Check out this trailer to learn about a brand new healthcare podcast from Salesforce created exclusively for health plans launching this Fall! 

The Payor Principle Podcast Trailer

Trailer

Dr. Sindhu Pandit: Among our Medicaid population we're seeing changes in employment, and maybe some challenges with affordability. So this is a widespread issue, and really we have a huge opportunity, especially payors, to engage their members in a way that's preventative, and also perhaps proactive, to meet them where they are and offer support: virtual care, for example; or grief counseling services; behavioral therapy.Ciji Adams: That was Dr. Sindhu Pandit, clinical advisor at Salesforce, discussing the importance of payors proactively engaging high-risk member populations during the COVID-19 pandemic. That's just one of the insightful interviews you'll hear on The Payor Principle, a new eight-part limited series podcast from Salesforce. I'm Ciji Adams, payor lead for healthcare and life sciences industry marketing at Salesforce. And we're here to help you understand how technology can move your business forward and thrive during, and after the pandemic. From creating digital engagement strategies to reach members wherever they are...Kevin Riley: Health plans need to be a little bit more proactive for the digital environment of reminding people with small, simple, actionable steps. Not telling them what they should go do, but reminding them," Here is a thing that you could do. Click here and take action against it."Ciji Adams: ...To leveraging predictive data insights to improve health outcomes.Dr. Barry Chaiken: And what you need is you need to have, in your organization, a level of data literacy that people understand what data analytics and dashboards and visualizations mean. You need to have a culture of data, so that people understand and accept data as being something that they should rely on to make their decisions.Ciji Adams: And identifying how to safely reopen your business.Djuro Stojsavljevic: When we consider reopening, we have to plan and orchestrate at how to bring them back. And that's that command center piece, right? You have to kind of put that orchestration together. And by putting in place that planning the logistics communications, you can then resume operations, while at the same time making sure you're protecting employees.Ciji Adams: We've got the insights you won't want to miss. Hear from industry leaders, inside and outside of Salesforce, who are taking a digital-first approach to the top issues facing health insurance today. So subscribe now on your favorite podcast app. And join me for our first episode, launching this month in September. Happy listening!

Interview with Sean Kennedy, a public sector health, go-to-market lead, and senior interoperability architect at Salesforce. Sean brings over 25 years of health IT experience, talks about interoperability and integrating data and technologies when it comes to safety, care coordination, and public health. He also covers new interoperability legislation for electronic health data and ways to ensure your systems are up to date and compliant.

Sean Kennedy

Public Sector Health Go-to-Market Lead & Senior Interoperability Architect at Salesforce

 Drive Interoperable Systems and Data Integration with a Unified Platform

Interoperability enables a more effective healthcare system

CMS and ONC interoperability rules for health plans 

Current state of interoperability for health plans

CG Adams: Hello, everyone, and welcome to The Payer Principle, a Salesforce healthcare podcast created exclusively for payers. I'm your host, CG Adams. On the show you'll hear insights from healthcare industry experts and trailblazer organizations on all things payer, such as trends, business challenges, and the latest technological solutions. Today's episode focuses on interoperability and the importance of integrating data, systems and technologies. I'm joined today by Sean Kennedy. Sean is currently a Public Sector Health Go- To- Market Lead and Senior Interoperability Architect at Salesforce and has over 25 years of health IT experience. Sean, welcome to the show, it's great to have you on today.Sean Kennedy: Thanks, CG, happy to be here.CG Adams: So let's start with the basics. How would you define interoperability?Sean Kennedy: Interoperability is essentially the extent to which systems can share data and interpret that shared data. Whether within or between organizations, it's all integration. You need to establish the pathway for data to flow, that pathway, however, has interoperable qualities, best categorized by HIMMS as foundational, structural, semantic and organizational. So examples would be being able to share data from a PCP to a specialist, or a hospital to a skilled nursing facility, to coordinate a referral or a discharge, as examples.CG Adams: And what exactly is the current state of interoperability today?Sean Kennedy: Well, honestly CG, it could be better. It's been a slow build for years. Data is nearly all digital for payers, providers, but sharing within and between organizations is really proven challenging, resulting in a number of challenges, right? Fragmented patient, member experiences, we've got delayed digital transformation, in large part due to the incompatibility of legacy and modern systems, and we've got a growing inventory of costly point to point, hard to maintain integrations. Now, the good news is that 21st Century Cures Act, in its use of APIs without special effort requirement, are now in effect through the new interoperability rules, which means organizations will increasingly feel the pressure to meet rural requirement deadlines to share their digital data. The other item that's driving, if you will, the status quo, is COVID. If there is any silver lining to COVID- 19, it is that it is speeding healthcare's digital transformation. Telehealth technologies have seen unprecedented growth. The need for data has never been more critical. Heck even the public health system is getting their well- earned attention and seeing a much needed upgrade. Central to all of this is the sharing of data. And HIEs, they can play a really important role here given they frequently sit at the intersection of all these organizations. So with COVID, with the new rules, we have a need to more easily and quickly share data and our requirement to do so. So the conditions to springboard the current state of interoperability are here.CG Adams: So now that you've defined interoperability for us, why do you feel like it's so critical to the healthcare industry in particular?Sean Kennedy: Well, most importantly, it's a safety thing. Without visibility to your medical history, to your allergies, your meds, your current conditions, doctors are flying blind. Second, it improves care coordination and experiences of patients. Think about how often you need to restate your history verbally to your care team. One other item that is certainly relevant during our pandemic is the need for more accurate public health data. Public health professionals need that data quickly to better understand the scope of the problem and tracers need contact information that is frequently missing from reimported lab results. Bottom line, interoperability promotes a safer, more real- time and less burdensome healthcare system.CG Adams: So how has Salesforce, a company better known for CRM software, involved with healthcare interoperability? What is our contribution? Our approach?Sean Kennedy: Sure. So frequently Salesforce is used to extend the value of an EHR or a claim system or other source or destination system. As such, we see all sorts of integrations from batch files to real- time calls, from API based queries to event driven push messages, from restful exchanges to presentation layer integrations. In any case, it is vitally important to first define the business need, to define the use case. That use case, whether to load patient data, to schedule an appointment or outreach around gaps in care, must be defined to understand the data needed, the source systems at play and the directionality and timing of the data. Once you define the use case, you can identify the integration layers. What is the security handshake? Is this a data or process or application layer integration? After the type of integration needed is established, you then select the integration approach. Use a middleware or not, query response or event- based as examples. Finally, after you have defined the integration pathway, you select the implementation approach. Do it in- house or contract externally. And we offer a range of capabilities to enable integration, from our multi- layer integration support to a range of data models. Provider, clinical, financial care plan, in which you can persist or virtualize your data through a myriad of APIs, which we've been maturing since we first launched them 20 years ago, to our integration orchestration capabilities that enable end-to- end connectivity.CG Adams: Sean, I want to double- click into a concept, an acronym that you had in your last response there around APIs or application programming interfaces, which have been instrumental in revolutionizing healthcare. How is the payer market evolving to adopt these APIs to drive more interoperable systems?Sean Kennedy: Right. Well, healthcare has been on this API trajectory for a while now. FHIR has been gaining momentum, now culminating in being incorporated in the new rules. 21st Century Cures Act launched the government's interest in the use of APIs and the rules implementing the Cures Act cemented them in March of this year. And along the way, standards groups have emerged like the Da Vinci project to better describe uses of FHIR in the payer space, for use cases such as eligibility and benefit response or coverage requirements discovery, for prior authorization, for provider directory query and update, for check claim status, et cetera. With the rules now in effect, payers are working hard in the midst of a pandemic, I may add, to meet rule requirements. And we, as a provider of tech services to our payer customers, are working hard to provide the capability necessary to hasten digital transformation efforts.CG Adams: That's such a critical point to make, in that basically the interoperability rules that you referenced that are coming from the centers for Medicare and Medicaid services, are really accelerating more adoption around API uptake and interoperability within the healthcare ecosystem.Sean Kennedy: Yeah, absolutely. For people in the integration space and people that really have a love for APIs, it's a welcome change for sure, but it comes with much work ahead.CG Adams: So, Sean, I know that you work really, really closely with a ton of payer organizations. I'd love to dive a little bit deeper into some of the examples of where you're seeing payers leverage APIs and other systems to drive more interoperable systems within their companies.Sean Kennedy: Yeah, absolutely. And, frankly, it's a bit of a mixed bag. API's in general are new to providers and payers. Providers have been moving FHIR for a while now, albeit with slow adoption, but unlocking EHRs has been a very big pain point for some time now. Payers are also moving toward API based exchange. As I mentioned, groups like the Da Vinci project are helping to make sense of the application of APIs among health plans. Their identifying priority use cases, defining the technical details that would bring them to life in a meaningful and more consistent manner. That said APIs are not wide use among plans right now. Many of the incumbent claims and eligibility systems are not enabled with APIs. So the big effort now is to develop a strategy to meet the rules that will require use of APIs among plans. Now that's not to say that APIs are not in use, they are. We see use largely for member service type exchanges, so surfacing member demographics to a call center agent, allowing them to quickly check the status of a claim, as examples. Some payers have provider directories, they can hit via API APIs. And APIs are also a bit more prevalent among payers with clinical systems, where FHIR APIs are in place enabling such use cases as medication reconciliation with members and generally surfacing member clinical data, like gaps in care for at- risk contracts.CG Adams: Sean, tell us about the new interoperability rule and how payers can take action to comply with CMS interoperability requirements.Sean Kennedy: I think it starts with getting to know the rules and I would do that quickly. Rules are in effect now. And the first major date is January 1st of next year, 2021, with an enforcement push to July for two APIs, patient access and provider directory APIs. So within a year from now, regulators will begin inspecting to see that payers have gone from limited use of APIs to then putting into place two APIs that will almost certainly see heavy traffic. That is not a lot of time. So, first, it's important to know that there are two rules, one from ONC and one from CMS, both of which implement provisions of the 21st Century Cures Act. And both intend to advance interoperability, give patients, members access to their data and attempt to make the healthcare system more accountable and price transparent. The big thing to know of the ONC rule is that FHIR R4, now a normative standard, is now the standard for patient population services for providers. And USCDI defines the minimum data set to be exchanged. For CMS, and specifically for payers, you have two APIs coming. Patient access API, where your members will be able to access their claims and counter and cost data via third party app, and the provider directory API that will allow discovery of your providers. USCDI also applies to you as part of the payer- to- payer data exchange, where you need to be able to send clinical data to another plan in the event a member chooses to switch plans, as an example. While this one is not required until April of 2022, many organizations are viewing these two APIs and the payer- payer exchange as really one project to tackle at an enterprise level.CG Adams: So you're seeing payers really look at addressing all three of these different requirements simultaneously?Sean Kennedy: Yes, absolutely. Because the time span is really July 21 is when the enforcement starts for the two APIs, in April of'22 is when payer- to- payer exchange happens. Given API APIs are likely to be used for all three, it really takes that longer view and couples of them as a project, at least what we've heard from some of our customers.CG Adams: Sean, let's wrap up the episode by talking about what do you think is on the horizon? What is the future state of interoperability?Sean Kennedy: Well, I think the big state that we're going to see is really this interoperability has always been a bit of a barrier to achieving that value- based healthcare system that we're looking to get to, other factors certainly there. As we start to cross over, and we now start to see interoperability within organizations and between organizations and, frankly, between providers and payers, and those barriers start to drop. Now, you're going to start to see that seamless, authorized access to information. You're going to start to see patients now have greater access to their data via these new consumer apps that likely will become available as the APIs get put into place. So you're going to see patients with their data, able to do things with their data and share it in ways that they find valuable to them. You're going to see a lot of the friction taken out of healthcare because data is more easily moved around, but ultimately I think these rules are a good thing. It's really helped the market, or will help the market, get to where it's struggled to get to, and allow us to do it now in a more consistent and timely manner.CG Adams: Sean, thank you so much for joining us today on the Payer Principle podcast and for all of your insights.Sean Kennedy: CG, thanks for having me. It was really a great effort.CG Adams: Listeners, if you want to learn more about our interoperability solutions, visit salesforce. com/ healthcare. I'm your host CG Adams. Thank you for listening.

Technology – and now, the pandemic – have accelerated consumer expectations across all industries. What does that mean for payors? Joe Pulice, a payor go-to-market lead with nearly 30 years of experience, including at Molina, United Healthcare, and Cigna, discusses how to transform the member experience by facilitating omnichannel engagement, sharing records in safe and specific ways, and tracking member preferences.

Joe Pulice

Payor Go-to-Market Leader at Salesforce

How to Create Member Experiences that Build Trust, Loyalty, and Retention

Transforming member experience in a nutshell 

COVID-19 has reinforced the need to deliver more valuable member experiences

Members are demanding a better experience from health plans

CG Adams: Hello, everyone. And welcome to the Payer Principle, a Salesforce Healthcare Podcast, created exclusively for payers. I'm your host, CG Adams. On the show you'll hear insights from healthcare industry experts in trailblazer organizations on all things payer, such as trends, business challenges, and the latest technological solutions. Today's episode focuses on member experience and how healthcare consumers are demanding a more connected and personalized experience from their health plans. I'm joined today by Joe Police. Joe is currently a payer go to market leader at Salesforce with nearly 30 years of experience in healthcare, having worked for a major payer, such as Molina, United, and Cigna. Joe, welcome to the show. It's so great to have you on today.Joe Police: Thank you CG. I'm honored to be here with you today and looking forward to the discussion.CG Adams: So let's go ahead and jump in. According to the Salesforce Connected Healthcare Consumer Report, 67% of consumers would switch or supplement health insurers after a bad experience. Why does member experience matter so much right now, Joe?Joe Police: Payers simply can't afford to ignore their experience any longer. And they know that. Member expectations have been changing with society's technology advancements. And the bar has been raised to a new level, given technology disruptions from other industries, such as fast food apps, driving apps, et cetera. Member's expectations are now the same for health insurance as they are for any other industry.CG Adams: So the consumerism of healthcare is really lending itself to consumers wanting more from their healthcare organizations. I want to dig into what are some of the latest trends around member experience. Can you tell us a little bit about those?Joe Police: Sure. Obviously the biggest trend is around virtual health, such as tele- health. And not only the expectation, but the need to meet and treat has changed drastically. So many see more value in telehealth services because of a greater convenience or affordability. Also, the advantage of relatively healthy patients staying out of the physical provider location, and therefore slowing the spread of the viral infections, like say the flu, or COVID. And that translates to a healthier population. Beyond tele- health, we're seeing providers looking heavily for support from AI analytics tools, such as Tableau. Healthcare insurers are beginning to focus on social determinants as a way to boost health care outcomes and reduce costs as well. Payers waving the out of pocket expenses for COVID- 19 are considering when and if to roll back how they handle COVID and how they do authorizations, et cetera. So they're looking at the entire spectrum of how they approached healthcare.CG Adams: Joe, how do these trends translate into strategies that payers implementing when it comes to delivering a better member experience?Joe Police: We see payers really wanting to transform the member experience. And we define transforming member experiences as significantly improving communication and data flow across consumer marketing, member sales, member service, care management, et cetera, to create a 360 degree view of the member. There's three areas that really affect transforming member experience. So the first one is, omni- channel engagement. And that is kind of the key funnel for this type of engagement. And the message needs to be the same across the channels. Is it the same across the channels? Is the information gathered fueling next best actions? Are the members preferences being tracked? Are they being respected? And are they being used even?CG Adams: And when you say member preferences, you're referring to how a member wants to be engaged by their health plan, correct?Joe Police: Exactly. So, there's a difference between, say the senior citizen that only likes to speak on the phone, versus say the young 20 something who can speak through their app. So how do they like to work to communicate? That is kind of what we're talking about. That translates into the digital engagement. So it's the use of the channels and real- time data to meet the member where they are, maybe say at the point of service. How do we get the information to them when they show up at the doctor's office, when they're in the ER, when they are at the pharmacy, whatever the case may be? And then the third would be interoperability, sharing EHR medical information in safe and specific ways. All this translates into an experience. Did we make them feel satisfied? Did we make them feel answered? Most importantly, did we make them feel valued? They'll remember those feelings. They won't necessarily remember what was said on the phone. It's a fully integrated system that makes that achievable.CG Adams: I want to unpack that third trend, interoperability. Earlier this year, the centers for Medicare and Medicaid services, CMS, announced a new interoperability rule that requires many types of insurers to provide electronic health data in a standard format by 2020. What effect do you feel that that rule and those new requirements are going to have on member experience?Joe Police: It's an incredible step in the right direction and for the future of healthcare. Things like member access to data via API, claims, and counters, formulary data, as well as clinical data exchange that will facilitate moving between providers for a more seamless experience, and streamlining, prior authorizations, medication reconciliation. All this stuff is a real net benefit to the member. However, it won't be a panacea as we in healthcare are so far behind other industries. And I think that for the future of healthcare, it's vital that we must get to a point where we have a better system of interoperability.CG Adams: I completely agree. I think that having more interoperable systems is going to be huge when we think about the impact to making member experience be more comprehensive, be more digitally sound, be less fragmented. So Joe, where do you see the industry going from where it's come from? We've come a pretty long way, don't you think, when it comes to member experience?Joe Police: Boy, have we. That's a great question, CG. I can remember, gosh, back in 1992, when I was a customer service rep at Cigna. And having a phone call from a senior citizen, who said," I just have a few claims that I'm just really having trouble with." And I said," Well, just send them to me." And this was in the early nineties, so you didn't have digital integration. It was just a phone call and mail. And so she sends me this shoe box full of claims that spanned like five years.CG Adams: Wow.Joe Police: Yeah. And so the first call resolution was not going to happen with that one. But you think about an experience like that, and it took me a month to get through all of her issues, but I did. And that was the way things were back then. Now, you have this modern experience of say tele- health, and you have a member in a tele- health engagement with their primary care physician, who provides a referral. And you could potentially have that referral authorized in the middle of that call. And multiple people going in multiple directions to wrap their arms around this member digitally. And I think that if you want to know where it's come from, it has come from shoe boxes full of claims to multiple people surrounding a member with care and getting them the care that they need. And I think that that's exciting.CG Adams: Well, I'm glad that you no longer have to worry about seniors sending in claims physically via shoe boxes. We definitely have made some huge strides as an industry when it comes to delivering a better member experience. We have some room to go, but I think both you and I are pretty optimistic about where we're headed. Finally, I want to hear your thoughts on COVID- 19 and how it's really changing the healthcare landscape. What are your thoughts?Joe Police: With the outbreak of COVID now, we have not just an opportunity, but a duty to bring the full capabilities and resources of the industry to take care of members and patients, not just manage their care by being consumed by KPIs and data. The focus is shifting to addressing social determinants, risks, availability of data, and ease of use of self- service, options that bring about a more cohesive experience.CG Adams: Joe, thank you so much for joining us today on the Payer Principle Podcast and for all of your insights.Joe Police: Oh gosh, thank you, CG. I really appreciate the opportunity.CG Adams: To learn more about our payer solutions, visit salesforce. com \ healthcare. I'm your host, CG Adams. Thank you for listening.

Medicare, Medicaid, and social determinants of health are hot topics right now. Dr. Sindhu Pandit, a practicing physical medicine and rehabilitation physician and clinical advisor at Salesforce, gives her perspective on how payors can help patients through physical and behavioral barriers to healthcare e.g. fear of healthcare facilities due to COVID-19. She dives into ways to tailor communications, promote digital literacy, and empower members to take control of their health.

Sindhu Pandit, MD

Global Clinical Lead at Salesforce

How to Serve Medicare and Medicaid Populations in the New Normal

Engaging Medicare populations during the COVID-19 crisis

Two considerations for educating members during the pandemic

Health plans can optimize existing tools to enhance member engagement

CG Adams: Hello everyone and welcome to the Payer Principle, a Salesforce healthcare podcast created exclusively for payers. I'm your host, CG Adams. Today's episode focuses on how payers can better serve Medicare and Medicaid populations and the importance of how to address social determinants of health that can negatively affect these groups. I'm joined today by Dr. Sindhu Pandit. Dr. Pandit is a practicing physical medicine and rehabilitation physician with over 10 years of clinical experience and currently is a clinical advisor on the Healthcare and Life Sciences Go To Market team at Salesforce. Dr. Pandit, welcome to the podcast. It's great to have you here today.Dr. Sindhu Pandit: Thank you for the invitation and happy to be here.CG Adams: So according to the Centers of Medicare and Medicaid Services, there are over 62 million Medicare and 64 million Medicaid beneficiaries respectively. That amounts to almost one third of the US population, which is not a small number. What exactly are we seeing Medicare and Medicaid members struggle with during the COVID- 19 crisis?Dr. Sindhu Pandit: This is a pretty diverse population, but behavioral health really is what comes to mind when I think about this population. We're seeing large increases in those battling depression and anxiety. And right now, it's incredibly imperative that we address this for all of our population, but especially our vulnerable.CG Adams: And seniors are especially vulnerable during this time?Dr. Sindhu Pandit: Senior loneliness is a big deal. People are being isolated. They hear in the news and among their loved ones that they're considered to be high risk. It's causing increased anxiety and fear. 26% of our Medicare beneficiaries live alone. So they are having challenges going out and getting their errands done. And the way they were accomplishing them before, they're possibly afraid to go out to public spaces, or maybe their support system isn't there to help them get their groceries in the way they used to. Maybe they used to have an aide, but that aide no longer is visiting with them. They used to go to their pharmacy in person, but now they are trying to shift that and they may not understand how to opt for mail order, mobility considerations.CG Adams: All of these things are really exacerbating the situation for our senior population. What else?Dr. Sindhu Pandit: Among our Medicaid population, we're seeing changes in employment and maybe some challenges with affordability. So this is a widespread issue, and really, we have a huge opportunity, especially payers, to engage their members in a way that's preventative, and also perhaps proactive, to meet them where they are and offer support. Virtual care, for example, grief counseling services, behavioral therapy.CG Adams: I think that everyone can relate to this concern, right? We all have a parent or a grandparent or potentially a loved one or a friend that's elderly and may potentially be sheltering in place by themselves. So it's definitely very important that people are made aware of some of the different issues or challenges that vulnerable population may be dealing with as they're sheltering in place. Let's jump to social determinants of health, a hot topic for healthcare payers. The US Department of Health and Human Services define social determinants as health conditions in the environment in which people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning and quality of life outcomes and risk. What social and economic considerations are impacting Medicaid and Medicare members as they're sheltering in place, aside from some of the behavioral health considerations that you just informed us of?Dr. Sindhu Pandit: Yeah. Social determinants of health has become a lot more commonplace in terms of conversations when we're discussing general healthcare. And right now, we are definitely having to address many of those aspects of a person's sort of larger environment, as you well- described, that supports their healthy or their ability to live healthy. A couple come to mind that are a little bit more top of mind right now, not to say that any is less important, but access, access is a big deal for many of our seniors, especially with mobility issues, and as I mentioned earlier, those that had aides and others that were supporting them in order to access the different points of care in order to maintain that healthy life. Transportation is one consideration, but maybe they don't understand where they can go because they're now sheltering with their loved ones in a different state. With the Medicaid population, they may have other challenges such as having to support their children who are now at home with them and in a virtual learning environment. And so they're not able to leave their home to access the care they once were potentially doing, or maybe they're afraid to go to the hospital or to the clinic that they were going to because the number of patients that are being seen there have increased and they're afraid of exposure. So that topic is coming up a lot because, A, can they get to where they need or are they avoiding where they need to go? And we need to be ahead of that conversation with these patient populations.CG Adams: Affordability comes to mind as well. There's been huge economic implications from this pandemic.Dr. Sindhu Pandit: And that is affecting this vulnerable population in a pretty profound way. Can they afford what they were doing to support their healthy life prior? If someone is making the decision between obtaining food or obtaining other needs such as for their own health, that's a really difficult decision for families to make. I think that's where the payers can really help sort of meet the patients where they are and help them come up with the solution or options rather to meet this need that has become a lot more top of mind than ever before.CG Adams: So how can payers help to educate members during the pandemic so that they can be more informed and live healthier lives while we're sheltering in place?Dr. Sindhu Pandit: Yeah. When talking about educating members, one is actually health literacy, making sure that when education or information is disseminated to a member, that it accounts for their understanding of information around their health. So if you can personalize that messaging, they can probably have a better comprehension of what it is that is trying to be communicated to them. So you can personalize the information for that member based on their ability to comprehend the information. The second is actually digital literacy. There's a misconception that this population doesn't have a device or maybe they're not comfortable using options such as a portal or mobile apps. It's interesting because Pew Research has showed that 96% of adults in the US actually have a cell phone. That might not be a smartphone, but they do have a cell phone. And there's another survey that recently came out by MediaLogic that showed 94% of seniors use the internet every day.CG Adams: Wow. That's a pretty large number.Dr. Sindhu Pandit: Yeah. I was surprised as well. And I think it's important to kind of keep in mind that if you're able to figure out what channel is most appropriate for the person you're reaching, and then also cater the message to the way that they can consume it in the best manner, then I think you'll really resonate with that person and have a better outcome. So I think there's a lot more we can do in customizing the information, if you will, individualizing the messaging.CG Adams: And so, one of the things with customizing the messaging, if we're thinking about members that may have learning disabilities or accessibility issues, can payers also look to create materials that cater to those individuals?Dr. Sindhu Pandit: Oh, absolutely. In fact, that's such an important point that you bring, I mean, large print, for example, if that's appropriate, braille. If physical materials are being sent out, what is the primary language that your member speaks? Those types of things are now, not only is the information available, but we can actually leverage tools out there in order to disseminate information in the most appropriate and the most successful manner for that member to consume and to act upon.CG Adams: It sounds like there's a really large opportunity for payers to really think about personalizing and customizing information to help educate members from a health literacy and digital literacy perspective and really think about what is the best channel to engage these individuals on and how can I tailor the information in a way that's going to resonate with them and educate them on how to live a healthier life, right? And stay informed with real- time information.Dr. Sindhu Pandit: Yeah. It's not only cost- effective and efficient, but it's going to result in better outcomes.CG Adams: Absolutely. And so knowing that health literacy and digital literacy are very important when it comes to educating members, you also touched upon some tools that health plans can leverage as they're looking to engage members during this time. Can you tell us a little bit more about that?Dr. Sindhu Pandit: Yeah. Payers can create tailored communications that are personalized for the members according to their status and their condition, as you mentioned, but also create journeys that allow for continuous engagement regarding their health, and appropriately opt in or disseminate educational information as appropriate via that journey. You can leverage assessments, questionnaires, so that you can gather more information to understand what is the situation that your member is currently managing. Are they quarantining, for example. If the survey or the assessment yields a positive answer to that or an affirmative answer to that, then you can offer more assistance to that individual around quarantining. Do they have access to their medications? Do they have food? And then you can help fill those gaps as and when they're presenting themselves versus after the fact.CG Adams: Are there other considerations, especially in times of impending crisis, where members may be impacted by hurricane season, wildfires, et cetera?Dr. Sindhu Pandit: You know, there are ways that we could get ahead of issues as well. In some areas where you can predict natural disasters, for example, you can plan in advance with those members to fill prescription medications in advance or to switch them from pharmacy pickup to mail order. In a case like this in this pandemic situation, we can do the same. If you see a lapse in refills, we can certainly help by asking that member via survey, via a question or a phone call out if that's what they prefer, if they're having trouble getting their medications.CG Adams: So from portals to assessments, to questionnaires, to omni- channel communications and thinking about medication delivery services, there are a multitude of already existing tools that health plans can basically look to today to engage members in the Medicare and Medicaid populations to stay healthy during the crisis.Dr. Sindhu Pandit: Yeah, I think it's not so much that we need to discover new ways to communicate or to engage, I think we will need to look at the tools that we have and optimize and improve and to customize so that we meet the patient or the member where they are. For example, portals are very common for payers to offer access to for their members, but 47% of Medicare beneficiaries feel that their plan's portal are rarely or never useful to them. And I think that's a pretty telling statistic. And so having a tool, if we're not optimizing it, doesn't really speak to the power that the tool has in order to meet the needs of your member.CG Adams: That's a really great call- out. Dr. Pandit, you've given us an amazing insight today on the Payer Principle podcast and we are very thankful for you sharing all of your insights. Thank you for being here today.Dr. Sindhu Pandit: This is such an important conversation and I really appreciate you asking me to be on. Thank you for the time.CG Adams: Thank you. To learn more about our payer solutions, visit salesforce. com/ healthcare. I'm your host, CG Adams. Thank you for listening and make sure to check out the rest of the podcast.

Kevin Riley, senior vice president for healthcare and life sciences at Salesforce, discusses how payors can increase consumer loyalty with robust digital engagement. He offers use cases and strategies for engaging members with varying degrees of digital literacy. He also speaks about the value of self-guided care and the potential for artificial intelligence (AI) to influence positive member and business outcomes.

Kevin Riley 

Senior Vice President, Healthcare and Life Sciences at Salesforce

Strategies to Enhance Digital Member Engagement

Simplicity and proactiveness are key for digital engagement

Artificial intelligence will be a key differentiator among health plans 

This episode features Dr. Barry Chaiken, clinical lead at Tableau with over 20 years of public health and healthcare industry experience. Dr. Chaiken addresses the difficulties of calculating medical loss ratios and acknowledges the myriad “unknowns” for payors’ expenses over the coming year or two. He gives a lesson on predictive analytics and offers advice on how to create a culture of data to improve outcomes.

Barry Chaiken, MD 

Clinical Lead at Tableau Software, A Salesforce Company

Unlock the Power of Predictive and Actionable Analytics to Improve Business Outcomes

A culture that embraces data analytics is key for decision-making

Why analytics are more important than ever regarding COVID-19

Leveraging analytics for COVID-19 population health initiatives 

Payors face unique challenges when it comes to reopening. In this episode, DJ Stojsavljevic, director of Payor Strategy, provides a phased approach that keeps employees and members safe and informed. Expect an in-depth discussion on contact tracing and emergency response management, employee wellness and assessment, and shift management with Work.com solutions.

DJ Stojsavljevic

Director of Payor Strategy, Salesforce

 Reopening Safely with Work.com

How work.com helps businesses reopen safely

Omni-channel communication is key to keeping members informed during COVID-19

Command centers enable employee readiness to return to work

CG Adams: Hello everyone and welcome to the Payer Principle, a Salesforce healthcare podcast created exclusively for payers. I'm your host CG Adams. On the show, you'll hear insights from healthcare industry experts and trailblazer organizations on all things payer, such as trends, business challenges and the latest technological solutions. Today's episode focuses on how payer organizations can take a phased approach to reopen safely and keep employees and members safe and informed during the COVID- 19 pandemic with work. com. I'm joined today by DJ Stojsavljevic. DJ is currently the director of payer strategy for the healthcare and life sciences team at Salesforce and has over 15 years of combined technology and healthcare experience. DJ, welcome to the show. It's great to have you on today.DJ Stojsavljevic: Thanks for having me CG.CG Adams: DJ, in response to COVID- 19, Salesforce along with our partners launched work. com to help businesses and communities reopen. Tell us about work.com and what exactly it is.DJ Stojsavljevic: Work. com include solutions ranging from contact tracing, to emergency response management, to employee wellness assessment and shift management. And that's there for accelerating private and public sector responses to the COVID 19 pandemic. I think for everyone, COVID 19 has caught the world by surprise, without a doubt. And technology has always been at the forefront of helping change people's lives. Salesforce realized the importance of this and is responded with work. com.CG Adams: At the heart of work. com is a Command Center. Can you tell me about that?DJ Stojsavljevic: In any type of catastrophe situation, you always have this Command Center or this main hub and Command Center is really what we focused on, and it's to drive all the readiness for employees, partners and members in three key areas that are going to meet those federal, state and local requirements. And those include the adherence to be able to develop and make sure that you're adhering to those policies. Also to make sure that you're able to plan for social distancing for when people do return or all those partners and all those members, how are they going to interact and make sure that social distancing's in place from space planning and then make sure that those employees procedures are put in place so they can return to work. Now, information can quickly be enacted because one core important areas, it's not only to be able to set this up, but we have to visualize this data. We have to take in those internal external sources directly and make those accessible to employees, partners and members.CG Adams: Now that you've oriented us a little bit into exactly what work. com is, let's dive into what's happening with payers now in direct response to the pandemic. What are some of the unique challenges that payers are experiencing as they're working remotely during COVID- 19?DJ Stojsavljevic: Well, when you look at a payer's kind of the ecosystem in their organization, they touch multiple different people in different ways. They touch their community, their members, employees and partners. And so you have to be able to communicate with all of them. One of the first things that they're looking for is identifying which departments and teams are going to return first. The other thing is to develop that communication strategy so that you have constant communication with those employees, those partners and the members are informed and up to date. Third item is reporting on employee health and regulatory and running the business. And we'll talk a little bit more as we go through this podcast a little bit more of how they're doing that exact and what we're hearing from them. Also, making sure that you have major enterprise health plans that are assessing those requirements in the early stage, by utilizing tools like Trailhead, so that you're collecting wellness assessment and making sure that people are completing those assessments and fully acknowledge that they understand them, because if they don't, then you may be at risk and you may have a considerable outbreak within your organization.CG Adams: Tons of challenges that payers are experiencing brought on by the pandemic, keeping some of those that you just mentioned in mind, what exactly are payers having to consider when it comes to reopening?DJ Stojsavljevic: Yeah, five major areas. First one is facility management. Second one is capacity planning. Third is shift scheduling. The fourth is to be able to do employee contact tracing. And then five is to have all of this managed in one area called Command Center.CG Adams: Tell us a little bit more, let's start with facility management.DJ Stojsavljevic: Facility management is really, how are you going to take the layout if it's local branches, if it's your home offices, what do you take as far as those multiple floors how everything is going to be spaced? How are you going to determine social distancing? And then how are you going to manage to be able to make sure everybody is going to be organized within those layouts of those floors and for those buildings? Capacity planning is to look at those floor plans and determine how many people can you fit and manage that high traffic areas? You can't have people moving around like we did before this new normal and so you really have to understand how that's going to look and make sure the capacity for those floors are determined. Shift scheduling is this is a really unique area, but it's a main focus is what are the most essential workers that have to come back first? And this is really comes into that phased approach. And not only scheduling them, but how are you going to make sure when they do arrive on site, they have to make sure to thermal temperature check, which badges are activated, which are not, how is HR going to engage during this process as they start to come back on the schedule? And then make sure that managers are following up on that. The fourth one employee contact tracing, I think we're hearing a lot about contact tracing and we're hearing about how are we going to track this? How are we going to make sure we acknowledge if something does happen how do we react to that? Making sure that badges are disabled, only the healthiest people are going to be able to come on board. How are we going to take care of those people that do have the symptoms? And how are we going to have the action plan adjusted for that? And then from an asset management perspective, need to organize and structure so payers are trying to make sure they're up to date and compliant with any regulations that are coming in, not only from a state local area perspective, but also from the federal area. All of these have to be together so that you have the latest information to be able to manage that. And obviously when we bring all that together, that's where everything comes into Command Center.CG Adams: Understanding the challenges that payers are facing at the moment and some of those top of mind considerations, I want to double click into exactly how work. com can actually help them navigate this difficult time. Can you tell us about some of the key features of work. com?DJ Stojsavljevic: Yeah. Let me talk about two key areas I think that the payers have top to mind on top of the five that we talked about, but contact tracing and emergency response management. Contact tracing, obviously the spread of COVID, we've seen this recently with the spikes in the amount of positives. And so you have to consider the importance of work.com is not only is COVID but it's also in preparation for now that this is the new normal, how are we going to constantly track this moving forward in any type of pandemic like this? These diseases, these type of pandemics, they can impact the health of the payer community and contact tracing really is developed to allow payers through guided interview templates, to collect data from individuals who are infected or potentially exposed through transmission from either through friends or through family members. Now that data can be used to be able to create those visual maps of contacts and locations and to be able to monitor potential interactions and outbreaks. This is especially important as people are being brought back in the phased approach and to be able to respond very quickly because a single platform is critical to identify, understand and respond. And this leads to our next topic, which is emergency response because you can't have one without the other. When you do have this outbreak, you have this exposure, what do we do? Three key elements to have emergency response management module is to identify quickly those emergencies, deliver emergency care and you are going to have to allocate the resources quickly to meet those emergency that requires payers and providers to identify it, to establish a triage and evaluate those members and patients and to make sure that they have ongoing engagement and monitoring. Because you can't just say," Hey, you've got it," and then you just move them along. We have to monitor this. Because there'll be a time that they no longer have COVID, but maybe some of the family members that they've come into new contact with, it's kind of a revolving door. You have to be very careful. You have to have the operations, you have to have rules and you have to deploy the resources.CG Adams: And you make such a salient point there that these two things go hand in hand, contact tracing and emergency response management. Now that we're a little familiar with the key features of work. com, what's the recommended path forward for how and when businesses should reopen?DJ Stojsavljevic: Yeah. CG, it's really a down to a three- phased approach is what we've learned. Number one is to be able to stabilize. Number two is to reopen and number three is to grow. And to stabilize, you have to mitigate your short term risks and stabilize operations. You have to execute a robust in crisis response to protect and run the business during lockdown. That's that crisis response center. What we were kind of talking about is how do you stabilize now? How do we work to put a plan together with what we have today? They're working out there remotely, all of that's important to kind of stabilize. When we consider reopening, we have to plan and orchestrate how to bring them back. And that's that Command Center piece. You have to kind of put that orchestration together. And by putting in place that planning, the logistics communications, you can then resume operations while at the same time, making sure you're protecting employees. And now finally in grow, you can accelerate the change to grow in the next normal. By accelerating through digital transformation to become faster and more relevant to customers than before the crisis. I think what's huge about this is the lack of communication now. We've heard it across multiple different topics and conversations as COVID has happened and a lot of it is down to communication. And so when you can grow by accelerating that digital transformation through a lot of communication, that's going to be a key to understanding how are you going to be able to get past this?CG Adams: Understanding that phased approach is going to be really critical for payers and their employees. What about members? Where do members fall within all of this? How can payer organizations apply a member- centric approach in mindset to reopening safely?DJ Stojsavljevic: Yeah, CG, I'm going to take this a little bit different into a different path. And I think you've heard a lot about the Command Center, developing the plans and executing those plans for return to work for employees. But I think members are such an important part of that community to payers. How do you communicate is a very, very strict focus right now. We hear it across many of the payers. And I think when you're on a platform, why did work. com go on to a Salesforce platform? Because it offers so many different ways to communicate, to follow a member's journey. One area I wanted to kind of discuss about is marketing has taken a completely different view on this and different path. We talk about a member journey, you also have to communicate what are the new COVID- 19 plan benefit updates? When you now have indicated that members, what's going to happen with the payer? How are they reopening? How are you going to interact with their employees? What's going to be the new normal? If your members have come down with COVID- 19, you have to now communicate to them quickly about what their plan benefit updates are. How are they going to stay healthy? You have to have the ability to do that. Then you also have to be able to indicate if they have the symptoms, we need to get them to a provider into that location that's for testing. To be able to communicate that way. The platform really allows you to extend beyond just work. com, but that flexibility to market and have constant communication is a key component. You have to make sure that every channel of communication is available to members, SMS text, email, brokers and of course social media. Because this is so critical that they understand not only what treatment opportunities are available to them under benefits, but where can they go to make sure that they can get healthy and that they have the right information?CG Adams: DJ, thank you so much for joining us today on the Payer Principle podcast and for all of your insights.DJ Stojsavljevic: Thank you so much for having me, CG. This is a great topic and the timing couldn't be more perfect.CG Adams: Listeners, if you want to learn more about how your organization can reopen safely, visit work. com. I'm your host CG Adams. Thank you for listening.

Salesforce

A new podcast created exclusively for the healthcare insurance industry, The Payor Principle offers actionable insights to help payors navigate business challenges, while future-proofing business for tomorrow. In each episode, our resident payor guru and podcast host Ciji Adams speaks with industry experts about healthcare trends and the challenges and opportunities to improve the experience and achieve better healthcare outcomes for members.


The Payor Principle, a Salesforce Podcast

SEASON 1 | EPISODE 1 | 02:41 MIN | 09.25.2020

The Payor Principle Podcast Trailer

SEASON 1 | EPISODE 2 | 13:38 MIN | 09.25.2020

Drive Interoperable Systems and Data Integration with a Unified Platform

SEASON 1 | EPISODE 3 | 09:39 MIN | 09.25.2020

How to Create Member Experiences that Build Trust, Loyalty, and Retention

SEASON 1 | EPISODE 4 | 13:03 MIN | 09.25.2020

How to Serve Medicare and Medicaid Populations in the New Normal

SEASON 1 | EPISODE 5 | 23:46 MIN | 09.25.2020

Strategies to Enhance Digital Member Engagement

SEASON 1 | EPISODE 6 | 20:54 MIN | 09.25.2020

Unlock the Power of Predictive and Actionable Analytics to Improve Business Outcomes