Provider Roadmap for Success on CRM POINT OF VIEW SERIES Prepared by Silverline’s Healthcare Practice: Jim Rogers, RN, BSN Senior Director Healthcare Practice Matt Gretczko Senior VP & GM Healthcare Practice About Silverline Silverline is a Salesforce Platinum Cloud Alliance Partner head-quartered in New York City with experienced, innovative consultants nationwide. They are focused on developing powerful solutions, deployed on the Salesforce Platform, and robust third party apps. Silverline’s results-driven methodology leverages best practices acquired from over 1,100 implementations, driven by their Industry focused approach, including a dedicated Healthcare Practice. Silverline operates across various Healthcare industry sub- segments including Provider, Payer, and Medical Device, along with a specialized focused on Oncology, Labs, and Fertility.
Transcript
Provider Roadmap for Success
on CRM
POINT OF VIEW SERIES
Prepared by Silverline’s Healthcare Practice:
Jim Rogers, RN, BSNSenior Director
Healthcare Practice
Matt GretczkoSenior VP & GM
Healthcare Practice
About SilverlineSilverline is a Salesforce Platinum Cloud Alliance Partner head-quartered in New York City with experienced, innovative consultants nationwide. They are focused on developing powerful solutions, deployed on the Salesforce Platform, and robust third party apps. Silverline’s results-driven methodology leverages best practices acquired from over 1,100 implementations, driven by their Industry focused approach, including a dedicated Healthcare Practice. Silverline operates across various Healthcare industry sub-segments including Provider, Payer, and Medical Device, along with a specialized focused on Oncology, Labs, and Fertility.
Table of Contents
Provider Relationship Management 5
Consumer & Patient Engagement 9
Ambulatory Care Coordination 13
Transitions in Care 19
Specialty Care Coordination 28
About the Authors 33
These opportunities will be presented in the context of using Salesforce Health Cloud and leveraging Silverline’s best practice
approach to patient engagement.
“ With twenty years’ experience in healthcare, and twelve years creating and operationalizing patient journeys on the Salesforce platform, I look forward to sharing my experience and success working with large healthcare systems in Texas and Colorado and their provider groups, clinically integrated networks and accountable care organizations. Silverline is focused on helping healthcare organizations, as providers of healthcare services to patients, be successful in five key areas as healthcare reimbursement models shift from fee for service to fee for value. Our clients can leverage the Salesforce Platform to effectively navigate patients on their healthcare journey.
Jim Rogers, RN, BSN
“
reating and defining your provider network is a critical first step in managing patients and navigating them within your healthcare system. The successful result of this is two-fold: create continuity of care for your patients to increase efficiency and effectively track quality; and increase opportunities to retain downstream revenue within your network. Whether you are creating a new clinically integrated network for payer contracting, standing up a new accountable care organization (ACO) or simply want to manage referrals from primary care to specialty care and services within your healthcare system.
The key to defining your provider network in a manner that impacts your patient navigation is to build and maintain provider profiles that go beyond the traditional credentialing data to include services provided in the clinic; procedures performed in the clinic and the outpatient setting; locations with directions, parking instruction, and public transportation routes; scheduling rules or restrictions at the provider, clinic or insurance level; and up-to-date notifications on provider availability.
It is also important to track provider participation in your individual ACO’s, risk-based programs, and value-based programs. Silverline’s Provider Network Management point of view includes the ability to manage contract
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SECTION 1
Provider Relationship Management
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During a recent webinar, we asked attendees to describe current utilization of CRM. We
found 43% of respondents were evaluating CRM options, 21% were using one and looking
to expand, and another 21% were using one. That makes 85% of respondents, namely
CIOs, indicating that CRM is currently or will be a piece of their technology infrastructure –
this is a tremendous statistic.
PROVIDER ROADMAP FOR SUCCESS ON CRM
done very successfully at a large provider group in Texas. Tracking the HR, IT, Telecom, Real Estate, Legal, Credentialing, and other processes in Salesforce allows the individual departments to collaborate and simplify communication while introducing the provider to the new network and the network to the new provider. This can help change referral patterns and increase in-network utilization up to 90 days before their go-live date.
Engaging with providers in your network is critical to increasing quality and enhancing the patient experience. Provider Relationship Managers, sometimes called Physician Liaisons, are valuable members of the provider network but often lack the tools to effectively communicate and track their relationship with providers or collaborate with others calling on providers or clinics. Whether it’s gathering the latest provider and clinic demographics, automating communications and updates within the network or sharing information with providers on the status of referrals, Silverline can help ease the burden. Move away from spreadsheets, SharePoint, and notebooks and consider using Salesforce Communities as the hub of information sharing within your provider network.
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requirements, compliance, and milestones, along with the aforementioned data elements. It also includes a robust provider search tool that allows an agent to match a patient and a provider based on customizable attributes including specialty, insurance, location, experience, gender, and appointment availability. This can be launched for both appointment scheduling or referral management with one click. It also allows you to create and manage the providers and clinics in tiers, or the relationship between the provider and the healthcare system. For example, some providers in your network may be employed, while others may be members of your CIN/ACO or be on active staff with a healthcare facility. Silverline’s Referral Management accelerator includes safe harbor scripts to inform the consumer/patient of the relationship between the provider and the healthcare system and the order in which providers will be offered.
One unique approach to provider network management is to manage the onboarding process for providers and clinics in Salesforce. This has been
he primary hub of communication between consumers or patients and a healthcare system is the Patient Engagement Center (PEC). While many consumers search websites for their healthcare content, it’s important to offer opportunities to speak directly with healthcare professionals via phone, chat or email.
According to Salesforce’s 2017 Connected Patient Report, eighty percent of all patients communicate with their PCP via phone to schedule appointments. Millennials are twice as likely to use email and nine times more likely to use text to schedule an appointment.
So, the first order of business is omni-channel support. Engage consumers shopping for healthcare services across multiple channels (email, phone, chat, and text) via multiple tools and sources - campaigns, events, and websites. Offer appointment reminders via email or text. Create chat channels based on targeted web clicks. Silverline’s best practice approach to patient engagement is designed to support multiple communication streams and, connected to your phone system via computer telephony integration (CTI), intelligently route calls to the appropriate agent based on past encounters, expertise, or language preferences - the automated screen pop.
The PEC, sometimes called a Patient Access Center (PAS), is the main conduit for consumers to enter your healthcare system and the primary tool in keeping patients loyal your providers. We tend to defer to “Patient Contact” vs. “Patient Access” as our efforts are broad enough to support all activities, inquiries, and interactions that patients have across various people that may be included in the center including call center agents, health advocates, or clinicians. It is also important to note, that a Patient Engagement Center
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Millennials are twice as likely to use email and nine times more likely to use text to schedule
an appointment.
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According to Salesforce’s 2017 Connected Patient Report, eighty percent of all patients
communicate with their PCP via phone to schedule appointments.
PROVIDER ROADMAP FOR SUCCESS ON CRM
existing and future digital channels. Silverline’s PCC solution fully integrates with the Salesforce Platform including Health Cloud and supports both of Salesforce’s user interfaces: Lightning and Classic.
Consider creating a Salesforce Community for patients that includes options for self-scheduling, patient-specific educational content, and the ability to upload documentation or even data from a fitness device. Silverline’s Lightning Bolt Template called ScheduleMe.Health can be used to display appointment availability and allow patients to choose and schedule appointments with providers. Availability can come from an EHR, scheduling system or be created in Salesforce. Communities also offer a way for patients and their caregivers to collaborate and communicate on tasks specific to their care plan.
does not have to be physically located in one place - all of our solutions are cloud-based and can be consumed by resources operating in one or multiple locations with the same experience. More healthcare organizations than ever are focused on the “patient experience”. Here’s a secret: Patients just want convenient, real time access to their providers clinics and support staff. That means after hours and on weekends. Most people do not have time at work to wait 30 minutes to speak with someone. Most people do not decide they need to see a doctor during business hours. If you want to create a better patient experience, fill your providers’ schedules and keep patients in your network, make your contact center 24/7. Cost effective? Absolutely! Replace your after hours answering service. Utilize nurse triage protocols to disposition patients to a PCP appointment in the morning vs. a midnight ED visit at your competitor. Prevent readmissions by making proactive outbound calls to recently discharged patients with chronic conditions.
With Silverline’s best practice approach to patient engagement, the possibilities are endless. Expand your contact center service lines to include find a provider, referral management, event registration, and nurse triage. Implement a concierge care model, providing access to defined patient groups such as at-risk patients or employer contract patients through unique channels. It is also possible to connect to drive patient engagement through preventative care outreach, and targeted outreach based on diagnoses or chronic conditions, by leveraging Silverline’s solution in coordination with Salesforce’s Marketing Cloud - a robust toolset to drive consumer engagement through campaigns, journeys, and targeted messaging across
SECTION 2: CUSTOMER & PATIENT ENGAGEMENT
“Do you have a defined business objective focused on innovation, consumer engagement, or digital transformation for FY2018?” The results were just as telling, albeit not that surprising. Over 50% of the respondents have indicated they did which further validates how CRM is becoming a high priority effort within most healthcare organizations.
eimbursement Models are changing as a result of the ACA. Healthcare reimbursement is moving from Fee for Service to Fee for Value. Ninety percent of Medicare payments will be tied to quality or value in 2018.
FEE FOR SERVICE FEE FOR VALUE
Reimbursed for line item services Payment rewards population value: quality and efficiency
No incentive to increase quality of care
Quality impacts reimbursement
No shared financial risk Partnerships based on shared risk
No incentive to produce better outcomes
Incentives aligned with outcomes
No incentive to collaborate Collaboration encouraged and rewarded
Focused on episodic care and the acute stay
Focused on ambulatory care, navigating healthcare journeys
These changes necessitate a change in the way healthcare organizations care for patients. It requires an active engagement between patients, their
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Silverline enables providers to identify and manage care gaps by
creating campaign creation and referral management utilizing HEDIS Measures.
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coordination. Active care coordination consists of assigning an RN to actively reach out to and manage the care of a patient through the PCP-defined care plans, standing order sets, and remote monitoring. Passive care coordination is accomplished through passive interaction with patients to include addressing gaps in care and monitoring for events that would increase their risk score. This can be done with assessments, documentation of barriers to care, or notifications of adverse events from a health information exchange (HIE).
Disease management is an important component of a successful ambulatory care coordination model. Organizations can develop and implement disease specific care plans and protocols for diseases such as asthma, chronic obstructive pulmonary disease (COPD), congestive heart failure (CHF), diabetes, hypertension (HTN). These protocols can be developed in-house or linked to protocols from respected healthcare organizations such as Cleveland Clinic, Mayo Clinic, or Geisinger. Silverline has leveraged Salesforce’s Health Cloud that has care plans and the framework to support such capabilities built in.
Many of the Medicare innovation (alternative payment) models, such as Chronic Care Management (CCM) program and Medicare Shared Savings Program (MSSP) have specific requirements for reimbursement. For example,
families and the healthcare organization that now has reimbursement tied to the patient’s healthcare outcomes. It is no longer enough to be reactive to acute patient episodes, but healthcare organizations must be proactive to prevent or reduce these acute episodes, thus increasing the patient’s quality of life.
The first step in developing a successful ambulatory care coordination model is to know your patients. In order to effectively manage risk (increasing shared savings and quality incentives while reducing readmissions and unnecessary care) a healthcare organization must risk stratify its patient population to identify high risk and high cost patients in real time. This can be done with external risk stratification tools with the risk score imported to Salesforce, but there must be a real time nurse-driven factor that can change the patient’s risk score as needed. It’s not enough to rely on claims data, which is typically 60-120 days old.
The high risk/high cost patients can be assigned to active care coordination while the moderate to low risk patients can be assigned to passive care
SILVERLINE POINT OF VIEW SERIES
SECTION 3: AMBULATORY CARE COORDINATION
PROVIDER ROADMAP FOR SUCCESS ON CRM
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Silverline’s CCM component for Health Cloud includes a countdown timer to satisfy the 20 minute minimum contact requirement while also providing a billing model for organizations that provide this service for PCP’s.
As mentioned above, preventative care plays an important role in increasing the quality of care while reducing the cost of care for at risk patients. Silverline’s Care Gap Management approach allows for the tracking of care gap campaigns and associated referrals utilizing HEDIS measures as the framework and linking object. This allows for both the identification of eligible patients and the navigation of patients to the appropriate provider for testing and treatment in a Patient Engagement Center setting through the use of outreach workflows and reminders. Silverline’s Nurse Triage accelerator allows nurses to navigate consumers and patients to the most appropriate level of care and place of care within a healthcare organization. It utilizes the gold standard for nurse triage: Schmitt-Thompson Clinical Content. It provides call center nurses with the tools and information they need in an easy-to-access format so they can utilize symptom-based protocols and determine the most appropriate disposition and care advice to callers.
The tracking of quality and compliance within these programs is critical. Each program has unique documentation standards, intervention timing and quality indicators. Each payor, government or commercial, manages their fee for value programs differently. The ability to customize the reporting and dashboards to meet these unique requirements makes Salesforce the perfect platform for ambulatory care coordination.
SILVERLINE POINT OF VIEW SERIES
SECTION 3: AMBULATORY CARE COORDINATION
Silverline creates solutions that leverage Salesforce Health Cloud and align with the Health Cloud Roadmap.
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SECTION 4
Transitions in Care
he transition of a patient from one healthcare treatment setting to another is typically called care transitions or transitional care management. Common transitions include Emergency Department or Acute Inpatient stay to home. However, many patients require a carefully scripted “step-down” care transition from an acute stay to skilled nursing, then to outpatient rehabilitation or home health. These transitions are often initiated by a case manager in the inpatient setting, but once the patient leaves the hospital, there’s little contact or follow-up post-discharge.
That’s the crux of the problem. While hospitals have traditionally served as the focal point for initiatives to reduce readmissions, it’s clear that there are multiple factors that impact re-admissions involving downstream providers the patient’s return to health and home. Not to mention keeping track of these activities is often difficult or non-existent given they often operate outside of an EHR.
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Nearly one in five Medicare patients discharged from a hospital—approximately 2.6 million
seniors—are readmitted within 30 days, at a cost of over $26 billion every year.
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4 Medication Reconciliation Many patients will leave the hospital with new prescriptions for medications
• Review all medications the patient is taking as prescribed by hospital providers, PCP and specialists.
• All providers may not share an EHR, so it’s important to provide this information.
5 Develop and implement a follow-up/outreach plan• This can include a series of phone calls and
assessments, virtual visits, remote monitoring devices or visits to healthcare settings such as skilled nursing facilities or long term care centers.
Medicare is driving many of the changes in managing care transitions. The Affordable Care Act (ACA) created a Community Based Transitions Program (CCTP) which utilizes community-based organizations (CBO’s) to manage transitions for high risk Medicare patients to improve the quality of care and prevent readmissions. Medicare also created CPT codes and a fee schedule to reimburse providers (usually PCP’s) for transition care management (TCM) services. This is a huge opportunity for physician groups to improve the quality of care for patients being discharged from the emergency department or hospital while receiving additional compensation. Many organizations are using a centralized model and the Salesforce platform to manage these transitions in care.
The key components in developing a successful Care Transitions Program include the following:
SILVERLINE POINT OF VIEW SERIES
SECTION 4: TRANSITIONS IN CARE
1 Begin discharge planning before the patient is admitted This is not possible in all cases, but when the inpatient stay is planned, assess the patient’s familiarity with the procedure and follow-up care.
• Assess for barriers to care and amount of support the patient will have as they transition to home.
• Discover patient education opportunities such as never having anesthesia before or what to expect in a hospital stay.
2 Coordinate with case manager during inpatient stay
3 Reinforce discharge plan and instructions Most patients do not remember discharge instructions given at the hospital or Emergency department in the rush to vacate the room and arrange for transportation
• If transitioning to another care setting, educate the patient about what to expect.
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The following services can be managed in a remote or call center setting by dedicated nurses:
• Interactive contact made with the beneficiary and/or caregiver, as appropriate, within two business days following the beneficiary’s discharge to the community setting can be made by clinical staff who have the capacity for prompt interactive communication addressing patient status and needs beyond scheduling follow-up care.
• Communicate with agencies and community services the beneficiary uses.
• Provide education to the beneficiary, family, guardian, and/or caretaker to support self-management, independent living, and activities of daily living.
• Assess and support treatment regimen adherence and medication management.
• Identify available community and health resources.• Assist the beneficiary and/or family in accessing needed
care and services.
These services require access to a robust database of providers, facilities, services and community-based organizations to effectively manage the care transition. Following the 30 day TCM period, high risk/high cost patients can be assigned to active care coordination while the moderate to low risk patients can be assigned to passive care coordination. Active care coordination consists of assigning an RN to actively reach out to and manage the care of a patient through the PCP-defined care plans, standing order sets, and remote monitoring. Passive care coordination is accomplished through passive interaction with patients to include addressing gaps in care and monitoring for events that would increase their risk score. This can be done with assessments, documentation of barriers to care, or notifications of adverse events from a health information exchange (HIE).
Many of the services for TCM are performed by the healthcare provider such as the mandatory face-to-face visit, reviewing discharge information and determining the need for additional testing and treatment. However, there is a significant role for clinical staff, such as an RN Care Coordinator, to impact the quality of care and prevent readmissions. These services can be provided via telephone, email or face-to-face.
SILVERLINE POINT OF VIEW SERIES
SECTION 4: TRANSITIONS IN CARE
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Silverline’s best practice approach to patient engagement for care transitions can help manage the activities that are required summarized below:
• Manage Acute Care Discharges Coordinate the acute care (hospital) to home care journey for patients needing additional care settings post-hospital stay
• Transition Care Management Satisfy requirements for Medicare’s transition care management (TCM) program
• Engage via Communities Create pre-procedure and post-procedure pathways and workflows via patient communities
• Prevent Readmissions Provide nurse triage, education and support to patients and caregivers through to prevent readmissions
• Step-down Care Management Manage transition services roadmap: Acute Care > Skilled Nursing > Rehabilitation > Home Health
• Compliance Measures Track interventions and compliance with Medicare Episode-based Payment Initiatives
SILVERLINE POINT OF VIEW SERIES
SECTION 4: TRANSITIONS IN CARE
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SECTION 5
Speciality Care Coordination
ealthcare organizations tend to specialize in certain disease-specific programs or service lines:
• Oncology MD Anderson, Memorial Sloan Kettering, Cancer Treatment Centers of America
• Cardiology & Heart Surgery Cleveland Clinic, Mayo Clinic
• Gastroenterology & GI Surgery Mt Sinai, Johns Hopkins
• Orthopedic Surgery Hospital for Special Surgery (NY), Rush University Medical Center (Chicago)
However, every healthcare organization has programs or service lines that they are known for in their community and drive significant revenue into their healthcare system. They all provide disease-specific care utilizing evidence-based protocols. There are three specific programs we will discuss in detail: Oncology, Weight Loss Surgery and Orthopedic Surgery.
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Weight Loss SurgeryBariatric or Weight Loss Surgery is a growing use case within healthcare organizations as the US population struggles with obesity. Weight loss has significant health benefits and can reduce or eliminate the impact of multiple chronic diseases including: diabetes, hypertension, high cholesterol, obstructive sleep apnea and joint pain. While there are several different types of procedures, all surgery candidates go through a detailed qualification process:
• Meet insurance criteria• Psychological evaluation• Labs and imaging• Diet and exercise modification• Pulmonary, GI and Cardiac clearance
There is also a significant post-procedure follow-up protocol with specific milestones to be achieved. Users vary widely, based on the program type. If there’s a marketing component, marketing and patient contact center would be involved. Nurse coordinators would manage the overall process while dieticians would have regular interactions with the patient. Referral coordinators would manage the myriad of testing and clearances required. Patients could also be included to report weight, diet and exercise while completing assigned tasks.
A new study by Imperial College London and World Health Organization found a tenfold increase in childhood and adolescent obesity in four decades.
SILVERLINE POINT OF VIEW SERIES
SECTION 5: SPECIALTY CARE COORDINATION
OncologyAs cancer care has transitioned from an acute episode to a chronic disease, treatment has become more complex. Most healthcare organizations operate virtual cancer centers with care providers and facilities in different locations and often on different EHR’s. Nurse Navigator programs are necessary to navigate patients through prevention, screening, and diagnosis treatment while accounting for a patient’s barriers to care, support system and educational needs.
Referral management is also a key component because many of the imaging and treatment facilities are siloed and the referral decisions can be made by multiple providers on the care team. A strong referral management framework increases patient satisfaction and downstream revenue. Users are both clinical (RN’s, Social Workers) and non-clinical (Referral Coordinators, Lay Navigators).
There is a voluntary Oncology Care Model from Medicare in which healthcare organizations can choose to participate. It creates a six month episode of care for chemotherapy in which providers are paid a per beneficiary per month fee in addition to fee for service. They can also earn shared savings for reducing the total cost of care.
Orthopedic SurgeryPrograms for knee and hip joint replacement are expanding across the US and are divided into two groups: hospitals performing in-patient procedures and ambulatory surgery centers performing outpatient procedures.
On the inpatient side, most hospitals are participating in Medicare’s Comprehensive Care for Joint Replacement (CCJR). This is a mandatory shared savings model where a hospital is paid for a joint replacement episode and responsible for managing the total cost of care including the procedure, hospital stay and post-acute care. It is based on the Medicare bundled payment for care improvement (BPCI) programs that were voluntary.
In these programs, the incentive is to shorten the acute stay and the post-acute inpatient rehabilitation or skilled nursing stay through the use of patient education and care coordination. Specific outreach and engagement protocols are designed to assess the patient’s post-procedure progress over 90 days to reduce complications and prevent readmissions.
On the ambulatory care side, surgeons have partnered with outpatient surgery centers to create short stay joint replacement episodes that reduce the cost of care. This also requires nurse navigation to guide the patient through the pre-surgical preparations and post-surgical recovery period. Since there is no overnight stay, nurses are critical in creating a virtual care team to ensure the patient does not have any complications or acute events.
Regardless of the specialty care service line, healthcare organizations are focused on providing evidence-based care. They provide disease-specific care coordination and management services based on best practice protocols. Silverline’s best practice approach to patient engagement, leveraging Salesforce Health Cloud allow organizations to effectively navigate patients through these procedures by establishing a framework for activity, task, and communication tracking to ensure a patient is informed and engaged throughout the journey. Further, we support the establishment of onboarding programs by leveraging campaigns and other native consumer engagement marketing tools.
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SECTION 5: SPECIALTY CARE COORDINATION
Jim Rogers is a dynamic, passionate leader in Patient Relationship Management, Care Coordination and Population Health Management. His past experience includes valuable time spent as a Salesforce Architect, Administrator, and Consultant.
Utilizing a unique blend of clinical, technical, and strategic expertise, Jim as a Registered Nurse, helps Silverline further extend value to customers by speaking from a ‘real world perspective’ as a user of the Salesforce platform. He is passionate about Healthcare and has deep knowledge about many of the initiatives that are front and center for Healthcare executives, whether care coordination, population health management, or patient access centers. His expertise further reinforces Silverline’s differentiator as an implementation partner with unique industry knowledge.
Connect with Jim on:
https://www.linkedin.com/in/jimrogersrn/
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Jim Rogers, RN, BSNSenior Director,
Healthcare Practice
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About the Authors
att is an experienced executive, strategic thinker, and consultant operating at the intersection of Technology and Healthcare. Matt is passionate about driving innovation within the Healthcare industry to reinforce the shift to consumer centered and value-based care, along with exploring how new technology trends such as CRM, cognitive, and big data further expedite the overall path to improvement. Prior to Silverline, Matt was a Healthcare technology and management consultant, and has had senior positions in product management and solution architecture as a co-founder of Healthcare startups focused on the provider onboarding and revenue cycle continuum. He has been working with Salesforce.com and related cloud/industry applcations for over 10 years. He resides in NYC with his wife and daughter.
