Provider Network Management with Salesforce

Solving the Use Case

Overview

Salesforce Health Cloud empowers payers to grow provider networks in order to broaden access to care and offer more services to its members.

Because these implementations will include member data, we recommend implementing Salesforce Health Cloud. Its out-of-the-box object model is more suited for the structural – and compliance requirements – of healthcare data.

First of all, we define the personas, permissions, and roles in Health Cloud. These roles are created so that each job function has access to the data, workflows, and custom layouts they require. The basic profiles and roles include:

• Executive
• Sales Management
• Provider Representatives

Physician Network Data Model

Our Health Cloud configuration relies on a combination of standard and custom objects representing relationships, insurance policies, contracts, credentials, physical locations, specialities, and physicians.

The most basic object model looks like this:

• Provider
  The provider object is based on the standard "account" object and represents a hospital, clinic, or healthcare group. Account-to-account and account-to-contact relationships facilitate connections between clinical and non-clinical organizations. In the case of multi-site providers, hierarchies can be built using parent/child relationships. Additionally, we ensure that practitioners can be easily associated with provider groups. This object’s fields can store various details such as location, specialties, number of beds, facility class, operating hours, patient ratings, and more.
• Contract Object
  The contract object is end-to-end lifecycle manager that ensures contract details are accessible in one place. This means that payers and providers are held accountable to the payment models, care outcomes, and service level commitments they agreed to. The object is usually customized based on a variety of provider relationship types, like participating providers and non-participating providers. Additionally, they're flexible enough to accommodate a variety of payment types, like percentile-, fee-for-service, and category-based payments. The contract object is usually built with the help of a third-party integration, like Titan Forms. Titan Forms is built into a customized workflow that represents the contract lifecycle, from initialization to signature.
• Credentials
  The credential object is designed to store certifications and licenses that demonstrates a provider meets the standards needed to treat a payer network's members. Fields on this object store data related to physician speciality, education, medical history, board certifications, and malpractice insurance coverage.

The connections between providers, contracts, and credentials in the Health Cloud platform empowers payers to establish relationships with the right healthcare organizations. We build the following features to solve the provider network management use case:

• Enhanced provider discovery with integrated NPPES search
• Engaging, omni-channel marketing campaigns that target the right providers
• Workflows that digitize the credentialing and application processes and minimize manual data entry with NPPES integration for validation
• Automations that quicken the contracting process through contract creation, redlining, and signatures
• Lifecycles that guide staff through provider onboarding processes
• Real-time dashboards that track performance by account, physician, and campaign

These features allow payers to build, grow, and retain the provider networks that will give its members better access to care.