely, personalized care, and extending the boundaries of traditional healthcare visits. The issue is further complicated by the limitations of electronic health record (EHR) systems, which only recently began to facilitate sharing patient data between doctors, insurance companies, and specialists. The result is that many healthcare organizations are struggling to provide comprehensive, coordinated support to their patients due to a lack of resources and time. Salesforce offers significant advantages for value-based healthcare models such as Medicare, as it empowers healthcare providers to manage patient data, monitor outcomes, and enhance care coordination. With its advanced data management and analytics capabilities, Salesforce can help providers identify high-risk patients and devise targeted care plans to enhance health outcomes and reduce costs. Providers can also leverage Salesforce to monitor patient progress and outcomes over time, gaining insights to make informed decisions about care delivery and resource allocation. Additionally, Salesforce’s collaborative tools and mobile applications enable providers to streamline care across different settings and ensure timely and appropriate care delivery.

Ready to get started?

These days, leveraging technology like Salesforce is crucial for companies to stay ahead and meet the evolving demands of their clients. With a wide range of features and benefits like, seamless integration with other systems, customizable dashboards and reports, and automated workflows, Salesforce has become an indispensable tool among insurance agencies. Access Global Group’s team of certified experts know Salesforce inside and out. This means that when they come to you, no stone is left unturned and they’re able to solve any conflict with agility and accuracy. Regardless of where you are in the digital transformation journey, Access Global Group will provide customized solutions that align with your goals so you can focus on not only reaching them, but going far beyond what you thought was possible. Our unique project methodology of customer centricity allows us to provide intuitive solutions that are acutely catered to your organization’s needs. And as your premier Summit Salesforce Partners and Consulting Services/Managed Services experts with over 15 years in the industry, we’ll use our technical expertise to meet your unique needs and generate real change within your organization.
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