VBCRM: A new idea for a new era of healthcare CRM

Why should consumer marketing, patient engagement, care experiences, quality outcomes, marketing effectiveness, and financial performance remain separate factors within a healthcare organization? The answer: They shouldn’t.

KEY POINTS

• To master the consumerization of healthcare demands we cost-effectively close a large CRM data gap, redefining what we mean by CRM in the process
• Fee-for-service entities can benefit from infusing CRM personalization with population health data, analytics, and insights
• Risk-bearing entities can expand and tune their risk pool, improve care journeys, keep patients in-network, and enhance care quality by leveraging pop health data with retail CRM

By Gary Druckenmiler Jr. and Amy Stevens

Gary Druckenmiller is general manager of consumer CRM at Innovaccer. Amy Stevens is general manager of provider performance and value innovation at Innovaccer.

Chocolate was invented 4,000 years ago in ancient Mesoamerica, present day Mexico. The first patent for peanut butter was issued to Marcellus Gilmore Edson in 1885. But it wasn’t until 1928 when Harry Burnett (H.B.) Reese brought these two sweets together to create something sweeter than the both of them individually: The Reese’s peanut butter cup.

The earliest online reference to customer relationship management (CRM) in healthcare appears in 1996. The notion of population health management (PHM) dates to 2003, when David Kindig, MD, PhD, and Greg Stoddart, PhD wrote a paper entitled, “What is Population Health?” But it wasn’t until 2023 that Innovaccer brought these two ideas together—CRM and PHM—to create something sweeter than both of them: VBCRM, or “value-based CRM.”

Hold on. That doesn’t mean CRM exclusively for value-based care. It just means that some things are better together. So it is with chocolate and peanut butter. And so it is with CRM and PHM data, analytics, insights, and workflows.

The simple idea is to weave CRM data into the longitudinal consumer/patient record, apply the analytics made possible by that, integrate the resulting holistic insights into the relevant workflows and—voila!—transform enterprise healthcare communications and the clinical patient journey, together.

This is not unlike the profound impact that occurs when data from EHRs and other HIT systems are connected and made interoperable by a third-party data platform and PHM solutions in value-based care settings. Suddenly, clinicians have a unified patient record that serves as a single source of truth about the patient at the point of care, enabling data-driven, AI- and analytics-enhanced decisions that close care gaps, improve outcomes, stratify risk, drive interventions, and accelerate success with VBC models.

Imagine what happens when that longitudinal patient record is enriched with Healthcare CRM (i.e., consumer and socioeconomic) data, and put into the hands of savvy healthcare marketers, communicators, and experience leaders. Now they can understand the whole person—not just an abstract retail persona—and ensure their communication and experience engagement strategies are perfectly aligned to each individual with a hyper-personalized journey, both retail and clinical, throughout the care continuum.

Here are just a few of the countless examples that are enabled when you bring CRM and PHM data together; set smart algorithms against the data to produce more highly nuanced or even entirely new, never-seen-before insights; and then drive the workflows, automation, and interventions that have a practical impact on business objectives. To wit:

• Understand which people in a population, market, contract, etc., would most likely "activate" with engagement, behavior change, compliance (e.g., use in-network facilities or stop using the ED instead of urgent care, etc.).
• Run a diabetes A1C screening campaign to increase diabetic compliance and heath via a communication journey that uses highly coordinated and pre-planned email, phone calls, SMS messages, direct mail, etc. Narrow the target demographic to include patients with a diagnosis of diabetes who have no indicator of an A1C test in the last six months, and exclude patients under 18 and those who are already in a care protocol. And here’s where traditional CRMs fall down: See the clinical results tied to the campaign, no matter where the test was done! For example, if the test was performed outside of the health system, at a competitor such as Quest or LabCorp or a doctor's office (in other words, beyond the traditional CRM’s line of sight), that information isn’t lost. It’s collected and added to the patient’s unified record, and can be seen and acted upon. For example, if a person’s A1C was unremarkable, exclude them from the campaign.
• Align departments to avoid undesirable patient experiences scenarios like this one: A patient has Medicare, and is required to go through a process before they’re eligible for a total or partial knee replacement (e.g., physical therapy, etc.). The patient is working with a care manager to follow that protocol. On the other side of the house, the communications team is working on a total knee replacement campaign. But because of siloed data and a lack of coordination, they reached out to that same Medicare patient. That patient responds and schedules a consultation, even though they’re not eligible because they're still in a care protocol.

Finally, healthcare marketers and leaders can deliver value for the healthcare organization, value for consumers, value for patients, value for providers, value to the community and, yes, value to the US healthcare system overall, no matter what reimbursement model is in play, be that fee-for-service (FFS), value-based care (VBC), and other alternative payment model (APM).

That extreme level of value realization is absent in a healthcare organization’s CRM function, the marketing/strategy function, and in the value-based care function today. Indeed, a 2023 Innovaccer survey of healthcare leaders found:

• 76% are not using data-driven patient engagement at all
• 64% are not using data-driven patient engagement to improve care coordination
• 80% are not mapping consumer journeys in alignment with patients’ personalized continuum of care

What are they using CRM for? New patient acquisition, mostly. They’re helping consumers find care, but are unable to use CRM to guide them through the care experience or engage them to retain them to keep their customers for life.

Likewise, CRM tools are bottled up in marketing, and their full potential value isn’t realized across the healthcare organization. CRM typically isn’t extended to an organization’s population health teams or value-based care entities. And isn’t that silly? Risk-bearing entities have similar needs, just in a different context. They need to find, guide, and keep their members, covered lives, and beneficiaries for life.

Most healthcare organizations have massive blind spots in their understanding of consumer behavior and clinical needs across the patient journey, because they have massive gaps in their consumer/patient data. They don’t have the PHM data they need within their CRM to go further, and expand the value realization that CRM, when coupled with PHM data, analytics, and workflows, can deliver to a healthcare organization.

To fully address the consumerization of healthcare demands that we close this CRM data gap. In healthcare, you don’t have to be an ACO or other at-risk organization in order to benefit from infusing your CRM personalization efforts with population health data, analytics, and insights. And if you’re a risk-bearing entity, there’s no better way to expand or otherwise fine-tune your risk pool, improve care journeys, keep patients in your network, and enhance care quality than to leverage the power of your pop health data with retail CRM capabilities.

According to the latest HCP-LAN survey of 63 health plans, 40.5% of payment today is pure FFS, 19.5% is FFS with ties to quality and value, 32.9% are APMs built on a FFS architecture, and 7.5% of payment is population-based. Healthcare today needs a CRM solution that can work across all of these payment models. That’s exactly what the VBCRM concept is about.

From pure FFS to full-risk and everything in-between, every healthcare organization can now realize the maximum value of their CRM investment to find, guide, and keep patients for life, from illness to wellness to prevention. And that’s as sweet an idea as a peanut butter cup.

Old-school retail CRM vs. VBCRM: A fragmented view vs. the full family picture by fusing CRM and PHM data, analytics, and workflows

Take your CRM to a higher power with VBRCM, the concept behind Innovaccer’s new Health 1:1 for Enterprise CRM. Show consumers and patients that you really know them. Address every single patient individually and uniquely using longitudinal patient data, hyper-personalized outreach and engagement, unified enterprise-wide analytics and performance measurement, consumer journey mapping, and more. Deliver a consumer-centric 1:1 health experience that’s never been possible before.

How Can Innovaccer Help?

The Innovaccer platform’s Enterprise Customer Relationship Management (CRM) solution uses a unified patient record to boost patient acquisition, enable clinically personalized patient journeys, enhance retention, and improve the bottom line.

By integrating and activating all patient data through a longitudinal consumer/patient record, health systems can attract new consumers more effectively; accurately guide patients throughout their care journey in a way that is smart enough to recognize specific requirements of their health plan; and better coordinate episodes to improve experiences, care, and your organization’s financial outcomes.

As the industry’s only Enterprise CRM built from the ground up exclusively for healthcare—populated with all of your relevant CRM, EHR, HIT, claims, consumer, and patient data from day one—there’s simply nothing else like it in healthcare … and no faster way to get started accelerating your success with consumer and patient engagement.

About Innovaccer

Innovaccer Inc. is the #1 data platform for value-based care. The Innovaccer platform unifies patient data across systems and care settings, and empowers healthcare organizations with scalable, modern applications that improve clinical, financial, operational, and experiential outcomes. Innovaccer’s EHR-agnostic solutions have been deployed across more than 1,600 hospitals and clinics in the US, enabling care delivery transformation for more than 96,000 clinicians, and helping providers work collaboratively with payers and life sciences companies. Innovaccer has helped its customers unify health records for more than 54 million people and generate over $1 billion in cumulative cost savings. The Innovaccer platform is the #1 rated Best-in-KLAS data and analytics platform by KLAS, and the #1 rated population health technology platform by Black Book. For more information, please visit innovaccer.com.