Is Salesforce the big tech company that figured out healthcare?

Salesforce was just another tech company trying to make it in the healthcare business in 2015 when it launched a health cloud product with a handful of customers and little fanfare.     

“There was cynicism. We have seen so many companies come in and say the things that Salesforce said,” said Alexander Lennox-Miller, healthcare IT analyst at CB Insights, a New York-based market intelligence firm. “The fact that they’ve stuck around for the long haul has made the difference. They’ve gotten to understand the nuances of this space.” 

While other tech giants have faltered trying to figure out what they’re trying to do in healthcare, Salesforce has quietly become a big player in the space. Experts say the company’s rise has coincided with a healthcare industry that’s increasingly open to customer-focused technology. 

 “Of the big tech companies coming in, they have a right to win,” said Julia Hu, CEO of Lark Health, a Mountain View, California-based virtual chronic care management services company. “They’re masterful at applying the principles of customer relationship management to run more effective businesses in healthcare.” 

Salesforce’s customer base has grown to include health systems, insurance companies, public health departments, pharmaceutical and life sciences firms, retail health, digital health companies and more. The company has evolved and rapidly iterated, updating its health cloud last September to connect with remote patient monitoring and other connected devices. Executives say its goal is to create a cloud-based, consumer-centered ecosystem connecting clinical, financial and consumer data. 

But despite this, Salesforce still faces significant challenges. Its competitors include two major electronic health records vendors as well as digital health startups looking to capitalize on the consumer-driven technology trend that has emerged in the wake of the pandemic.

CRM tools, effectively applied, have shown they can help in COVID management and other use cases."
Adam Cherrington, KLAS Research

The COVID effect 

Both Kevin Riley, chief customer officer for Salesforce’s healthcare and life sciences division, and Dr. Geeta Nayyar, chief medical officer, came to the company in the early months of the pandemic. 

“I saw where the puck was going with COVID and had that ‘a-ha’ moment that Salesforce just became that much more relevant than they ever were,” Nayyar said. Prior to Salesforce, she was at Greenway Health, an EHR and practice management solutions company. 

Two developments during the pandemic buoyed Salesforce’s position in healthcare. First, companies in other industries began using its technology to launch internal and external health and wellness campaigns. 

“Right now, I’m talking to every major retailer that we work with. I’m talking with travel and hospitality customers. Every company is a healthcare company,” Nayyar said. 

Secondly, the health crisis has required healthcare organizations to communicate with and guide patients through a specific care journey, said Adam Cherrington, senior research director at KLAS Research, based in Orem, Utah. This has put a company like Salesforce at the forefront, experts say.

“The entire world focused on essentially the same care journey and healthcare organizations united and recognized the need to simplify access and communication,” Cherington said. “CRM tools, effectively applied, have shown they can help in COVID management and other use cases.” 

Northwell Health, the largest health system in New York, has partnered with Salesforce since 2016. At first, it used the technology to recruit providers, and then later to handle patient access via its call centers. In the earliest months of the pandemic, the health system needed to quickly deploy testing and then later vaccines. 

Dr. Kevin Bock, Northwell’s chief health information officer, said the health system launched a registration and scheduling platform in a matter of weeks to handle all incoming requests. Once the vaccine was available, the platform easily handled the different age and regulatory requirements, he said. 

“That system we put up delivered a half-a-million vaccines to New Yorkers,” Bock said. “Salesforce is very good at helping understand context and putting workflows around context. I think that's one logical reason why quietly they’ve advanced in this space.” 

We think it’s great. We think it validates that CRM is just as important as EHR."
Kevin Riley, Salesforce on Epic's entry into the CRM space

Rise of customer relationship management 

Organizations have been shifting toward consumer-focused technology for a while and the pandemic accelerated that process, said Leah McCanna, senior director at Huron Consulting, a Chicago-based firm. The shift to consumerism is particularly true in the provider world, she said, as more health systems recognize the limited ability of electronic health record systems.   

“CRM isn't just a marketing solution,” McCanna said. “It’s an end-to-end consumer solution in a way that an EHR is not. The EHR is a back-office tool. It's not your engagement tool.” 

But it has not been easy for every health system to make this shift. While some are running use cases and one-off pilots, McCanna said many are still figuring out how CRM technology can be used within their system. 

“Getting to the point of figuring out what a CRM can do for them is the biggest challenge that health systems face,” McCanna said. 

Part of this challenge is that clinical evidence and peer-reviewed data for this technology remains limited, according to Lennox-Miller. While it may be easier for systems like Northwell Health or Mayo Clinic to experiment, he said many organizations won’t have the resources needed to invest in a comprehensive CRM unless they can get proof it works. 

Healthcare is an industry that’s hard pressed to change and many outside tech companies have tripped themselves up on its complexities, Cherington said. There is also the matter of reimbursement, he said. 

“While health systems trudge along the seemingly endless transition to value-based care, they still seek to improve revenues by holding on to fee-for-service methodologies. As a result, their engagement strategies will be siloed and limited,” Cherington said. 

Epic challenge on the horizon?

Outside of an industry that’s hard pressed to change, the biggest test Salesforce may face comes from Verona, Wisconsin-based Epic Systems. The EHR giant showcased Cheers, its version of a customer relationship management tool, at the Healthcare Information and Management Systems Society conference in February. 

Salesforce said it isn’t deterred. “We think it’s great. We think it validates that CRM is just as important as EHR,” Riley said.  

But CB Insights’ Lennox-Miller said that if Epic, which is in one-third of hospitals across the country, can get its act together on this platform, it should scare the Salesforce team. 

“If Epic suddenly had a really good, mature, well built, easy-to-use CRM that could access a breadth of non-Epic data, if it could do multimodal messaging and create patient profiles…that would devastate any other CRM in the market,” Lennox-Miller said.

At a recent event, Epic CEO Judy Faulkner said the company’s CRM is making strides and that the company has put a lot of resources into developing it. Along with its market share, Lennox-Miller said Epic has access to payer data, which gives it a competitive advantage. 

There’s also Cerner, which formed a partnership with Salesforce in 2018. Then it was bought by another tech giant, Oracle, which is pushing most Cerner clients to use its own CRM. Lennox-Miller said these companies could be tough competition for Salesforce.

“Those two companies make up a gigantic sector of the market,” Lennox-Miller said. “The biggest question that any software company in healthcare gets is, ‘Can I use this with my EHR?’” 

Salesforce faces competition in the startup world too, experts say. One company in this space, Lennox-Miller said, is San Francisco-based Innovaccer, which has raised more than $375 million and is valued at $3.2 billion.    

“What we’re seeing now with Salesforce, Innovaccer and a lot of companies that are in this space, is that they're trying to act as the central data pivot in healthcare, where the EHR is one source of data coming into that but it isn't the primary source of truth,” Lennox-Miller said. “When we talk about Salesforce going after EHRs, I think that’s where we’re headed.” 

This story first appeared in Digital Health Business & Technology.