AI-first CRM built for Healthcare
C3 AI CRM for Healthcare is the only AI-first CRM built for healthcare providers, payers, and life sciences companies in biotech, pharmaceuticals, and medical devices. It delivers industry-specific, AI-enabled capabilities for healthcare enterprises and includes the comprehensive sales, marketing, and customer experience capabilities of Microsoft Dynamics 365 and Adobe Experience Cloud. Using C3 AI CRM, healthcare organizations improve patient outcomes, reduce healthcare costs, accelerate time to market for new products, prevent fraud, reduce readmission rates, and improve profitability.
AI CRM for the Digital Age
Traditional CRM applications are systems-of-record with analytic capabilities constrained by limited and often outdated data. C3 AI CRM unifies data from a broad set of enterprise and extraprise sources to create powerful new predictive insights that power healthcare solutions.
Forecasts of future revenue are often limited as the data in the CRM are biased, based on anecdotal evidence, frequently inaccurate, and therefore of limited use in making data-driven sales, financial planning, clinical investment, and operational decisions.
C3 AI CRM both expands the data inputs beyond traditional CRM data to all enterprise data (e.g., medical affairs, field notes, claims, billing) and extraprise data (e.g., provider data, EMRs, news, disease trends). The solution applies AI to analyze unstructured data such as provider notes for sentiment, accurately determining probability of closure, forecasting expected revenues, identifying areas of risk and opportunities, explaining underlying evidence on the predictions, and recommending next steps and offers to improve the forecast. C3 AI CRM streamlines the revenue forecasting experience with an AI-first workflow, starting with an accurate forecast and immediately telling the user where they need to focus, why, and what they can do about it.
With C3 AI CRM, sales leaders can better set and meet sales targets, prioritize activities to mitigate risks and realize new opportunities, and empower sales teams with relevant information and insights in order to increase win rates; sales representatives can prioritize their time on the highest value opportunities armed with actionable insight; and business leaders have realistic, more accurate revenue forecasts that they can use for planning operations and cash flow.
The loss of insurance premiums from member cancellations leads to lost revenue and reduced negotiation power with providers, and because payers lack data on all factors affecting member enrollment and retention, accurate prediction of member churn has been impossible.
C3 AI CRM identifies members at risk of churn and recommends best offers and optimized plans to maximize member renewal during open enrollment periods.
With C3 AI CRM, healthcare payers can proactively engage members at risk of churn, reduce cancellation rates to protect revenue, and better manage resources based on accurate enrollment predictions.
Member Churn Management
Next Best Offer
Chronic conditions such as heart disease, diabetes, cancer, and obesity account for as high as 90% of national healthcare spending. While payers are the entities with highest economic incentives to ensure better outcomes of chronic conditions, management of these disorders traditionally has been left to providers and patients with varying degrees of success. Profitability and outcomes suffer because payers do not have tools to help providers and patients improve management of chronic conditions and minimize associated complications with these conditions.
C3 AI CRM leverages AI to identify patients with costly chronic conditions, recommends personalized products and services that help minimize disease complications and adverse events, and predicts short-term and long-term health outcomes of recommended treatments.
With C3 AI CRM, healthcare payers can influence patient care for chronic conditions, optimize patient health outcomes, and reduce short-term and long-term costs associated with chronic conditions.
To generate a product forecast, sales reps and channel partners commonly have to rely on intuition to anticipate the deals that will close and the products that are likely to be purchased. When error-prone estimates are aggregated, the result is highly inaccurate forecasts and costly production planning challenges.
C3 AI CRM improves product forecasting and supply planning by both expanding the data inputs beyond CRM data to all enterprise data (e.g., production, supply chain, logistics, research) and extraprise data (e.g., economic data, hospital feeds, news, disease trends). The solution applies AI to accurately and dynamically determine forecasted demand – at a granular level and with significant lead time – along with the evidence explaining the increases or decreases over time. C3 AI CRM integrates directly into supply chain and production planning systems in order to feed those processes timely, actionable forecasts so that they can plan efficient operations, maintain low inventory levels, and feed revenue forecasts the right inputs.
With C3 AI CRM, healthcare enterprises have a much more accurate, granular, forward-looking, and dynamic view of demand so that planning teams can not only meet customer demand but do so at lower costs to patients and without large inventory reserves.
Healthcare Fraud Detection for Payers
Healthcare fraud is a widespread problem for payers with false and misleading claims causing financial loss. Detecting and preventing healthcare fraud is currently costly, slow and error-prone, often requiring specialized healthcare fraud investigators who may not have the data and analytical resources to detect all fraudulent activities.
C3 AI CRM scans each member’s prior claims, medical records, and prescription history, as well as each provider’s business performance, financial transactions, and guideline compliance. This helps healthcare investigators detect fraud in anomalous claims and mismatches between diagnoses and provided care.
With C3 AI CRM, healthcare payers can improve detection of fraudulent claims and identify new forms of healthcare fraud, reducing costs and the number of cases fraud investigators assess.
Processing millions of claims submitted by providers and patients is highly resource-intensive, manual, error-prone, and time-consuming. Payers lack modern, sophisticated tools to do this in an efficient and automated manner.
C3 AI CRM applies AI and advanced machine learning algorithms to facilitate medical claims management, enabling insurers to automatically identify missing information, route claims, customize explanation of benefits, and predict expected volumes of claims and patient inquiries in the future for optimized resource planning.
With C3 AI CRM, healthcare payers manage claims faster, eliminate manual claims processing, improve profitability, and achieve member satisfaction goals.
Patient Risk & Adherence Monitoring
Improve patient outcomes and avoid re-admission fines, leveraging AI to identify and monitor patients at risk of developing serious clinical concerns, non-adherence, or preventable clinical emergencies.
Optimize staff schedules based on real data from past patient loads and capacity requirements to ensure an engaged, utilized, and satisfied care team.
Clinical Trial Management
Accelerate availability of new life-saving therapies on the market by using AI to streamline design and management of clinical trials from study site selection to patient enrollment and regulatory submissions.
Call Center Deflection
Leverage AI and advanced machine learning techniques to provide accurate predictions of the types and frequencies of member inquiries, helping payers reduce call center costs.
Insurance Premium Optimization
Integrate historical claims data, medical records, and financial and employment histories, powering AI and machine learning algorithms to optimize premium and service offerings via each member’s personalized health insurance plan.
Member 360-Degree View
Enable service managers to engage with members through personalized and targeted preventive care recommendations while helping to prevent costly medical treatments in the future and improve member satisfaction.