• 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.

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