By Fadesola Adetosoye

People who have lived in large cities often say they love the neighborhoods. In the best ones, you can find pretty much everything you need within a few blocks of home, from grocers, pharmacies and restaurants to services of all kinds. People get to know you and what you need or want pretty quickly.

A customer relationship management (CRM) system can be set up for use in care management to provide this supportive neighborhood feel. It’s a way of bringing together all the resources a patient needs in one place, and it can enable easy communication between the patient and the caregivers. A CRM becomes the patient’s neighborhood, where he or she is known and understood. And it enhances caregivers’ ability to share relevant information to support the patient’s best outcome.

This is especially useful if you are concerned about the social determinants of health for a patient. Too often, a person’s ability to achieve a good outcome is hindered by socio-economic factors such as income, transportation, lack of family support or even access to high quality food. A CRM system can help you connect the patient to social services and other support systems that can ameliorate these challenges.

Beyond impeding a good outcome, these factors are often the cause of high medical costs for patients. The right supportive systems may forestall ER visits, readmissions and the need for expensive medical interventions.

Creating the neighborhood
Systematic care coordination provides a unique opportunity for health plans to collaborate with clinicians and hospital systems to improve care and provide real-time case management for their health plan members. A CRM platform facilitates health plans’ efforts to integrate the entire spectrum of services that can positively affect patient outcomes. This matters, because healthcare providers don’t always have systems in place to connect patients to non-medical, but critically important, services and support.

The CRM operates as a virtual neighborhood, offering a streamlined and centralized mechanism for coordinating both care and communication about that care. It provides a safe, secure platform for members, their families, the care team and community service providers to share information pertinent to the patient’s well-being. Core functions of a CRM platform enable key components of a care management program like:

• Discharge planning
• Care plan templates
• Distribution of health education content
• Member and provider portal integration
• Risk assessments
• Satisfaction survey distribution and analysis

As health plans consider alternative payment models to better address the needs of their population, data aggregation to drive care delivery transformation is extremely important. The Centers for Medicare and Medicaid Services (CMS) is testing new payment models that address the health-related social needs of its Medicare and Medicaid beneficiaries. CRMs offer a cost-effective and lightweight mechanism to automate and incorporate clinical and non-clinical data.

In our current state, health plan case managers are often limited to their personal knowledge of disease management programs and available social services. A CRM platform aggregates the knowledge of all who use the platform, broadening resources for all. For example, if one case manager knows about a useful community resource and adds it to the CRM, all others using that platform can see that resource. It not only aggregates knowledge, it enables spread of that knowledge throughout a community. Like a neighborhood message board, which lets everyone know who you can call for yard work, pet sitting and babysitting, a CRM lets everyone know where to get supplemental groceries, transportation, social support or other services for a patient.

Health plans can use this same platform to design workflows that increase member and family engagement, provide systematic risk stratification for their members, and identify social and community programs beneficial to their ongoing care management.

The platform capabilities of a CRM provide a cost-effective way for seamless integration with third party platforms. Because of this, CRMs can enhance workflow redesign to better streamline clinical and social intervention processes. As data aggregation becomes of increasing interest to support care delivery transformation, the agility of the CRM platform allows for health plans to manipulate the data to help transform other areas of its business, such as prior authorization and utilization management, among others.

Adding automation to the CRM can reduce costs of care management
It is also possible to use robotic process automation to customize and configure rules to identify socioeconomic programs, either offered by the health plan or by community-based organizations. An automated process can help health plans quickly identify which services a member may be eligible for, reducing the number of hours their case managers spend by as much as 30%. It can help with researching programs, making connections to the patient, and tracking member participation.

Effective use of a CRM can also enable social networking and virtual support groups for health plan members, and provide a low-cost tool for care collaboration among clinicians and other healthcare support workers. This includes, for example, identifying the appropriate types of member communications and program incentives for the beneficiaries.

While CRM systems may have started with retailers wanting to improve customer service, they have grown far beyond this limited use, and a growing number of health plans see the platform as an affordable way to meet a host of care coordination and member engagement needs.

About the author: Fadesola is NTT DATA's Global Practice Leader for Care Management and Population Health solutions. She is an experienced Health Policy and Federal Affairs professional with ten years of experience in healthcare policy, program/project management and infrastructure development.