Medicare Plan Company Transforms Healthcare Management
Company Type: Medicare Plans and Preventative Care
Industry: Healthcare / Life Sciences
Sub-Industry: Payer / Provider
Products Purchased: Salesforce Health Cloud, Salesforce Marketing Cloud, Data Cloud, Unified Health Scoring, Integration
Introduction:
A Medicare Plan Company (MPC) creates products specifically tailored to those living in Long Term Care, Assisted Living, and Memory Care facilities. Their goal is to provide members with high quality benefits, care and comfort.
Challenges Addressed:
MPC worked with CopperHill to address challenges spanning intake, compliance, automation, and data management.
One key area in which they are actively working to enhance is the management of new leads and members. CopperHill’s work with MPC has lead to an overall smoother enrollment experience for members. MPC also recognizes the importance of data integrity and is actively exploring ways to improve their data management practices, aiming to provide more real-time accessibility in the future.
Managing permissions to contact members while ensuring regulatory compliance posed a complex and necessary task for MPC. The qualification process for insurance plans demanded extensive manual effort and specialized expertise, adding to the operational challenges. With the help of CopperHill MPC no longer needs to exert manual effort on their qualification process, as it is now fully automated. The organization also faced difficulties in accurately tracking and documenting sales interactions, impacting comprehensive customer relationship management.
HIPAA compliance requirements further accentuated the need for data protection and management solutions. MPC’s reliance on fax communications for information exchange in healthcare introduced obstacles in terms of speed and accuracy, thus impeding communication.
A significant challenge involved managing patient relationships and related individuals’ information. The organization struggled with unifying systems and data across various facilities, operating in isolated silos. Additionally, its appointment scheduling process was inefficient and time-consuming.
Solutions Implemented:
- Intake Process and Permissions: The MPC data lake is housing resident data from all MPC facilities- each with their own EHR instance. CopperHill worked with MPC on an integration that pulls that resident data into Salesforce, and pushes details back to the data lake including completed application information.
- Qualification Automation: Automation based on Medicare eligibility criteria enabled automated lead creation, simplifying the sales process and reducing manual efforts.
- Scope of Appointment Compliance: A dedicated scope of appointment object and a user-friendly documentation button improved compliance with regulations and provided a centralized repository.
- Application Automation: MPC automated the insurance application process, using FormTitan for form creation and data synchronization within Salesforce.
- Fax Solution Integration: Integration with Concord Cloud Fax improved communication by automating data extraction from HIPAA-compliant faxes using Artificial Intelligence (AI) and Optical Character Recognition (OCR) capabilities.
- Health Cloud Functionality: The use of patient cards and timelines in Health Cloud enabled easy access to patient information, conditions, and allergies, for data visualization.
- Appointment Scheduling: Salesforce Scheduler improved appointment scheduling by automating assignments, by considering various criteria like appointment type and facility selection.
- Marketing Cloud Integration: A Marketing Cloud landing page housed permissions to contact, while personalized journeys improved communication and education through tailored emails.
Future Considerations:
In a future phase 2, MPC is ready to continue upgrading their operational landscape. They plan to explore an integration with Salesforce and the Centers for Medicare & Medicaid Services (CMS), for an easier client experience around the application submission process.
MPC aims to bolster data management practices by standardizing patient information and related fields. This initiative is pivotal in ensuring reliable insights and informed decision-making.
Additionally, MPC is considering the adoption of Salesforce’s Unified Health Scoring (UHS), powered by Data Cloud, to elevate data quality, providing comprehensive insights into patient health for more tailored and effective care strategies.
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