Utilization Management (UM) has been a familiar term since the 1970s, but its significance has grown considerably as a tool for managing medical costs. The pressure to contain costs amid overutilization and resource waste has intensified, prompting health insurers (payers) and employers to seek ways to control premiums and claims trends. Salesforce Health Cloud for Payers explained. What started as a rudimentary pre-hospitalization check has evolved into a multifaceted utilization review process involving prospective, concurrent, and retrospective evaluations. Modernizing a decades-old process, addressing fragmented UM systems, and establishing a unified source of truth for care management pose significant challenges. Enter Salesforce Health Cloud. Salesforce Health Cloud streamlines care requests, enabling payers to manage precertification and prior authorization efficiently. The Care Request feature in Health Cloud supports various payer UM processes, including prescription drug preauthorizations, service preauthorizations, and admissions review, facilitating informed decision-making and ensuring patients receive necessary care. How Tectonic can help: Tectonic specializes in providing solutions to payers facing UM challenges. Leveraging Salesforce products, we assist health and life sciences clients in maximizing authorizations, creating member service solutions, and deriving actionable insights from captured data. With our industry expertise and tailored consultation, we offer a blueprint for success across all functional areas within payer organizations. Discover how Tectonic can empower your organization to overcome UM challenges and achieve operational excellence. Contact us today. Like1 Related Posts Health Cloud Brings Healthcare Transformation Following swiftly after last week’s successful launch of Financial Services Cloud, Salesforce has announced the second installment in its series Read more Salesforce Government Cloud: Ensuring Compliance and Security Salesforce Government Cloud public sector solutions offer dedicated instances known as Government Cloud Plus and Government Cloud Plus – Defense. Read more PII Explained Personal Identifiable Information (PII) is defined as: Any representation of information that permits the identity of an individual to whom Read more Case Study: Health Payer/Provider Onboarding/Network Growth After doing their initial Sales Cloud implementation and SAP integration over 12 years ago, this company was only leveraging Salesforce Read more