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Healthcare CRM boosted by Salesforce entry

Customer relationship management in healthcare is getting a boost from Salesforce's move into health IT, but other vendors, such as hc1.com, are already occupying the space.

CRM powerhouse Salesforce garnered a lot of attention when it announced its move into the health IT market.

However, vendors such as hc1.com are already selling cloud-based systems for customer relationship management (CRM) in healthcare, setting the stage for a serious battle in this growing new market between a giant software company and niche healthcare CRM competitors.

Brad Bostic, hc1.com's chairman and CEO, founded the Indianapolis company in 2011 to concentrate on the client, or patient, end of healthcare. It’s what he calls "healthcare relationship management."

Nowadays, Bostic says that while he welcomes Salesforce into healthcare, his health IT-specific company is already doing what Salesforce is planning with its Health Cloud platform, a patient data aggregation system.

CEO of hc1 criticizes Salesforce CRM move

The Salesforce Health Cloud, Bostic maintained, is really just "a marketing strategy."

"It's really helpful to us to have that sort of hype machine raising awareness" about CRM in healthcare, Bostic added. "But Salesforce has it right. They're not wrong that healthcare has to focus on customer relationship management."

Bostic's criticisms of Salesforce's approach are points that Salesforce's chief medical officer, Joshua Newman, M.D., refuted.

Salesforce already has experience selling into the pharmaceutical and health laboratory markets, and the company is building on those roots with Health Cloud, Newman said.

"We're already part of the health IT world," he said.

Meanwhile, hc1.com claims it has some 500 healthcare industry customers around the world, including Cleveland Clinic, Alere Inc., Sonic Healthcare Limited and AmeriPath, Inc.

Eskenazi Health using hc1.com software

Also among hc1.com's customers is Eskenazi Health in Indianapolis, which runs the 315-bed Sidney and Lois Eskenazi Hospital, among 80 healthcare facilities, and employs 4,440 across Indiana.

Eskenazi launched a pilot program with hc1.com in late 2014 and went live with it in February 2015 at the main hospital's outpatient care center, which sees 110,000 patients a year across 38 specialties.

Parveen Chand, Eskenazi's COO, said that as a "safety net provider" in the region, Eskenazi has a vested interest in staying in touch with its patients, especially with the expansion of Medicare and the rise of value-based reimbursement, in staying in close touch with its patients.

We've modeled a very specific data model for healthcare. We realize that healthcare is unique.
Joshua Newman, M.D. Salesforce

"We have a loyal customer base. … But we have to stay engaged with our patients," Chand said. "Our biggest gap is patient engagement."

One of the largest problems Eskenazi has faced in that regard is patient no-shows for scheduled medical appointments. Indeed, at some of the health system's clinics, no-show rates ran at 35% to 42%, until Eskenazi started using hc1.com's patient engagement texting system to automate appointment reminders, Chand said.

Personalized text reminders start a week before appointments, then escalate to 72 and 24 hours before patients are supposed to show up for their clinical sessions.

Text reminder system reduces patient no-shows

No-shows started decreasing almost immediately, Chand said, and are now hovering at around 10% to 25%. Perhaps more importantly, Chand noted, hc1.com's analytics parse appointment attendance data to root out no-show patterns, such as whether patients have daycare issues or have trouble making, for example, Monday appointments.

"This platform really gives us an opportunity to see what's happening with our patients, and without penalizing them you can go back and do outreach," Chand said. "If we're not paying attention, then we lose that patient."

Asked to comment on the Salesforce move into health IT, Chand said he believes hc1.com is "two or three years ahead" of the San Francisco CRM giant, and that specialized healthcare CRM vendors are "a little more nimble."

"Generic" vs. native health IT CRM systems

Bostic sees healthcare-specific CRM systems as having the following advantages over what he called larger, "generic CRM" systems:

  • Security: Generic CRM data often resides in a multi-tenant database environment with other clients.The more users associated with that database, the greater the security risks. Healthcare requires a secure private cloud environment with dedicated databases for each client. 
  • Encryption\Standard healthcare objects: "Generic" CRM data models consist of rigid standard objects, allegedly making them expensive to customize to fit healthcare needs. A healthcare CRM platform offers data objects for the "unique healthcare landscape" including diagnosis, ordered panels, host code and others, Bostic said.
  • Customized databases: According to Bostic, "generic" CRM systems require expensive customizations to manually map relationships between database objects. "By comparison, a healthcare CRM like hc1.com was designed to mimic the complex healthcare industry, where it is common for a physician to have relationships with multiple healthcare locations, or for a lab to have relationships with many hospitals," he said.

Salesforce rebuts criticisms

Newman, who is also Salesforce's general manager for healthcare and life sciences, dismissed Bostic's criticisms, saying Salesforce's cloud systems are among "the most rigorous on the planet" when it comes to security.

Indeed, Newman noted that leading financial and governmental organizations use Salesforce applications, including CMS, the U.S. Department of Veteran Affairs and the Centers for Disease Control and Prevention.

In fiscal year 2015, Salesforce posted $5.37 billion in revenue, according to the company, making it one of the world's biggest software companies.

"I don't think any startup can compete," Newman said, referring to hc1.com and others.

Newman also countered Bostic's pointabout data models.

"We've modeled a very specific data model for healthcare," Newman said. "We realize that healthcare is unique."

Salesforce developed its patient data models for Health Cloud using Fast Healthcare Interoperability Resources (FHIR), an increasingly popular new standard for exchanging health IT data.

As for building connections to EHRs and other repositories of health data to make the Salesforce's CRM system a true "longitudinal" health record that comprises a thorough accounting of patient's health information, Newman asserted: "We're very good at making those interactions."

Newman also said Salesforce is not trying to build connections directly to interoperability-challenged EHRs, but rather going through middleware partners using APIs to interoperate with widely used EHRs.

Salesforce says Health Cloud ready this winter  

Since Salesforce unveiled Health Cloud in September just before its massive Dreamforce 2015 user conference, the company has been sending sales teams to health IT conferences and deploying developers to bring the product to market.

The company is now running pilots at multiple healthcare organizations, including providers and payers, and is planning a rollout in early February, Newman said.

"It's pretty exciting. The talent we have is top notch, and this is something we're actively committed to," he said. "We're happy we have the technology."

Next Steps

Previous EHR vendor projects preceded Salesforce's healthcare CRM endeavor

Salesforce's healthcare division among attendees at Connected Health conference

CareNotify mobile app permits early appointment check-in

This was last published in December 2015

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