Who We Serve in Healthcare
Specialized Health Cloud implementations tailored to the unique workflows and regulatory requirements of each healthcare segment.
Healthcare Providers & ACOs
Health systems, hospitals, physician practices, and Accountable Care Organizations (ACOs) seeking to unify patient data, improve care coordination, and excel in value-based care models.
Key CRM Requirements:
- Patient 360 view with EHR/HIE integration (Epic, Cerner, Allscripts)
- Care plan automation for chronic disease management and care transitions
- Referral management with real-time provider availability
- Population health analytics for quality metrics and care gap closure
- Telehealth integration and remote patient monitoring (RPM)
Health Plans & Payers
Commercial health plans, Medicare Advantage, Medicaid MCOs, and Third-Party Administrators (TPAs) focused on member engagement, risk stratification, and STAR ratings improvement.
Key CRM Requirements:
- Member 360 with claims, clinical, pharmacy, and SDOH data integration
- Predictive risk models for proactive care management
- Automated utilization management and prior authorization workflows
- Omnichannel member engagement for HEDIS compliance
- STAR ratings optimization and care gap analytics
Life Sciences & Medical Device
Pharmaceutical manufacturers, biotech companies, and medical device firms managing HCP engagement, patient support programs, and real-world evidence initiatives.
Key CRM Requirements:
- Unified HCP 360 view with multichannel engagement tracking
- Automated Sunshine Act reporting and adverse event management
- Patient support program (PSP) enrollment and adherence tracking
- Real-world evidence (RWE) integration from claims and EHR data
- Medical affairs and scientific engagement workflows
Accountable Care Organizations (ACOs)
Medicare Shared Savings Program (MSSP) ACOs and commercial ACOs managing attributed populations, quality reporting, and shared savings distributions.
Key CRM Requirements:
- Attribution management for beneficiary populations
- Quality measure tracking for MSSP/MIPS reporting
- Care coordination workflows across participating providers
- Financial settlement and shared savings distribution
- Claims data integration for utilization and cost analytics
Healthcare Use Cases We've Implemented
Real-world Health Cloud solutions addressing the most critical challenges in healthcare delivery, health plan operations, and life sciences.
EHR/HIE Integration for Patient 360
Fragmented patient data across Epic, Cerner, lab systems, and community HIEs creates incomplete clinical pictures and coordination gaps.
Bidirectional FHIR/HL7 v2 integration with EHRs and C-CDA document exchange with HIEs to unify demographics, encounters, diagnoses, medications, labs, and care plans in Health Cloud Patient 360.
Care Coordination & Care Plans
Manual care coordination for chronic disease patients, post-discharge follow-ups, and high-risk members leads to gaps in care and preventable readmissions.
Automated, evidence-based care plan templates with task routing to care teams, progress tracking, and alert workflows for missed milestones or deteriorating conditions.
Population Health & Risk Stratification
Reactive care management without predictive risk models or visibility into rising-risk patients and care gaps across attributed populations.
Predictive analytics using claims, clinical, pharmacy, and SDOH data to risk-stratify patients, identify care gaps (HEDIS, STAR ratings), and trigger proactive outreach campaigns.
Utilization Management & Prior Authorization
Manual prior authorization processes with lengthy approval times, inconsistent clinical decision support, and fragmented communication between plans and providers.
Automated utilization management workflows with InterQual/Milliman integration, real-time eligibility checks, clinical decision support rules, and portal-based provider communication.
Member/Patient Engagement Campaigns
Low engagement rates for preventive care, medication adherence, and HEDIS measure compliance due to generic, one-size-fits-all outreach.
Omnichannel engagement campaigns (SMS, email, IVR, portal) triggered by risk stratification, care gaps, and life events, with personalized content and telehealth scheduling.
Provider Network Management
Incomplete provider directories, manual credentialing, network adequacy gaps, and inefficient referral routing across complex provider networks.
Comprehensive provider directory with automated credentialing workflows, real-time availability, specialty-based referral routing, and network adequacy analytics.
HEDIS & STAR Ratings Optimization
Manual tracking of HEDIS measures and STAR ratings metrics with limited visibility into member-level care gaps and performance trends.
Automated HEDIS measure tracking with member-level care gap identification, targeted outreach campaigns, and real-time dashboards for performance monitoring.
Claims & Clinical Data Integration
Siloed claims adjudication systems (Facets, HealthRules) and clinical data sources prevent holistic view of member health status and utilization patterns.
Real-time and batch integration with claims platforms (EDI 837, 835), pharmacy benefit managers (PBM), and clinical systems for unified member analytics.
Healthcare Technology Integration Ecosystem
Pre-built integration accelerators for EHR, HIE, claims, pharmacy, and population health systems.
Electronic Health Records (EHR)
Health Information Exchanges (HIE)
Claims & Payer Platforms
Population Health & Analytics
Telehealth & RPM
Utilization Management
Healthcare Compliance & Regulatory Expertise
Deep knowledge of HIPAA, interoperability standards, and value-based care quality reporting requirements.
HIPAA Privacy & Security
- Business Associate Agreement (BAA) with Salesforce
- Field-level encryption (FLE) for PHI at rest and in transit
- Role-based access controls (RBAC) with minimum necessary access
- Comprehensive audit trails (field history, login forensics, API logs)
- Employee training on PHI handling and breach notification procedures
Interoperability Standards
- FHIR R4 compliance for API-based data exchange
- HL7 v2.x support for ADT feeds and clinical messaging
- C-CDA (Consolidated Clinical Document Architecture) for care summaries
- X12 EDI standards for claims and eligibility (270/271, 837, 835)
- NCPDP SCRIPT for e-prescribing and pharmacy data exchange
Quality Reporting & Value-Based Care
- HEDIS (Healthcare Effectiveness Data and Information Set) measure tracking
- STAR Ratings reporting for Medicare Advantage plans
- MSSP (Medicare Shared Savings Program) quality measures
- MIPS (Merit-based Incentive Payment System) reporting for providers
- CAHPS (Consumer Assessment of Healthcare Providers and Systems) surveys
Proven Healthcare Implementation Expertise
AI-Powered Patient Engagement & Care Coordination
Healthcare organizations are using AI to improve patient engagement, streamline care coordination, and reduce administrative burden—while maintaining HIPAA compliance.
HubSpot Breeze AI for Patient Communications
Automate outreach, education, and appointment reminders
Salesforce AgentForce for Patient Support
24/7 AI-powered patient service and triage
Ensure HIPAA-Compliant AI Implementation
Our AI Strategy Consulting helps healthcare organizations navigate AI adoption while maintaining strict HIPAA compliance, BAA requirements, and PHI security standards.