CRM For Managed Care Organizations

MCO CRM

Customer Relationship Management (CRM) software was born and raised in traditional SMBs and enterprises.

Healthcare CRM is a more recent adaptation of traditional CRM, designed to be a fit for organizations within various healthcare sectors, including MCOs.

HMOs, PPOs, POS plans and independent practice associations can now all benefit from deploying CRM technology. But the selected CRM system needs to first have been adapted to the MCO segment’s business model.

Vendors like Salesforce have heavily adapted their core platforms to the needs of managed care organizations and other healthcare organizations.

The adapted core platform can, in turn, be further tailored to the specific needs of each MCO through configuration, integrations and third party add-on functionality.

In most cases, organization-specific configurations can be created without coding, using declarative point & click tools. Configurations and integrations are often performed by a CRM vendor’s services partner–one that specializes in the healthcare industry. Some organizations choose to self-implement.

For MCOs, multiple levels have come into play with regard how CRM can deliver benefits:

  • Classic CRM functionality that applies to MCOs
  • Core CRM product adaptation to MCO business models and processes
  • Third party add-on products and integrations (a healthcare industry specific CRM “ecosystem”)
  • Industry-focused services delivery organizations

Applying classic CRM functionality to MCOs

MCOs have substantially different business models from commercial enterprises. However, a number of traditional CRM features and processes can be applied to MCOs. We’ll look at those first. Then we’ll look at MCO and healthcare specific functionality.

Centrally store member & program information

As is the case with many traditional enterprises, data within MCOs is often scattered across the organization in different silos. Spreadsheets tend to be the largest single type of silo. Email address books are next in line. Silos can also be databases that range from Access to SQL Server.

Perhaps the most widespread benefit to CRM is consolidating those silos into a single, shared repository. Of course, user permissions determine who has access to what member data.

Acquire and retain members

Commercial enterprises continually seek to acquire more paying customers. MCOs want to acquire more members. Many elements of the acquisition process that were developed for industry also apply to MCOs. Rating potential “buyers” and tracking communications with them are two examples.

Track member referral sources

Traditional commercial CRM is good at tracking lead sources all the way through to revenue. Marketers know what campaigns contributed to the sales of which products and services.

In a similar way, MCO CRM can be set up track member movement from referral source through to revenue. The path might look something like this:

  • A patient is referred to an MCO
  • The referring person or entity is selected within the prospective member’s CRM record
  • The patient ultimately becomes an MCO member
  • The member or the government program pays premiums, copays and program fees
  • The multi-year revenue from each member is tracked back to the referring entity

This tracking allows the actual revenue from each referral source to be viewed in reports and dashboards. Decisions can be made about which sources to focus on.

Healthcare Specific CRM Functionality

There are many attributes to an MCO CRM system that do not have equivalents in traditional enterprises. Most are specific to patient care.

Streamline Patient Intake

An MCO CRM system can streamline the patient intake process. A tablet-ready screen can be configured to take the place of standard paper intake forms.

Coordinate Patient Care

With multiple caregivers having access to the same patient profiles, coordination of patient care is easier and more efficient.

The patient view within MCO CRM is very different than what is seen on the screen for a traditional CRM “contact”. This is because interactions with patients are much more extensive and time-sensitive than interactions with enterprise customer contacts.

Manage Patient Cards & Timelines

A customizable patient card that’s displayed in CRM gives care coordinators the at-a-glance information they need about a patient’s contact information, conditions, prescriptions, appointments, and other information from their medical records. The timeline shows important schedule items.

MCO CRM - Patient Card & Timeline

Manage Care Plans

In MCO CRM, one or more care plans can be created for each patient.

Care plans can be created around anything from smoking cessation to Diabetes Type II management.

Create Patient Communities

An online patient community is included in CRM healthcare offerings such as Salesforce. Unlike with a standalone patient community or portal, a CRM-based community already contains information about patients. This minimizes the need for synchronizing data from multiple sources.

Setting up a patient community should not be something that requires a developer.

Engage More Directly With Patients

CRM can be the hub for a variety of one-to-one communication with patients.

Chat, telehealth services & SMS are now integral functionality within systems such as Salesforce. All forms of engagement are recorded in the patient’s record.

Third Party Products

The ecosystem of third party vendors with solutions that connect to healthcare CRM is expanding rapidly. Examples of third party enhancements that have been released or that are coming include:

  • Wellness action plan apps
  • Electronic healthcare form signatures
  • Member prioritization
  • Automated assignment of clinical goals
  • Smart patient-provider matching and scheduling
  • Evidence-based tools and activities for behavioral healthcare

CRM used to be only a partial solution for managed care organizations. That’s no longer the case. Efforts by vendors to adapt their core platforms and the entry of services partners that specialize in healthcare CRM delivery now allow MCOs to benefit from CRM as much as traditional enterprises–if not more.

About the Author

John RousevilleJohn Rounseville is Co-Founder and VP of Business Development at Saxa Solutions in Boston, MA. Saxa specializes in consulting services for Salesforce Health Cloud customers. For more information about Salesforce in your sector, contact John.

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