Blue Shield of California says its new customized Salesforce care management system will help it expand and scale more in-depth care services to members and expand self-service capabilities for employers in order to improve access to higher quality care.

WHY IT MATTERS

Blue Shield and Salesforce announced the expanded collaboration, which leveraged data expertise from KPMG, to improve the agility of member services and streamline the end-to-end enrollment life cycle, according to an announcement Wednesday. 

The new clinical care management system, called Care Connect, combines data from 13 disparate systems – including clinical, lab, pharmacy, behavioral health, care gap and other key sources of member health data. 

"With a growing member base and increasingly complex medical cases, Blue Shield of California needs a holistic, unified view of its members to customize care plans and address health challenges across every step of its care journey," Amit Khanna, senior vice president and general manager for health and life sciences at Salesforce, said in a statement.

Unifying member data across multiple sources can help to identify goals and interventions for better outcomes and lower costs, he added.

"Care Connect allows Blue Shield’s clinical care teams to better understand our members and provide holistic care support through a new, integrated source of truth," Tracy Alvarez, vice president of medical care solutions at Blue Shield of California, said. 

"This game-changing technology has helped us reimagine how to provide personalized and simplified healthcare experiences for our members."

The collaboration also created a single self-service digital experience for Blue Shield's employers and brokers, according to the payer. 

With the new automation capabilities, digital enrollment increased by 75% and manually reviewed group enrollment decreased by 50%, Blue Shield said.

THE LARGER TREND

Unifying health insights – from electronic health records, social and behavioral data, assessments and more – can improve operational efficiencies on the provider side, as well, according to Salesforce.

Earlier this year, the cloud provider released a number of real-time data and artificial intelligence integrations on Customer 360 for Health, including prior authorizations, intake and patient scheduling. 

To support patients at home, at work or on the go, Salesforce also released more "care from anywhere" tools – remote patient monitoring, connected health, medication management and others – last year.

"For years, the healthcare system has struggled to catch up with the innovation we were seeing across other industries," Kevin Riley, SVP and general manager of healthcare and life sciences at Salesforce, said in a statement in 2022. 

"But the pandemic forced us to accelerate digital transformation and provide the healthcare system with digital-first and always-on patient-focused solutions."

In an email to Healthcare IT News about Blue Shield's announcement, Khanna said that “Care management and coordination are core elements to support health plans in improving outcomes," and the company "will continue to enhance this with our integrations to clinical guideline systems and help health plans effectively close gaps in care."

ON THE RECORD

"Our goal is to improve how we engage with and care for our members across their interactions with Blue Shield of California and we now have a platform approach that allows us to create unified member experiences," Bill Giard, Blue Shield's vice president of enterprise architecture and health innovation, said in the announcement.

Andrea Fox is senior editor of Healthcare IT News.
Email: afox@himss.org
Healthcare IT News is a HIMSS Media publication.