The managed package includes five different data models and it continues to expand. General understanding of data models and the out-of-the-box capabilities of Health Cloud. Member model, which is the first decision point in the Health Cloud journey. Our latest guidance for new Health Cloud implementations is to use personal accounts in this core component. Next, we have the Care plan Data Model, which is used for care coordination and patient management. Third, is a Clinical Data model, where the transactional information from your EHR's, electronic health records, can be found. Next, is the Payer Data model, which is a comprehensive set of objects, relationships, and workflows like insurance carriers. And lastly, the Provider Data model, which is a collection of objects and workflows to manage credentialing, onboarding, and recruiting.
Business accounts to store information about companies you do business with, records in 2 separated objects: Account & Contact. Many contacts can be related to an account. Contacts to multiple accounts allow association of contact to more than 1 account, such as a consultant who works for several companies.
Two Records Presenting as One:
- Appears to be a single record with both account and contact fields, such as first and last name email address, etc.
- Behind the scenes, still a separate account and contact record.
- Person Account - Person
- Relatively few limitations
Like a Person Account, But Appears As Two Records:
- One account record linked to one contact record.
- Health Cloud UI and automation make it "feel" like a single record.
- Still appears as two separate records outside of Health Cloud.
- Was the original model used by Health Cloud.
- Not recommended for new implementations.
Don't forget to check out: Benefits of Salesforce Implementation for Healthcare
Now we look at the relationship between clinical and the Care Plan Data Models. The clinical data model captures information that is coming from an EHR system via some type of integration middleware and will display information commonly associated with the HR's, such as allergies, medications, and chronic conditions. In the absence of integration, you can store information your users collect in those objects. Also, have the Care Plan Data model. A care plan is simply a record type of case. Essentially it's going to inform the system as to which information we intend to capture and how going to help a patient manage a particular condition.
Utilization Management Data Model
- It enables the customer to streamline a care request through collaborative workflows, and provide members and providers insight into its processing, include:
- Prior Authorisations
- Appeals & Grievances
The Objects Are Salesforce Core Objects
Healthcare Financial Data Model:
The financial data model enables customers to gain insight into patients’/members’ insurance information. This includes:
Claims objects are modeled as virtual objects. Data continues to reside in the source system and is surfaced in Health Cloud in real-time.
- Practitioners, business organizations, and organization hierarchy
- Physician/organization affiliations
- Practicing locations
- Operating hours
- Specialty, Taxonomy
- NPI and provider identifies
- Insurance payer and plan networks
- Business APIs for creating and updating provider information.
Check out another amazing blog by Sweta Dey here: Salesforce Experience Cloud Can Be Used To Complement Commerce Cloud
- Mulesoft connector to CAQH org for simplified access to preview and direct assure services for provider data management.
Care Program Management
Increase program adherence and improve patient outcomes with care program management. Easily enroll and manage patients to drive the maximum impact for your programs. Capture eSignatures to stay compliant and easily manage authorization and consent forms. Patients can access their care program details and resources from any channel.