By Patrick Allen
When COVID-19 hit, it sent shockwaves through the entire healthcare industry, from patients and hospitals to providers and payors. For Clover Health, a leading American Medicare Advantage health plan operator and technology company, time was of the essence. Many of its members not only live in areas significantly impacted by the pandemic (Clover’s largest markets are in the Northeast) but also battle chronic illnesses, which made them extremely vulnerable to the virus. With its Clover Care Visit (CCV) program firmly in place prior to the pandemic and a key differentiator between Clover and its competitors, Clover’s clinical staff were routinely visiting members in their homes or a Clover office to build deep and personal relationships and identify clinical & non-clinical barriers to health.
Once the severity of the pandemic became clear, however, Clover realized the urgency in transitioning to a virtual visit model, which would create the need for a new centralized scheduling and tracking tool. In addition to significant operational changes, Clover was experiencing an abnormally high call volume from members asking if upcoming appointments were canceled, where they could access COVID-19 resources and how they could receive medications without leaving their homes. To ease the strain on the call center, it became apparent that Clover needed additional communication channels to push information to their members instead of requiring them to call. Clover’s legacy tools were simply not up to the task of managing operations and communication amidst the pandemic.
Recognizing the need to rapidly adjust core processes in order to adapt to a remote care model as cases surged in its key markets, Clover turned to EPAM and Salesforce to help build email and SMS (text message) communication channels to keep patients and providers informed and connected. Providing education concerning mail order and delivery prescription services available to Clover members ranked among the most critical needs, particularly with shelter-in-place orders.
Because Clover relied on Salesforce technology to support key parts of its clinical and customer service functions, it naturally chose to leverage Salesforce Health Cloud tools as their backbone to respond rapidly to the changing healthcare market. With Clover’s support & direction and EPAM’s Salesforce and healthcare expertise, a Salesforce Health Cloud solution was in place in about a week, enabling Clover to effectively transition to a virtual model and share COVID-19 updates and valuable resources with members. The new care model encompassed three key components:
COVID-19 Resources Page – Within hours, a digital resource page was developed on Clover’s website using Salesforce Community Cloud, which addressed frequently asked questions, provided COVID-19-related updates to patients and offered user-friendly articles to educate members on the pandemic. Clover was also able to reduce call volumes and unnecessary wait times by directing members to this page for the most up-to-date information.
Clinical Services Console – Within eight days, Clover and EPAM launched a clinical services console through Salesforce Field Service Lightning that provided a 360-degree view of each member. This functionality enabled Clover to continue CCVs through virtual visits for members with chronic conditions and support patients who tested positive for COVID-19 but could not access their primary care physician. The clinical services console automatically identified a specific nurse practitioner (NP) to schedule appointments based on specialty, language, location, time zone and availability. By integrating Clover’s computer telephone service Five9 with Salesforce Health Cloud, the NPs could seamlessly access a member’s case materials and call them directly without leaving the platform.
Multiple Communication Channels – Through a multi-channel campaign of automated emails using Pardot, multi-language text messaging using Twilio and outbound phone calls using Five9, Clover was able to proactively send messages to help its members navigate the pandemic, including providing information about available benefits, including mail order and delivery prescriptions so that members could safely receive critical prescriptions. This allowed Clover to establish two new communication channels with their members—email and SMS—that were effective, as evidenced by a 40% open rate for email (double the industry standard).
EPAM and Clover worked together closely—defining future state criteria, gathering requirements and conducting frequent status updates—to deliver a holistic and fully integrated solution across their existing tech stack in accelerated time-to-market. Clover estimates that these tools will allow for a 50% increase in NP productivity . With this foundation in place, Clover is equipped to quickly respond to other market changes in the healthcare space by adapting to virtual appointments, standing up new resource pages within hours and reaching members through a variety of channels to focus further on specific clinical measures and value-based care initiatives. More important, Clover serves as an industry example of what’s possible in a time when everything seems implausible.
Patrick Allen is Principal, Healthcare Business Consulting for EPAM Systems, Inc, a leading global product development, digital platform engineering, and top digital and product design agency. He leads EPAM Continuum’s payor and provider clients through transformational business projects, enabled by human-centered design and technology. Prior to his role at EPAM Continuum, Patrick was a Vice President at Lumeris, where he started Medicare Advantage health plans in several markets, and a Senior Manager at North Highland.
From providers and hospital systems to payor organizations and healthcare ISVs, EPAM helps its healthcare customers navigate the changing healthcare landscape and deliver next-gen digital solutions that increase collaboration and empower patients to become more invested in their health. As a Salesforce Silver Partner, EPAM developed the Sitecore Salesforce Health Cloud accelerator, which helps healthcare organizations quickly develop a patient portal that reduces development costs, accelerates time-to-value and enables more personalized care experiences for patients. Learn more about EPAM’s healthcare expertise at www.epam.com/our-work/healthcare.
About Clover Health
Clover Health is a healthcare technology company with a deeply-rooted mission of helping its members live their healthiest lives. Clover uses its proprietary technology platform to collect, structure, and analyze health and behavioral data to improve medical outcomes and lower costs for patients. As a company whose business goals fully align with its members’ health needs, Clover works with members and their doctors to become a valued partner. This trust is built by proactively identifying at-risk individuals and teaming up with physicians to accelerate care coordination and simultaneously improve health outcomes and reduce avoidable costs. Clover has offices in San Francisco, Jersey City, Nashville, and Hong Kong. For more information, visit www.CloverHealth.com.