The U.S. healthcare system is the most expensive in the world, while struggling with access, outcomes, and efficiency metrics by most estimations. Paladina Health’s assertion is that traditional primary care in this country is broken. They are out to flip the standard fee-for-service model on its head as a direct primary care company, now the second largest in the country, to drive more value-based care for its clients.
Most of Paladina Health’s clients are employers, unions, school districts, or municipalities. Paladina Health signs unique contracts with each of these clients to drive down total cost of care while providing a significantly improved experience to their members. The clients see a high return on their investment — $1.85 for every dollar invested in Paladina. This is accomplished by building on-site or near-site care centers to their employers with a virtual care option, providing members increased access to care. In addition, their physicians are incentivized by the quality of service delivered rather than quantity.
All of this calls for a uniquely high level of patient engagement, which Tulley Orzech, Manager of Application Development for Paladina Health oversees by owning their use of Salesforce, which they adopted in 2011 for its deep customer relationship management (CRM) capabilities.
“Everything we’re doing right now, the end goal is to improve our patient digital experience. Paladina Health is a pretty innovative company, transforming the way that our country thinks about primary care. We’re trying to be really disruptive in that space, which means coming up with different ways to do things,” she said.
Sampath Narayanan, Paladina Health’s Chief Information Officer, agrees that innovation in healthcare comes with unique challenges as it relates to the tech stack an organization must employ, particularly if you have vision and want to grow.
“In healthcare, there are numerous technology platforms that all do very specific functions very well, but no one solution is going to provide all the answers. So it creates a challenge with a lot of disjointed systems that still exist in the industry,” Sampath said. “Obviously, if you have a small company, having one system for everything would work. But the more you try to scale and innovate, the more systems you must integrate. The time it takes to build and the time it takes to connect these systems is the challenge.”
Paladina Health uses eClinicalWorks (eCW) as their electronic health record (EHR), and they wanted to leverage what makes eCW powerful, while being able to build their own innovative and personalized consumer digital experience.
Initially, Paladina Health was using Salesforce Sales Cloud. And when Paladina Health first realized the need for integrations, they went the “build” route — developing two integrations internally. They used web services to do an ADT integration, the demographics from Salesforce to eClinicalWorks, then the appointments coming from eCW back to Salesforce. But the project became much more complicated than they anticipated.
“We spent an inordinate amount of time fixing those custom web services,” said Tulley. “It was something that I dealt with almost every single week, in one way or another.”
When they decided to implement Salesforce Health Cloud in late 2019, Paladina Health sought Bridge Connector’s help to get the most value out of their new Salesforce investment. Tulley was motivated to explore outsourced vendors, to free up her staff from the labor-intensive build and maintenance that their existing couple of integrations were costing them internally.
Not to mention, Paladina Health’s business model is unique from typical provider customers of both eCW and Salesforce, which led them to customize the use of both platforms. Something so simple as scheduling appointments — which every patient must do — becomes more complicated, because Paladina offers customized services to each of its clients. This means that the appointment options the patients are going to see will look different from one patient to the other. So, a much more customized Salesforce implementation — and a more manageable approach with integrations — was important for Paladina Health to move into the next phase with their personalization and patient engagement goals.
“We’re not a tech company, but we’re investing heavily in technology,” Tulley said. “Anything that takes our internal team away from innovating our own technology (and customized app) is not going to be sustainable for us. Sure, we’re growing our technology teams and our capabilities, but at the end of the day, our company will always be a healthcare provider first.”
One might think that “appointments” just involves one integration, but a scheduling workflow can call for many moving parts and integrations, according to Tulley. Paladina Health planned to comprehensively automate the flow of that data back and forth.
Tulley’s team needed the ability to push and pull different information about those appointments from eCW to acquire the multitude of data needed to customize and personalize the digital experience for each one of their members.
Since engaging with Bridge Connector, Paladina Health has automated six different Salesforce and eClinicalWorks integrations.
What this looks like is a unidirectional patient integration, pushing demographic and eligibility information from Salesforce Health Cloud into eClinicalWorks — set up that way because Salesforce is Paladina Health’s source of truth for eligibility, demographics, contact information, and any other information that they’re getting from the member, their clients, or their employers.
Paladina Health leverages a bi-directional scheduling integration to capture appointment data in Salesforce from eCW, and conversely capturing patient-driven appointments and prescription refill requests from Salesforce to eCW. Paladina Health providers and staff are using eCW as their central hub for scheduling and updating appointments. Paladina Health is enhancing the patient experience by providing a proprietary online health portal and mobile app, created through Salesforce community, that allows patients to create appointments based on schedule availability, reschedule, and cancel appointments as well. A patient can also easily request a prescription refill through the online health portal and mobile app, so it’s generated in Salesforce. While the appointments and refill requests are generated in Salesforce, they flow via eClinicalWorks integration to house all of the scheduling data in eCW as well. The refill request is assigned to a staff member in eCW to service the patient. So a more comprehensive layering of integrations has been critical to closing all of the various communication gaps that were occurring previously.
“Where we’ve really been able to scale in this realm is that I don’t want to staff a team of developers just for integrations,” she said. “It doesn’t make sense for us. So to have a partner like Bridge Connector that can manage all of these integrations allows us to spend that time doing other things now, such as building our own personalized patient engagement mobile app, which is great.”
“We no longer have that opportunity cost, trying to do this ourselves,” Tulley said. “Once our integrations with Bridge Connector were active for a couple weeks, we haven’t had to touch them. I don’t have to worry about them anymore.”
The decision to go with Bridge Connector over some competitors that they evaluated wasn’t just about the full-service aspect they offered, according to Tulley.
“Some of the other companies that we looked at quadruple your cost every single time that you add an integration. The transparent pricing and Bridge Connector’s approach enables us to move really quickly but also get really high-quality work,” she said.
Raised expectations also bled over into how Bridge Connector managed the technical relationships on behalf of Paladina Health with both vendors at play here, Salesforce and eClinicalWorks, which Tulley said she didn’t necessarily anticipate. Yes, Bridge Connector’s specialization in healthcare meant that their implementation teams were already speaking the same languages. But when on joint calls with eCW for example, her team also came to rely on Bridge Connector’s guidance, because they already knew eCW’s data model and had done the integrations before.
“If we went with another vendor, that just wouldn’t be the case,” she said. “I’m able to lean on Bridge Connector for information about how to do this now.”
What this allows Tulley’s team to do is to look at future projects through a different lens — what they’re doing today with communities, their future phases, with more focus, which also shortens their own software development life cycles.
“When it comes to an area requiring integrations, I just mentally check that off as something Bridge Connector is handling for us now. We get to take our eyes off of that ball as soon as we’re up and running, and the time we’ve been able to redirect has been significant,” Tulley said.
“In healthcare, I think we’ve historically underestimated the power of the patient as a consumer, and that’s what we are trying to overcome at Paladina Health,” said Sampath. “It would be amazing if every patient was able to manage their consumer experience in healthcare in the same way that they navigate their Amazon account, or in a way that rivals finance and retail industries. That’s what we’re building at Paladina Health.”