Collaborating Authors

Salesforce Health Cloud roadmap boasts payer tools, CX, AI


Salesforce Health Cloud's close relative, Health Cloud for Payers, has been pumped up with new tools for healthcare providers and payers to integrate patient insurance data and improve health plan member experience. Salesforce laid out a path for the near and long-term future for both Health Clouds that include AI enhancements and chatbots, links to other Salesforce Cloud systems with its new Customer 360 product and the ability to incorporate social determinants of health. Salesforce Health Cloud for Payers will see general release in October 2018 and February 2019 of new capabilities for complex care management, health plan membership, benefits and claims, insurance utilization management, quality measurement and member and provider services, the vendor said during its Dreamforce 18 conference here on Sept. 25. The CRM giant, which is this city's biggest tech employer and jams up downtown during its sprawling annual conference, first previewed Salesforce Health Cloud for Payers in early summer 2018. Josh Newman, M.D., chief medical officer and director of product management and health strategy, said in an interview here that MuleSoft, the software integration vendor Salesforce bought earlier this year, worked on building the two health systems upon the Service Cloud framework.

Transforming Healthcare


The amount of data that insurance companies, doctors, hospitals and patients have at their disposal is enormous. Payers have access to billions of pieces of claims data from doctors and pharmacies, while healthcare professionals across the country can collectively tap into millions of sophisticated electronic medical records that track patients and their progress. So valuable is all this information that some industry experts talk about data as the "new oil." The analogy is fitting: both are the raw material for creating value. That said, the ability to tie all these disparate pieces of information together is monumentally difficult.

NTT Data, Google Cloud co-developing new healthcare AI tools


NTT Data Services is working with Google Cloud to develop new analytics and AI technologies aimed at boosting the patient experience, streamlining operations and lowering costs for payers and providers. WHY IT MATTERS The two companies will collaborate on cloud-based digital tools to help providers harness data for improved patient outcomes and help payers better engage with their plan members, according to NTT Data. The vendor, which has worked with Google for years and became a Google Cloud Premier Partner this past month, says it aims to help its clients – more than 45 health systems, 50 health plans and 50 life sciences companies – manage value-based care by offering new infrastructure, application, business process and security technologies. Among the specific areas NTT plans to focus on with Google Cloud: patient engagement, population health, customer relationship management, clinical and claims apps and AI/automation. "Google Cloud is a leader in analytics and artificial intelligence," said Alan Hughes, President, Global Healthcare & Life Sciences, NTT DATA Services.

Early AI adopters beginning to see success predicting readmissions, ED visits


PHOENIX--Early adopters of artificial intelligence solutions are beginning to see success in clinical areas such as predicting readmissions and avoidable emergency department visits, according to a joint report from KLAS Research and the College of Healthcare Information Management Executives (CHIME). KLAS and CHIME polled early adopter healthcare organizations using AI software, specifically machine learning and natural language processing, to evaluate the gains they've achieved in clinical, financial and operational areas. "The most exciting insight from our research is that artificial intelligence (machine learning and natural language processing) has truly begun to make a difference in healthcare. It's not all just smoke," Ryan Pretnik, director of research and strategy at KLAS and co-author of the study, said via email. "Artificial intelligence is driving outcomes, saving patient lives, and driving operational and financial efficiencies for providers and payers."

Meet the Dynamic, Uncertain Healthcare Journey Head-On


An infographic from America's Health Insurance Plans (AHIP) details the many uncertainties facing payers and providers due to COVID-19 that throw into question how to set premiums for the 2021 individual market. Delayed elective and non-urgent care, losses in employer-provided coverage, and health care costs related to the pandemic are among the many uncertain factors that must be taken into account for setting premiums. This is just one small slice of the sudden disruption and upheaval to the entire healthcare industry that is affecting payers, providers and the healthcare consumer alike. Contributing to this break from norms is the trend toward healthcare consumerism that recognizes an empowered healthcare consumer as in charge of a dynamic, increasingly digital healthcare journey. As digital transformation accelerates and consumer behaviors rapidly change, payers and providers are challenged to deliver the consistent, relevant healthcare experience that consumers now expect.