Introduction
In recent times, the healthcare sector has faced an array of challenges, from escalating costs to physical obstacles like curfews and transportation closures, along with issues like medical device shortages and telehealth setbacks. Amidst this evolving landscape, the demand for patient-centric healthcare has emerged as a new reality, with patients seeking value-based and personalized care. In this context, data stands out as critical differentiator, holding the potential to transform the healthcare experience. This blog delves into how Salesforce Health Industry Cloud efficiently manages data, consolidating it into a single system to offer a comprehensive 360-degree view of the patient. It explores how various healthcare stakeholders, including Providers, Payers, Pharmacies, and MedTech companies, can leverage this holistic perspective of patient health anytime and anywhere to enhance the delivery of healthcare services.

Salesforce Health Cloud Overview
In 2015, Salesforce introduced Health Cloud, a comprehensive solution designed to address the unique challenges faced by the healthcare industry. Health Cloud offers a robust data model that facilitates seamless access to critical information for various stakeholders, including doctors, healthcare coordinators, patients, and specialists, across any device and in real-time. This digital healthcare platform integrates healthcare data models to foster connections among patients, providers, payers, MedTech companies, and pharmaceutical companies.

One of its key benefits is the provision of personalized and guided experiences for patients, improving treatment accuracy through telemedicine. It empowers healthcare providers to access comprehensive patient health histories from electronic health records (EHR) and wearable devices, enabling informed decision-making. Salesforce Health Cloud is fully compliant with the Health Insurance Portability and Accountability Act (HIPAA), aligns with Fast Healthcare Interoperability Resources (FHIR) R4 standards, and supports HL7 v2 standards.

Built on the Salesforce platform, Health Cloud leverages a range of platform capabilities, extending its functionality beyond the healthcare industry. It seamlessly integrates with Sales Cloud, Service Cloud, and Experience Cloud, ensuring full access to foundational capabilities across Salesforce’s suite of services.

Fig 1: Salesforce Health Cloud Ecosystem

“Exploring Patient-Centered Care Feature with the following Narration“

· Shankar is a patient who goes to St John Hospital for a check-up.

· Ria is Shankar’s wife.

·  St John Hospital is the provider.

· Francis Health Insurance offers a wide range of healthcare products to employers, individuals, and families.

· Azipharma is a Pharma company which launches medical devices by participating in care programs.

· Calpol MedTech is a company that manufactures and sells cardiac pacemakers to providers, clinics, and surgical centers.

· Arthur is the care coordinator at St John Hospital.

· Dr. Bass is Ortho surgeon at St John Hospital who is the provider.

· Dr. Arnold is Physician at St John Hospital who is a provider.

· Katy is the chief medical officer at St John Hospital.

· Evan is a medical representative at Calpol MedTech company.

To build a unified healthcare platform that will accomplish the above narration, St John Hospital has purchased Salesforce Health cloud license, which has Insurance data model, Provider Network Management, Utilization Management, Intelligent sales, console view, contact tracing, care plan.

· Azipharma company will conduct care programs only for St John hospital patients.

·  Francis Health Insurance company stores and manages members and healthcare plans related to St John Hospital patients.

·  Calpol MedTech schedules visits, checks Realtime inventory, and can initiate location-based transfer request using the products specific to St John Hospital. There is dedicated inventory for St John Hospital to check real time inventory status.

Fig 2: Patient Provider and Payer relationship diagram

Health Cloud Console:

While on an adventurous trip, Shankar experienced dizziness, leading him to seek medical attention at St. John Hospital. Upon his arrival, the care coordinator, Arthur, logged into the Health Cloud Console. There, he swiftly accessed Shankar’s comprehensive patient information on the patient 360 page. This page contained crucial details, including Shankar’s birthdate, gender, clinic visit history, care plans, previous medical issues, existing health conditions, treatment history, and prescribed medications – all conveniently consolidated in one place.

Thanks to this centralized patient data, Shankar did not have to give his old medical records. Consequently, the initial diagnosis of his ailment was expedited, enabling Arthur to promptly direct Shankar to specialized care. In Salesforce, patient accounts can be configured as personal accounts, specifically tailored to store information related to individuals.

Care Plan:

Arthur learns that Shankar has diabetes and selects the diabetic care plan template for him, which comes prepopulated with problem goals and tasks. This streamlined approach allows Arthur to promptly address Shankar’s healthcare needs. For Shankar, Arthur establishes a goal to reduce sodium intake by 50% and assigns tasks such as adhering to a low-sodium diet and engaging in daily walks. Within the care team, Arthur includes Ria in the role of caregiver and designates Dr. Arnold as the Primary Care Physician. Ria diligently monitors Shankar’s daily activities and reports the progress of the care plan goals to Dr. Arnold. When all the assigned tasks for Shankar are completed, Dr. Arnold updates the goal’s status as completed. Furthermore, the doctor can continuously track the patient’s health progress, and if necessary, adjust the care plan goals to address any evolving healthcare needs, ensuring a comprehensive and adaptable approach to Shankar’s well-being.

Social Determinants:

Shankar complains to Arthur, stating that he cannot attend regular hospital check-ups due to a lack of transportation. Patients may encounter challenges related to their physical environment and socio-economic status, both of which can significantly influence their overall health. To overcome these obstacles, care coordinators like Arthur can intervene by organizing transportation for Shankar, thereby mitigating potential health setbacks.

Patient Timeline:

In Health Cloud, every patient record has a timeline view, showing healthcare events and activities in chronological order. Arthur can filter the timeline related to Shankar’s appointments, how many he could attend, and how many he missed appointments, Arthur can view messages from medical practitioners, forms sent to the patient, diagnosed conditions, medical procedures, and other electronic health records. This feature helps Arthur to track individual patients’ healthcare events.

Provider Network Management:

Dr. Arnold, upon his initial enrollment at St. John Hospital, registered on the provider portal, completed the application form, and finished the credentialing stage. In Salesforce Health Cloud, Provider Network Management is seamlessly integrated, offering an efficient and user-friendly solution to streamline the onboarding, administration, and coordination of healthcare providers.

Provider Search:

Ria experienced a ligament tear in her ankle. She contacted Francis Health Insurance company, where a contact center agent utilized Salesforce Health Cloud to search for doctors. They input specific details such as specialization, visiting hours, available days, and facilities provided by doctors. As a result of this search, they retrieved Dr. Bass’s record and provided information regarding the benefits of existing healthcare plans. Dr. Bass is an orthopedic surgeon affiliated with St. John’s Hospital. The utilization of the provider search component sped up locating available doctors and connecting patients with appropriate specialization.

Utilization Management (UM):

UM aims to review and streamline the steps to provide timely and appropriate care. The UM data model supports various requests and appeals. For example, when Ria complains about ankle pain, Dr. Bass creates a care request for additional physio sessions and submits it to Francis Health Insurance Company, after a review, Francis Health Insurance clinicians approves the prior authorization request. Now Ria got additional coverage and gets extra physio sessions. The UM provided faster approval of requests submitted by providers, without too many BACK-AND-FORTH communications between provider and payers. This helped in providing right care at right time for patients.

Intelligent Form Reader:

At Francis Health Insurance Company, administrators receive a fax from Dr. Bass concerning the need for additional physiotherapy sessions for Ria. The administrator uploads the document, and an Intelligent Form Reader automatically extracts data from the document. As a result, a care request is submitted without the need for manual intervention. This care request can be subsequently submitted for approval either by a nurse or a doctor. The Intelligent Form Reader employs OCR (Optical Character Recognition) technology to seamlessly extract information from the document using Amazon Textract in Salesforce.

Commercial Sales:

Shankar receives an email regarding the medical care plans provided by Francis Health Insurance. A virtual appointment arranged with broker to further discuss Shankar’s preferences. During the appointment, they take into consideration Shankar’s medical conditions and medication requirements to determine the most suitable plan. Shankar gives his confirmation to the provided quote, electronically signs the application, and successfully enrolls in the selected plan. This feature ensures that patient receives automated notifications about healthcare plans, making it effortless for them to access these benefits through straightforward steps.

Care Program:

Shankar’s interest in learning more about glucose monitor devices led him to enroll in the diabetes care program sponsored by Azipharma company. As part of this program, the pharmaceutical company introduces a new blood glucose monitor device along with a medication called Metformin. By utilizing care programs, pharmaceutical companies engage patients at an early stage in clinical trials, enhance treatment adherence, and speed up bringing new treatments to patients preventing any major illness later. Prior to enrolling Shankar in the care program, he provides a digital signature and consents to participate in the program.

MedTech:

Katy, who serves as the Chief Medical Officer at St. John Hospital, takes the responsibility of overseeing surgical device inventory. She meticulously ensures their quality and cost-effectiveness. Evan, a medical representative representing Calpol MedTech, specializes in selling medical devices to various healthcare providers and facilities. During his meeting with Katy, he introduces a new model of a cardiac pacemaker.

Intelligent Sales:

Evan utilizes the Health Cloud Intelligent Sales app to efficiently schedule visits and oversee inventory management. Within this app, the Product Shortfall Projection component plays a crucial role in pinpointing potential inventory shortages and assessing associated revenue risks.

Location-based Transfer Request:

To prevent potential sales losses, Evan initiates a request to transfer inventory from a neighboring sales representative. This initiative-taking step helps ensure that they can meet demand and avoid missed sales opportunities. How St John Hospital will interact with other MedTech inventory.

Business Benefits of Health Cloud

Key Benefits of Health Cloud to Biotech/Pharma Companies

· Patient-Centric approach: Centralized patient information, including their medication history and prescribed medicines, within a single system enables pharmaceutical companies to lower their operational costs and deliver precise care to patients.

· Care Coordination: Care programs are instrumental in enabling pharmaceutical companies to educate specific patient groups about medications or vaccinations, thereby promoting informed healthcare decisions.

·  Clinical trial management: Pharma and Biotech companies can use health cloud to manage and track clinical trials.

Key Benefits of Health Cloud to MedTech Companies

· Increase Productivity: MedTech companies have experienced boosted sales thanks to the intelligent sales features within Health Cloud. These features provide real-time inventory insights and empower sales representatives to request inventory transfers based on availability in the nearest stock location.

· Scalability: Health cloud can grow with MedTech companies, accommodating their evolving needs as they expand their product line and customer base.

· Sales and Marketing Automation: Streamline sales and marketing efforts with automation tools, helping MedTech companies identify and target the right customer and track sales performance.

Key Benefits of Health Cloud to Providers

· 360-degree view: The console view within Health Cloud offers a comprehensive 360-degree perspective of patient data, encompassing patient demographics, medical history, care plans, household information, medication records, claims, diagnoses, and immunization history, all conveniently accessible on a single page.

· Patient engagement: Personalized healthcare for patients involves addressing their specific health issues. Providers can create tailored care plans, set individualized goals, and enroll patients in specialized care programs to ensure targeted and effective treatment.

· Population Health Management: The contact tracing feature enables healthcare providers to track diseases spread, gather patient data through surveys identify contacts of infected individuals, enroll them in care programs, and monitor their health closely.

· Targeted Intervention: To overcome social barriers faced by patients, it is essential to provide the right services tailored to their unique needs.

Conclusion

Salesforce Health Industry Cloud equips the healthcare industry with powerful tools and accelerators, fostering a shift towards personalized and patient-centric healthcare. This platform has revolutionized data management and real-time connectivity among all stakeholders, ensuring a seamless experience. Looking ahead of the future trajectory of Salesforce Health Cloud it will be marked by AI-driven solutions, poised to propel the healthcare sector into another era of innovation. This transformation will enable more effective healthcare management, redirecting the focus from mere medical record-keeping to nurturing meaningful and insightful patient engagement bringing AI, data, and customer experience together.

References

https://www.techtarget.com/searchcustomerexperience/news/252449394/Salesforce-Health-Cloud-roadmap-boasts-payer-tools-CX-AI