Analyzing Member Populations

Member segmentation is critical to any personalized engagement strategy. However, payers usually come across two major challenges when trying to segment members. First, they must gather data from a variety of disparate sources in order to create member profiles. Second, they need a platform that can then define unique populations based on a set of demographic, clinical, and risk-based criteria.

In this use case, we'll demonstrate how payers can segment member populations with Salesforce.


Segmenting member populations with demographic, firmographic, and claims data


A customer data platform (CDP) to unify data across disparate platforms into member profiles


Defined populations that empower personalized member journeys

Solving the Use Case


By executing member segmentation based on criteria like claims data, demographics, qualifying life events, social determinants, and clinical history, payers can develop communication strategies that lower service costs, prevent lapses in care, and encourage member renewals. This approach not only improves engagement, but also improves overall member satisfaction.

Current Gaps

Despite the numerous benefits, effective member segmentation has often eluded payers. One of the main obstacles is the availability of connected data. For instance, marketers or member communications teams don't always have real-time access to claims data, coverage dates, or life events, meaning they cannot promptly trigger appropriate member journeys.

Inaccurate, incomplete, or out-of-date data leads to ineffective member segmentation, ultimately impacting how well members can leverage their benefits. Moreover, privacy concerns surrounding the use and sharing of personal health information can also pose significant issues.

Additionally, data sources digital marketers have traditionally relied on, such as cookies and third-party data, are rapidly changing. As a result, effective segmentation in the future will depend on first-party data.


As first-party data becomes more important, more and more payers are using Customer Data Platforms (CDP) like Salesforce Data Cloud to solve the segmentation use case. By creating integrations via Mulesoft, Salesforce Data Cloud intakes data from a variety of platforms, including claims databases, EHRs, and marketing automation tools. This information can then be used to create unique, data-rich member profiles. Members can be grouped into a number of distinct populations based on age, social determinants, employer groups, or any other criteria stored in the database.

Consequently, they are able to analyze member populations according to a range of clinical and non-clinical attributes, enabling precise targeting of specific groups.

By harnessing the power of a CDP like Salesforce Data Cloud, healthcare payers can enhance their ability to segment with accuracy and efficiency.

Defined Popluations

Personalized Member Journeys

Engaged Members

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