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Agentforce to the Team

Salesforce Unveils AI-Powered Agentforce for Health

Salesforce Unveils AI-Powered Agentforce for Health to Streamline Healthcare Operations Salesforce is expanding its AI capabilities in healthcare with the launch of Agentforce for Health, a library of ready-made, autonomous AI tools designed to tackle time-consuming administrative tasks for providers, payers, and public health organizations. Unlike traditional AI assistants that require constant human input, Agentforce for Health leverages agentic AI, which can make independent decisions and operate with minimal intervention. This shift could be a game-changer for an industry grappling with labor shortages, burnout, and rising administrative costs—which McKinsey estimates at $1 trillion annually in the U.S. alone. How Agentforce for Health Works The new solution offers a range of AI-powered capabilities, including: By automating these processes, healthcare teams estimate they could save up to 10 hours per week, according to a Salesforce survey released alongside the product announcement. Salesforce’s AI Edge in Healthcare While tech giants like Google (Agentspace) and Microsoft are also investing in AI-driven healthcare solutions, Salesforce differentiates itself through its deep integration with its CRM platform. This allows Agentforce for Health to not only automate tasks but also seamlessly enhance patient engagement and care coordination. Additionally, Salesforce’s Einstein Copilot Health Actions, a conversational AI assistant launched in April, complements Agentforce by enabling interactive AI-driven decision-making for healthcare teams. Availability & Future Rollout Salesforce is rolling out Agentforce for Health’s AI skills through September for clients using its cloud platform. As AI adoption accelerates in healthcare, Salesforce is positioning itself as a key player in helping the industry reduce administrative burdens, improve efficiency, and enhance patient outcomes. Like Related Posts Salesforce OEM AppExchange Expanding its reach beyond CRM, Salesforce.com has launched a new service called AppExchange OEM Edition, aimed at non-CRM service providers. Read more The Salesforce Story In Marc Benioff’s own words How did salesforce.com grow from a start up in a rented apartment into the world’s Read more Salesforce Jigsaw Salesforce.com, a prominent figure in cloud computing, has finalized a deal to acquire Jigsaw, a wiki-style business contact database, for Read more Service Cloud with AI-Driven Intelligence Salesforce Enhances Service Cloud with AI-Driven Intelligence Engine Data science and analytics are rapidly becoming standard features in enterprise applications, Read more

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AI-Driven Healthcare

The Future of Healthcare is Digital

Transforming Healthcare with Salesforce Health Cloud In our rapidly evolving healthcare world, digital transformation is no longer optional—it’s essential. Healthcare organizations must leverage innovative solutions to improve patient outcomes, streamline operations, and drive financial growth. Salesforce Health Cloud empowers providers, payers, and life sciences companies to deliver personalized, connected, and data-driven care. The Urgency of Digital Transformation in Healthcare Healthcare organizations face increasing pressure from regulatory requirements, patient expectations for seamless digital experiences, and operational inefficiencies. Traditional systems are often fragmented, making it difficult to provide a unified patient experience. Salesforce Health Cloud addresses these challenges by enhancing communication, centralizing data, and optimizing workflows. Key Benefits of Salesforce Health Cloud ✅ Enhanced Patient EngagementPatients expect convenience, transparency, and personalization. Health Cloud delivers seamless communication through patient portals, automated reminders, and AI-driven insights—leading to higher engagement and improved adherence to treatment plans. ✅ 360-Degree Patient ViewBy integrating data from electronic health records (EHRs), wearable devices, and other sources, Health Cloud provides a unified patient profile. This empowers providers and payers to make data-driven decisions that improve both clinical and business outcomes. ✅ Operational Efficiency & Cost ReductionHealth Cloud automates workflows, reduces redundancies, and improves productivity by integrating clinical, operational, and administrative processes. Real-time collaboration enhances care coordination across teams and organizations. ✅ AI-Powered Insights for Better Decision-MakingWith AI-driven analytics and predictive insights, healthcare organizations can identify at-risk populations, optimize resource allocation, and enhance population health management. Salesforce Einstein AI helps forecast trends and personalize care recommendations. ✅ Interoperability & Regulatory ComplianceNavigating complex healthcare regulations is easier with Health Cloud’s secure architecture, ensuring compliance while enabling seamless data exchange between systems and stakeholders. Why Healthcare Organizations Should Adopt Health Cloud Investing in digital transformation provides a competitive advantage by improving patient satisfaction, reducing operational costs, and driving better health outcomes. Salesforce Health Cloud enables organizations to future-proof their operations, boost revenue, and implement a seamless, value-based care model. Use Cases of Salesforce Health Cloud 🏥 Health Insurers – Improve member engagement, claims processing, and care management to enhance efficiency and reduce costs. 🏥 Hospitals & Health Systems – Streamline care coordination, minimize readmissions, and enhance patient experiences with personalized care plans. 🏥 Home Healthcare & Telemedicine – Enable remote patient monitoring and virtual care, improving accessibility while reducing hospital visits. 🏥 Life Sciences Companies – Accelerate drug development, streamline clinical trials, and enhance collaboration with providers and patients. The Future of Healthcare is Digital Salesforce Health Cloud is at the forefront of healthcare’s digital revolution. By leveraging AI, automation, and seamless integrations, healthcare leaders can improve patient experiences, drive operational efficiency, and ensure long-term success. Now is the time to embrace a data-driven approach to healthcare management. Like Related Posts Salesforce OEM AppExchange Expanding its reach beyond CRM, Salesforce.com has launched a new service called AppExchange OEM Edition, aimed at non-CRM service providers. Read more The Salesforce Story In Marc Benioff’s own words How did salesforce.com grow from a start up in a rented apartment into the world’s Read more Salesforce Jigsaw Salesforce.com, a prominent figure in cloud computing, has finalized a deal to acquire Jigsaw, a wiki-style business contact database, for Read more Service Cloud with AI-Driven Intelligence Salesforce Enhances Service Cloud with AI-Driven Intelligence Engine Data science and analytics are rapidly becoming standard features in enterprise applications, Read more

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Autonomous AI Service Agents

How Do Autonomous Agents Work?

Autonomous agents like Florida Bay’s understand and respond to requests, and then act without human intervention. Give the agent a goal, and it generates tasks for itself, completes them, and moves on to the next one until the goal is achieved. Unlike traditional chatbots that follow predefined rules, autonomous agents operate in dynamic environments, making them perfect for complex tasks in customer service, marketing, commerce, sales, and more. While autonomous agents don’t need human help to complete their tasks, they still need you to describe the ideal goals and main objectives you want to achieve. Once in action, the agent can save your business significant time and resources and allow you to focus on improving the overall customer experience and driving growth–just like at Florida Bay. You might think setting up an agent takes a lot of time, but autonomous agents‌ require less time to build compared with traditional bots. And they can do more when you set them up with the right data and actions. Let’s take a look at the key components that make them effective. Data Data is the foundation of an autonomous agent‘s functionality. It’s what enables an agent to make informed decisions and execute tasks autonomously. At Florida Bay, the concierge agent analyzes opt-in data about the Smith family, including family member profiles, past travel history, and more, to gain a deeper understanding of their preferences. With these insights, the agent can personalize every aspect of their trip and provide a seamless and enjoyable vacation. Decision-Making When an autonomous agent analyzes data, it uses advanced decision-making algorithms to prioritize and execute tasks efficiently. For the concierge agent at Florida Bay, that means evaluating various options and scenarios to ensure that every decision aligns with the Smith family’s preferences and goals. Action Execution After making data-driven decisions, the agent seamlessly transitions to executing the planned actions. For the concierge agent, those planned actions might be autonomously reserving hotel rooms, arranging transportation, and more. This not only enhances the customer experience but also allows the business to save an immense amount of time and focus on other critical tasks that provide even better customer service. Learning and Adaptation Over time, the agent continuously learns from each interaction and adapts to improve future performance. It analyzes feedback and outcomes to refine its algorithms and decision-making processes to better meet the customer’s needs. In addition, autonomous agents are adaptable to various situations and can provide data-driven solutions to simplify and improve efficiency in a wide range of areas. Let’s take a look at that next. Autonomous Agents in Action Autonomous agents are becoming increasingly universal and offer support in a wide range of fields. Here are some industries where they bring significant benefits and support to CRM platforms. Healthcare An autonomous agent can engage with patients, providers, and payers to resolve inquiries, provide summaries, and take action. For example, a patient services agent can answer simple patient questions, help schedule appointments with the best physician, review coverage benefits, generate medical history summaries, and approve care requests. Example: A patient needs to schedule a follow-up appointment with a specialist. They use the healthcare provider’s agent to request the appointment. The autonomous agent checks the availability of the best-suited specialist, confirms the patient’s insurance coverage, and schedules the appointment. The agent also generates a summary of the patient’s medical history and sends it to the specialist in advance. This streamlined process ensures that the patient receives timely care and reduces the administrative burden on healthcare staff. Financial Services Banks can autonomously manage transaction disputes through various channels such as the banking app, SMS, website, or phone. Prebuilt service flows allow agents to file complaints, meet regulatory reporting requirements, verify transaction history, alert merchants, and even issue provisional credits or new cards. These autonomous agents only escalate to a human for final authorizations, saving time and allowing human experts to focus on more complex interactions. Example: A customer notices a fraudulent transaction on their bank statement and reports it through the banking app. The autonomous agent verifies the transaction history, files the complaint, and issues a provisional credit to the customer’s account. The agent also alerts the merchant and schedules a follow-up with a human representative for final authorization. This process, which used to take several days, is now completed within hours, significantly improving customer satisfaction and reducing the workload on human service reps. Insurance Insurance companies can autonomously update coverage, extend better pricing to qualified policyholders, update beneficiaries, schedule and deploy claims adjusters, and even issue claims checks or policy renewals—all without human intervention. Wealth advisors reported that 67% of their daily work is non–value-added administrative work. Autonomous agents can reduce this by planning, scheduling, and summarizing client meetings, drafting client communications, and ensuring compliance by routing communications to the proper licensed supervisors. Example: An insurance policyholder wants to update their beneficiary information. They use the insurance company’s mobile app to make the change. The autonomous agent verifies the policyholder’s identity, updates the beneficiary’s information, and sends a confirmation email. The agent also ensures that the change is compliant with regulatory requirements by routing the communication to a licensed supervisor for a final review. This process, which previously required a phone call and manual processing, is now completed in seconds, freeing up the policyholder’s time and reducing administrative workload. Retail Autonomous agents can share campaign insights, proactively manage customer outreach, and resolve cases for retailers. A personal shopper autonomous agent acts like a digital concierge for online shoppers, using generative AI to help customers on ecommerce sites, chat, or messaging apps like WhatsApp. While basic chatbots only solve predefined questions, autonomous AI agents learn from shoppers’ behavior and preferences and can provide natural language searches, conversational responses, and quick cart additions for instant checkout. Example: A customer is shopping for a new pair of shoes on an ecommerce site. The personal shopper autonomous agent, integrated into the chat feature, engages with the customer and analyzes their past purchases and preferences.

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ai arms race

AI Arms Race

AI Arms Race: Providers Catching Up to Payers in Claims Review The healthcare sector is in the midst of an escalating AI arms race as providers adopt the same artificial intelligence technologies payers are leveraging for claims review. Insurers currently lead this race, using AI to streamline processes such as prior authorizations, but experts predict providers will soon narrow the gap. Insurers’ AI Advantage Leading payers, including UnitedHealth, Humana, and Cigna, have integrated algorithmic decision tools to assess claims and determine coverage eligibility. These technologies allow insurers to flag services that fall outside plan criteria, ostensibly increasing efficiency. This trend is expanding, as evidenced by Blue Shield of California’s announcement of a partnership with Salesforce to pilot claims automation technology in early 2025. The nonprofit insurer claims this initiative will reduce prior authorization decision times from weeks or days to mere seconds, benefiting providers and patients alike. However, provider experiences paint a more contentious picture. Reports from lawmakers and healthcare executives suggest AI-driven claims processes lead to a surge in denials. For example, Providence CFO Greg Hoffman revealed that AI adoption by payers resulted in a 50% increase in underpayments and initial denials over two years, forcing providers to significantly increase manual interventions to resolve claims. A Battle for Balance The imbalance in AI adoption has prompted providers to take action. Experts like Jeffrey Cribbs, a vice president analyst at Gartner, see this as a forced “arms race” in which both sides are continually refining their tools. While payers focus on flagging potential exceptions, providers are working to develop systems for more efficient claims submissions and dispute resolution. Providence’s strategy includes outsourcing revenue cycle management to R1, a 10-year partnership designed to quickly address rising claims denials. Hoffman explained that building equivalent AI systems internally would take years, making partnerships essential for staying competitive in the short term. Collaboration Among Providers On the provider side, executives like Sara Vaezy, EVP and Chief Strategy Officer at Providence, emphasize the need for collaboration. She advocates for coalitions to share data and establish AI standards, which would allow providers to compete more effectively. Panelists at HLTH echoed this sentiment. Amit Phull, Chief Physician Experience Officer at Doximity, argued that AI could eventually “level the playing field” for providers by reducing the time required for claims documentation. Deloitte principal consultant Bill Fera added that AI would allow providers to quickly analyze policies and determine whether a patient qualifies for coverage under plan terms. The Road Ahead Despite the current disparity, experts believe AI will eventually equalize the claims review process. Providers are beginning to invest in tools that will help them handle vast amounts of data efficiently, offering clarity in disputes and cutting down documentation time. “It’s still early innings,” Phull said, “but the technology is going to go a long way toward leveling that playing field.” For now, however, insurers maintain the upper hand. As providers navigate the complexities of AI adoption, partnerships and collaboration may prove critical in ensuring they remain competitive in this rapidly evolving landscape. Like Related Posts Salesforce OEM AppExchange Expanding its reach beyond CRM, Salesforce.com has launched a new service called AppExchange OEM Edition, aimed at non-CRM service providers. Read more The Salesforce Story In Marc Benioff’s own words How did salesforce.com grow from a start up in a rented apartment into the world’s Read more Salesforce Jigsaw Salesforce.com, a prominent figure in cloud computing, has finalized a deal to acquire Jigsaw, a wiki-style business contact database, for Read more Service Cloud with AI-Driven Intelligence Salesforce Enhances Service Cloud with AI-Driven Intelligence Engine Data science and analytics are rapidly becoming standard features in enterprise applications, Read more

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Potential of GenAI in Healthcare

Potential of GenAI in Healthcare

Clinicians spend about 28 hours per week on administrative tasks, mainly clinical documentation and communication. Medical and claims staff reported even higher administrative loads, with 34 and 36 hours spent weekly on tasks like documentation, communication, and prior authorization. Many respondents linked these demands directly to burnout, with 77% of claims staff, 81% of medical staff, and 82% of clinicians citing administrative burdens as significant contributors. Additionally, 78% of payer executives and 85% of provider executives noted that administrative work is a key driver of staffing shortages.

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Value-Based Care Technologies

Value-Based Care Technologies

Essential Technologies for Value-Based Care Success As healthcare providers increasingly adopt value-based care, they must invest in the right technologies and resources to succeed in this model, which incentivizes high-quality, cost-effective care. Value-Based Care Technologies tie reimbursement to care quality, making providers accountable for patient outcomes while providing resources to enhance care. As of 2021, nearly 60% of healthcare payments were already tied to value-based models, according to the Health Care Payment Learning and Action Network (HCP LAN). While partnerships can initiate value-based care, providers must invest in the right technology to fully achieve the intended outcomes. Health Information Exchange (HIE) A robust health information exchange (HIE) is fundamental to value-based care, as it enables providers and payers to access high-quality data seamlessly. HIE allows healthcare professionals to share patients’ medical information electronically across organizations, promoting care coordination by giving providers a comprehensive view of patient needs. For patients, HIE enables more informed involvement in their care by making their health data accessible across specialists, labs, and pharmacies. While joining an HIE may involve new technology investments and workflow adjustments, it ultimately enhances provider access to critical health data. Population Health Management Tools Population health management tools help providers assess health outcomes within groups rather than focusing on individuals alone. These tools aggregate and analyze data, allowing practices to identify high-risk patients and create targeted interventions. This not only enhances health outcomes but can also reduce costs by avoiding expensive treatments. Patient engagement tools, such as telehealth and remote patient monitoring, are essential in population health management, especially for monitoring high-risk patients when in-person care is not feasible. Digital surveys integrated within patient portals can provide insights into social determinants of health, adding a broader context to patient needs. Data Analytics Data analytics transform healthcare data into actionable insights across four types: descriptive, diagnostic, predictive, and prescriptive. Providers can use these analytics to reduce hospital readmissions, predict diseases, and identify chronic illnesses. Data integration and risk stratification capabilities are especially valuable in value-based care, enabling providers to track patient health outcomes effectively and prioritize high-risk cases. Artificial Intelligence & Machine Learning AI and machine learning support many data analytics functions, helping identify patient needs and easing administrative burdens. Given staffing shortages and burnout—reported by 63% of physicians in 2021, according to the American Medical Association (AMA)—AI can automate tasks like documentation, charting, and scheduling, allowing providers to focus more on patient care. Additionally, AI-driven automation in revenue cycle management tasks, such as billing and coding, can reduce the administrative workload associated with value-based care. Price Transparency Technology Price transparency empowers patients to seek cost-effective care, a core principle of value-based models. When providers comply with transparency regulations, patients can better understand their costs and make informed decisions. For providers, leveraging price transparency tools ensures compliance and facilitates partnerships with payers by enabling more effective negotiation, which supports the overall goals of value-based care. As healthcare continues shifting to value-based models, investing in these technologies is critical for providers aiming for long-term success. While these tools rdo equire substantial investment, they are essential for improving patient outcomes, optimizing care quality, and ensuring sustainability in value-based care. When evaluating and choosing healthcare technology tools, contact Tectonic for help. Like1 Related Posts Salesforce OEM AppExchange Expanding its reach beyond CRM, Salesforce.com has launched a new service called AppExchange OEM Edition, aimed at non-CRM service providers. Read more The Salesforce Story In Marc Benioff’s own words How did salesforce.com grow from a start up in a rented apartment into the world’s Read more Salesforce Jigsaw Salesforce.com, a prominent figure in cloud computing, has finalized a deal to acquire Jigsaw, a wiki-style business contact database, for Read more Service Cloud with AI-Driven Intelligence Salesforce Enhances Service Cloud with AI-Driven Intelligence Engine Data science and analytics are rapidly becoming standard features in enterprise applications, Read more

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Agentforce in Healthcare

The healthcare industry is on the brink of a digital revolution, and in this era, Salesforce Agentforce—a new AI technology in healthcare—is set to play a pivotal role in providing innovative solutions that enhance AI-driven patient engagement, streamline processes, and improve overall AI services in healthcare. Salesforce Agentforce AI integration in healthcare will lead to significant cost reductions and improved operational efficiency. Healthcare organizations that leverage Agentforce have reported substantial improvements in productivity by automating administrative tasks and streamlining workflows. In this insight, we’ll explore Salesforce Agentforce—the new AI technology in healthcare—the role of conversational AI in healthcare, and what the future holds for AI-driven medical solutions. What is Agentforce and How Does It Support Healthcare? Salesforce’s Agentforce is designed to provide healthcare organizations with fully tailored AI-powered agents that can operate various tasks. These AI agents can handle customer support enquiries, assist in sales processes, and even provide real-time coaching for healthcare professionals. Agentforce AI agents can manage appointment scheduling, follow-ups, and patient enquiries efficiently. The agents also integrate robust data protection protocols to ensure all patient information is securely handled, helping healthcare providers streamline administrative processes while maintaining high standards of security and compliance. By leveraging these AI services in healthcare, organizations can optimize workflows and improve overall efficiency. Challenges in Healthcare AI Integration Healthcare organisations can face several challenges when integrating new AI technology in healthcare. These challenges include data security concerns, the complexity of managing diverse patient needs, and ensuring workflow efficiency. One of the key obstacles is gaining a unified, up-to-date view of patients, providers, and payers while still ensuring multi-channel communication. Data security is a top priority for healthcare institutions, as they must safeguard patient information while complying with stringent regulations. Salesforce Agentforce tackles these challenges by providing advanced security measures, automated workflow optimisation, and real-time decision-making support. Pre-Built Use Cases for Healthcare Salesforce’s Agentforce includes multiple out-of-the-box AI capabilities that enhance AI patient engagement and improve healthcare operations. Some of its key applications include: • Intelligent Document Processing: AI-driven data extraction from medical records reduces administrative workload, allowing healthcare professionals to focus on patient care. • Medical History Summarization: AI agents summarize patient medical histories, prescriptions, andfactors that influence health and well-being, enabling caregivers to make more informed decisions. • Automated Appointment Scheduling: AI-driven systems manage patient appointments, reducing wait times and improving the overall patient experience. • Claims Processing Optimization: AI consolidates data for claims processing, reducing delays and enhancing revenue cycle management. • Trial Candidate Matching: AI-driven algorithms identify suitable candidates for clinical trials by analyzing demographic and medical data. Custom AI Agents for Healthcare Agentforce also enables healthcare organizations to create custom AI agents designed for specific operational needs. These AI agents help automate repetitive tasks, improve AI patient engagement, and optimize care management processes. • Patient Services: AI-driven chatbots summarize medical histories, generate personalized emails, and assist with healthcare assessments. • Provider Network Management: AI optimizes provider networks by assessing provider details and minimizing patient wait times. • Program and Patient Outcome Management: AI offers real-time insights into patient adherence to programs and provides recommendations to improve satisfaction rates. • Benefits Verification: AI streamlines benefits verification through automated call scripts and pharmacy benefits summaries. The Future of AI in Healthcare As AI technology continues to evolve, we can expect deeper integration of AI services in healthcare, particularly in robotic-assisted surgeries, automated patient monitoring, and virtual healthcare assistants. These innovations will not only enhance patient engagement but also reduce the burden on healthcare professionals by automating time-consuming administrative tasks. Conversational AI in healthcare is set to play an even bigger role in the industry. AI-powered chatbots and virtual assistants will become more sophisticated, offering more accurate diagnoses, providing mental health support, and assisting in real-time patient interactions. This will lead to a more seamless, accessible, and efficient healthcare system. With these developments, healthcare providers will need to continue prioritising AI ethics, data security, and compliance to ensure that AI implementation remains both safe and effective. By leveraging trusted AI solutions like Agentforce, healthcare organizations can stay ahead of the curve, delivering cutting-edge care while maintaining operational efficiency. Implementing Agentforce with Tectonic AI Consulting and Integration Specialists – Partnering with the right AI implementation experts ensures smooth integration and better alignment with your healthcare operational goals. Organizations working with Tectonic, a trusted AI and Salesforce implementation partner, can accelerate the deployment of Agentforce, ensuring optimal efficiency and productivity. Tectonic specializes in integrating new AI technology in healthcare to enhance operational efficiency and improve AI patient engagement. Our Salesforce team has helped multiple healthcare organizations seamlessly implement Agentforce, ensuring that AI-driven workflows are tailored to meet the specific needs of their providers and patients. By working with Tectonics, healthcare organizations can leverage: • Seamless AI Integration: Ensuring that Agentforce aligns with existing systems and operational workflows. • Custom AI Development: Designing AI-powered solutions that address key industry challenges. • Ongoing Support and Optimization: Continuous monitoring and improvement to maximise the effectiveness of conversational AI in healthcare. Healthcare providers who collaborate with Tectonic can unlock the full potential of Agentforce, leading to enhanced patient experiences and streamlined operations. The adoption of new AI technology in healthcare will reshape the industry. Agentforce addresses key challenges in healthcare by offering conversational AI in healthcare, AI-powered automation, and data-driven decision-making support. As AI continues to evolve, Agentforce will play an increasingly vital role in optimising AI services in healthcare, empowering medical professionals, and ensuring better patient outcomes. Contact Tectonic today to learn more about implementing Agentforce and modernising your healthcare services. Content updated February 2025. Like Related Posts Salesforce OEM AppExchange Expanding its reach beyond CRM, Salesforce.com has launched a new service called AppExchange OEM Edition, aimed at non-CRM service providers. Read more The Salesforce Story In Marc Benioff’s own words How did salesforce.com grow from a start up in a rented apartment into the world’s Read more Salesforce Jigsaw Salesforce.com, a prominent figure in cloud computing, has finalized a deal to acquire Jigsaw, a

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Enhance Payer Patient Education

Enhance Payer Patient Education

Data and Technology Strategies Enhance Payer Patient Education Analytics platforms, omnichannel engagement tools, telehealth, and other technological advancements have become essential in driving successful, enhanced payer patient education. Cathy Moffitt, MD, a pediatrician with 15 years of experience in the pediatric emergency department and now the senior vice president and Aetna chief medical officer at CVS Health, understands the critical role of patient education. “Education is empowerment. It is engagement. It is very critical to making patients more equipped to handle their healthcare journey,” Moffitt said in an episode of Healthcare Strategies. “Even overseeing a large payer like Aetna, I still believe tremendously in health education.” Enhance Payer Patient Education For large payers, effective patient education begins with data analytics and a deep understanding of their member population. Through data, payers can identify key insights, including when members are most receptive to educational materials. “People are more open to hear you and to be educated and empowered when they need help right then,” Moffitt explained. Timing is crucial—offering educational resources when they’re most relevant to a member’s immediate needs increases the likelihood that the information will be absorbed and acted upon. Aetna’s Next Best Action initiative, launched in 2018, exemplifies this approach. Through this program, Aetna employees reach out to members with specific conditions, offering guidance on the next best steps for managing their health. By providing education at a time when members are most open to it, the initiative ensures that patient education is both timely and impactful. In addition to timing, payer data can shape patient education by providing insights into a member’s demographics, including race, sexual orientation, gender identity, ethnicity, and location. Tailoring educational efforts to these factors ensures that communication is accessible and resonates with members. To better connect with a diverse member base, Aetna has integrated translator services into its customer support and trained representatives on sensitivity to sexual orientation and gender identity. Additionally, updating the provider directory to reflect demographic data is crucial. When members see providers who share their language, culture, and experiences, they are more likely to engage with and retain the educational materials provided. “Understanding, in a multicultural and multifactorial way, who our members are and trying to help understand what they need…as well as understanding both acute and chronic illness from an actionability standpoint, where we can best engage to good effect as we reach out to people—that’s the cornerstone of our intent and our philosophy around how we scrub data,” Moffitt shared. With over 20 years in the healthcare industry, both as a provider and now in a payer role, Moffitt has observed key trends and identified strengths and weaknesses in patient education efforts. She noted that the most successful patient education initiatives have been in mental health and preventive care, with technology playing a crucial role in both areas. Patient education has significantly reduced the stigma around mental healthcare and highlighted the importance of mental wellness. Telemedicine has vastly improved access to care, particularly in mental health, Moffitt noted. In preventive care, more people are now aware of the benefits of cancer screenings, vaccines, wellness visits, and other preventive measures. Moffitt suggested that the increased use of home health visits and retail clinics has contributed to these improvements, particularly among Aetna’s members. Looking ahead, Moffitt predicted that customized engagement is the next frontier for patient education. Members increasingly want educational materials delivered in a personalized and streamlined manner that suits their preferences. Omnichannel engagement solutions will be vital in meeting this demand. While significant progress has been made in enabling members to receive educational materials through various channels such as email, text, and phone calls, Moffitt anticipates even more advancements in the future. “I can’t tell you exactly where we’re going to be in 10 years because I wouldn’t have been able to tell you 10 years ago where we are now, but we will continue to respond and meet the demands with the technological commitments that we’re making,” Moffitt said. Like1 Related Posts Salesforce OEM AppExchange Expanding its reach beyond CRM, Salesforce.com has launched a new service called AppExchange OEM Edition, aimed at non-CRM service providers. Read more The Salesforce Story In Marc Benioff’s own words How did salesforce.com grow from a start up in a rented apartment into the world’s Read more Salesforce Jigsaw Salesforce.com, a prominent figure in cloud computing, has finalized a deal to acquire Jigsaw, a wiki-style business contact database, for Read more Service Cloud with AI-Driven Intelligence Salesforce Enhances Service Cloud with AI-Driven Intelligence Engine Data science and analytics are rapidly becoming standard features in enterprise applications, Read more

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Boosting Payer Patient Education with Technology

Boosting Payer Patient Education with Technology

Data and Technology Strategies Elevate Payer-Driven Patient Education Analytics platforms, omnichannel engagement, telehealth, and other technology and data innovations are transforming patient education initiatives within the payer space. Dr. Cathy Moffitt, a pediatrician with over 15 years of emergency department experience and now Chief Medical Officer at Aetna within CVS Health, emphasizes the crucial role of patient education in empowering individuals to navigate their healthcare journeys. “Education is empowerment; it’s engagement. In my role with Aetna, I continue to see health education as fundamental,” Moffitt explained on an episode of Healthcare Strategies. Leveraging Data for Targeted Education At large payers like Aetna, patient education starts with deep data insights. By analyzing member data, payers can identify key opportunities to deliver educational content precisely when members are most receptive. “People are more open to hearing and being educated when they need help right then,” Moffitt said. Aetna’s Next Best Action initiative, launched in 2018, is one such program that reaches out to members at optimal times, focusing on guiding individuals with specific conditions on the next best steps for their health. By sharing patient education materials in these key moments, Aetna aims to maximize the impact and relevance of its outreach. Tailoring Education with Demographic Data Data on member demographics—such as race, ethnicity, gender identity, and zip code—further customizes Aetna’s educational efforts. By incorporating translation services and sensitivity training for customer representatives, Aetna ensures that all communication is accessible and relevant for members from diverse backgrounds. Additionally, having an updated provider directory allows members to connect with healthcare professionals who understand their cultural and linguistic needs, increasing trust and the likelihood of engaging with educational resources. Technology’s Role in Mental Health and Preventive Care Education With over 20 years in healthcare, Moffitt observes that patient education has made significant strides in mental health and preventive care, areas where technology has had a transformative impact. In mental health, for example, education has helped reduce stigma, and telemedicine has expanded access. Preventive care education has raised awareness of screenings, vaccines, and wellness visits, with options like home health visits and retail clinics contributing to increased engagement among Aetna’s members. The Future of Customized, Omnichannel Engagement Looking ahead, Moffitt envisions even more personalized and seamless engagement through omnichannel solutions, allowing members to receive educational materials via their preferred methods—whether email, text, or phone. “I can’t predict exactly where we’ll be in 10 years, but with the technological commitments we’re making, we’ll continue to meet evolving member demands,” Moffitt added. Like Related Posts Salesforce OEM AppExchange Expanding its reach beyond CRM, Salesforce.com has launched a new service called AppExchange OEM Edition, aimed at non-CRM service providers. Read more The Salesforce Story In Marc Benioff’s own words How did salesforce.com grow from a start up in a rented apartment into the world’s Read more Salesforce Jigsaw Salesforce.com, a prominent figure in cloud computing, has finalized a deal to acquire Jigsaw, a wiki-style business contact database, for Read more Service Cloud with AI-Driven Intelligence Salesforce Enhances Service Cloud with AI-Driven Intelligence Engine Data science and analytics are rapidly becoming standard features in enterprise applications, Read more

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Boost Payer Patient Education

Boost Payer Patient Education

As a pediatrician with 15 years of experience in the pediatric emergency department, Cathy Moffitt, MD, understands the critical role of patient education. Now, as Senior Vice President and Aetna Chief Medical Officer at CVS Health, she applies that knowledge to the payer space. “Education is empowerment. It’s engagement. It’s crucial for equipping patients to navigate their healthcare journey. Now, overseeing a large payer like Aetna, I still firmly believe in the power of health education,” Moffitt shared on an episode of Healthcare Strategies. At a payer organization like Aetna, patient education begins with data analytics to better understand the member population. According to Moffitt, key insights from data can help payers determine the optimal time to share educational materials with members. “People are most receptive to education when they need help in the moment,” she explained. If educational opportunities are presented when members aren’t focused on their health needs, the information is less likely to resonate. Aetna’s Next Best Action initiative, launched in 2018, embodies this timing-driven approach. In this program, Aetna employees proactively reach out to members with specific conditions to provide personalized guidance on managing their health. This often includes educational resources delivered at the right moment when members are most open to learning. Data also enables payers to tailor educational efforts to a member’s demographics, including race, sexual orientation, gender identity, ethnicity, and location. By factoring in these elements, payers can ensure their communications are relevant and easy to understand. To enhance this personalized approach, Aetna offers translation services and provides customer service training focused on sensitivity to sexual orientation and gender identity. In addition, updating the provider directory to reflect a diverse network helps members feel more comfortable with their care providers, making them more likely to engage with educational resources. “Understanding our members’ backgrounds and needs, whether it’s acute or chronic illness, allows us to engage them more effectively,” Moffitt said. “This is the foundation of our approach to leveraging data for meaningful patient education.” With over two decades in both provider and payer roles, Moffitt has observed key trends in patient education, particularly its success in mental health and preventive care. She highlighted the role of technology in these areas. Efforts to educate patients about mental health have reduced stigma and increased awareness of mental wellness. Telemedicine has significantly improved access to mental healthcare, according to Moffitt. In preventive care, more people are aware of the importance of cancer screenings, vaccines, wellness visits, and other preventive measures. Moffitt pointed to the rising use of home health visits and retail clinics as contributing factors for Aetna members. Looking ahead, Moffitt sees personalized engagement as the future of patient education. Members increasingly want information tailored to their preferences, delivered through their preferred channels—whether by email, text, phone, or other methods. Omnichannel solutions will be essential to meeting this demand, and while healthcare has already made progress, Moffitt expects even more innovation in the years to come. “I can’t predict exactly where we’ll be in 10 years, just as I couldn’t have predicted where we are now a decade ago,” Moffitt said. “But we will continue to evolve and meet the needs of our members with the technological advancements we’re committed to.” Contact Us To discover how Salesforce can advance your patient payer education, contact Tectonic today. Like Related Posts Salesforce OEM AppExchange Expanding its reach beyond CRM, Salesforce.com has launched a new service called AppExchange OEM Edition, aimed at non-CRM service providers. Read more The Salesforce Story In Marc Benioff’s own words How did salesforce.com grow from a start up in a rented apartment into the world’s Read more Salesforce Jigsaw Salesforce.com, a prominent figure in cloud computing, has finalized a deal to acquire Jigsaw, a wiki-style business contact database, for Read more Service Cloud with AI-Driven Intelligence Salesforce Enhances Service Cloud with AI-Driven Intelligence Engine Data science and analytics are rapidly becoming standard features in enterprise applications, Read more

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Improve Patient Care and Trust

Improve Patient Care and Trust

A recent survey conducted by Kyruus Health and shared with HealthPayerIntelligence reveals that consumers are demanding more accurate online provider data from payers to enhance access to care. Healthcare solutions from Tectonic and Salesforce improve patient care and trust by improving data accuracy. The survey, fielded by Wakefield Research in April 2024, involved 1,000 healthcare consumers. Nearly three-quarters of respondents (72%) had private health insurance, with Medicare being the second most common form of coverage (18%). The participants represented an even distribution across U.S. regions and age groups, with 57% identifying as women. Payers have historically struggled to maintain up-to-date provider directories, and this survey highlights the significant impact of these challenges. About 30% of consumers reported skipping care due to inaccurate provider information, with 70% of them seeking this data online. Consumers primarily rely on health plan websites or apps for provider information, with 32% naming these platforms as their first resource. Medicaid enrollees were particularly dependent on their plan’s digital resources, with 64% turning to these tools first. Besides health plan websites and apps, consumers also used general internet searches, provider or clinic websites, and healthcare information sites like WebMD. Social media platforms were also popular for care searches, with 77% of users turning to Facebook and 61% to YouTube. The survey also revealed that payers often fail to provide accurate cost predictions. Only 32% of respondents said their health plans offered accurate cost information. Price transparency tools are particularly important to younger generations, with 76% of Millennials and 80% of Gen Z respondents using these tools. However, 40% of Baby Boomers were unsure if their plans even offered such tools. Among those who did use them, 34% found that the tools presented incorrect provider data, with 45% of Gen Z reporting this issue. Inaccurate provider information can lead to significant negative consequences for consumers, including delays in accessing care, difficulties contacting preferred providers, and higher costs. Some consumers even reported accidentally receiving out-of-network care or forgoing care altogether due to these inaccuracies. These experiences not only hinder access to care but also damage consumer trust in their healthcare providers and payers. Overall, 80% of respondents said that inaccurate provider data affected their trust, with 27% losing trust in their health plans and 22% losing trust in their providers. The survey results underscore a clear call to action. Over 60% of consumers, and nearly 75% of Gen Z specifically, want their health plans to provide more accurate data. Tectonic has decades of experience applying Salesforce solutions to health care providers and payers. To address these concerns, the report recommends that health plans take three key steps: First, engage with members through appropriate channels, including social media. Second, unify and validate their provider data to ensure accuracy. Third, introduce self-service capabilities within their digital platforms to empower consumers. Reach out to Tectonic today if your organization needs help applying these three steps. Like Related Posts Salesforce OEM AppExchange Expanding its reach beyond CRM, Salesforce.com has launched a new service called AppExchange OEM Edition, aimed at non-CRM service providers. Read more The Salesforce Story In Marc Benioff’s own words How did salesforce.com grow from a start up in a rented apartment into the world’s Read more Salesforce Jigsaw Salesforce.com, a prominent figure in cloud computing, has finalized a deal to acquire Jigsaw, a wiki-style business contact database, for Read more Service Cloud with AI-Driven Intelligence Salesforce Enhances Service Cloud with AI-Driven Intelligence Engine Data science and analytics are rapidly becoming standard features in enterprise applications, Read more

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TEFCA could drive payer-provider interoperability

TEFCA could drive payer-provider interoperability

Bridging the Interoperability Gap: TEFCA’s Role in Payer-Provider Data Exchange The electronic health information exchange (HIE) between healthcare providers has seen significant growth in recent years. However, interoperability between healthcare providers and payers has lagged behind. The Trusted Exchange Framework and Common Agreement (TEFCA) aims to address this gap and enhance data interoperability across the healthcare ecosystem. TEFCA could drive payer-provider interoperability with a little help from the world of technology. TEFCA’s Foundation and Evolution TEFCA was established under the 21st Century Cures Act to improve health data interoperability through a “network of networks” approach. The Office of the National Coordinator for Health Information Technology (ONC) officially launched TEFCA in December 2023, designating five initial Qualified Health Information Networks (QHINs). By February 2024, two additional QHINs had been designated. The Sequoia Project, TEFCA’s recognized coordinating entity, recently released several key documents for stakeholder feedback, including draft standard operating procedures (SOPs) for healthcare operations and payment under TEFCA. During the 2024 WEDI Spring Conference, leaders from three QHINs—eHealth Exchange, Epic Nexus, and Kno2—discussed the future of TEFCA in enhancing provider and payer interoperability. ONC released Version 2.0 of the Common Agreement on April 22, 2024. Common Agreement Version 2.0 updates Common Agreement Version 1.1, published in November 2023, and includes enhancements and updates to require support for Health Level Seven (HL7®) Fast Healthcare Interoperability Resources (FHIR®) based transactions. The Common Agreement includes an exhibit, the Participant and Subparticipant Terms of Participation (ToP), that sets forth the requirements each Participant and Subparticipant must agree to and comply with to participate in TEFCA. The Common Agreement and ToPs incorporate all applicable standard operating procedures (SOPs) and the Qualified Health Information Network Technical Framework (QTF). View the release notes for Common Agreement Version 2.0 The Trusted Exchange Framework and Common AgreementTM (TEFCATM) has 3 goals: (1) to establish a universal governance, policy, and technical floor for nationwide interoperability; (2) to simplify connectivity for organizations to securely exchange information to improve patient care, enhance the welfare of populations, and generate health care value; and (3) to enable individuals to gather their health care information. Challenges in Payer Data Exchange Although the QHINs on the panel have made progress in facilitating payer HIE, they emphasized that TEFCA is not yet fully operational for large-scale payer data exchange. Ryan Bohochik, Vice President of Value-Based Care at Epic, highlighted the complexities of payer-provider data exchange. “We’ve focused on use cases that allow for real-time information sharing between care providers and insurance carriers,” Bohochik said. “However, TEFCA isn’t yet capable of supporting this at the scale required.” Bohochik also pointed out that payer data exchange is complicated by the involvement of third-party contractors. For example, health plans often partner with vendors for tasks like care management or quality measure calculation. This adds layers of complexity to the data exchange process. Catherine Bingman, Vice President of Interoperability Adoption for eHealth Exchange, echoed these concerns, noting that member attribution and patient privacy are critical issues in payer data exchange. “Payers don’t have the right to access everything a patient has paid for themselves,” Bingman said. “This makes providers cautious about sharing data, impacting patient care.” For instance, manual prior authorization processes frequently delay patient access to care. A 2023 AMA survey found that 42% of doctors reported care delays due to prior authorization, with 37% stating that these delays were common. Building Trust Through Use Cases Matt Becker, Vice President of Interoperability at Kno2, stressed the importance of developing specific use cases to establish trust in payer data exchange via TEFCA. “Payment and operations is a broad category that includes HEDIS measures, quality assurance, and provider monitoring,” Becker said. “Each of these requires a high level of trust.” Bohochik agreed, emphasizing that narrowing the scope and focusing on specific, high-value use cases will be essential for TEFCA’s adoption. “We can’t solve everything at once,” Bohochik said. “We need to focus on achieving successful outcomes in targeted areas, which will build momentum and community support.” He also noted that while technical data standards are crucial, building trust in the data exchange process is equally important. “A network is only as good as the trust it inspires,” Bohochik said. “If healthcare systems know that data requests for payment and operations are legitimate and secure, it will drive the scalability of TEFCA.” By focusing on targeted use cases, ensuring rigorous data standards, and building trust, TEFCA has the potential to significantly enhance interoperability between healthcare providers and payers, ultimately improving patient care and operational efficiency. Like Related Posts Salesforce OEM AppExchange Expanding its reach beyond CRM, Salesforce.com has launched a new service called AppExchange OEM Edition, aimed at non-CRM service providers. Read more The Salesforce Story In Marc Benioff’s own words How did salesforce.com grow from a start up in a rented apartment into the world’s Read more Salesforce Jigsaw Salesforce.com, a prominent figure in cloud computing, has finalized a deal to acquire Jigsaw, a wiki-style business contact database, for Read more Service Cloud with AI-Driven Intelligence Salesforce Enhances Service Cloud with AI-Driven Intelligence Engine Data science and analytics are rapidly becoming standard features in enterprise applications, Read more

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