Health-Cloud-Accredited-Professional Salesforce Health Cloud Accredited Professional Exam (WI25) Questions and Answers

Implementing Home Health scheduling in Salesforce Health Cloud requires assigning appropriate permission set licenses to users responsible for scheduling patient visits.

Field Dispatch Scheduler Permission Set License:

The Field Dispatch Scheduler permission set license is designed for users who manage and schedule field service operations, including home health visits. Assigning this license grants schedulers access to functionalities necessary for coordinating and dispatching healthcare providers to patient locations. This includes capabilities such as:

Scheduling Visits: Schedulers can create and manage appointments for initial assessments and recurring visits, ensuring that patients receive timely care.

Salesforce

Resource Management: Effectively allocate healthcare providers based on availability, location, and required skills to meet patient needs.

Access to Field Service Tools: Utilize tools within Salesforce to optimize routing, manage workloads, and monitor service delivery.

By assigning the Field Dispatch Scheduler permission set license, Bloomington Caregivers ensures that their scheduling personnel have the necessary access to efficiently coordinate home health services, thereby enhancing operational efficiency and patient satisfaction.

References:

Schedule Visits with Home Health

Home Health

To modify the timeline orientation in Health Cloud, administrators can adjust the Timeline View Configuration to display the timeline vertically.

Steps:

Access Timeline View Configuration:

Open the Health Cloud - Lightning Admin app in Salesforce.

Locate Timeline View Configuration records.

Edit the Configuration:

Select the relevant configuration for the timeline you wish to update.

Change the orientation setting to Vertical.

Save and activate the updated configuration.

Verify the Changes:

Check the timeline in the respective Lightning record pages to ensure the vertical layout is applied.

Why Other Options Are Incorrect:

A. Enable Timeline in Salesforce Setup: Timelines are already enabled in Health Cloud, and appearance changes are handled at the configuration level.

B. Toggle in Setup: There is no global toggle for orientation in Salesforce Setup.

D. Custom Metadata: Timeline orientation is not controlled by custom metadata; it's managed through view configurations.

Supporting Documentation:

Timeline Configuration Overview (help.salesforce.com)

For implementing a Contact Center leveraging Health Cloud, identifying pain points and defining project requirements involves collaborating with:

Contact Center Agent (Persona):

Frontline staff who interact directly with patients.

Provide insights into the day-to-day challenges in appointment scheduling, billing inquiries, and plan updates.

Salesforce Administrator (Stakeholder):

Responsible for configuring Health Cloud and implementing workflows to address identified pain points.

Integration Architect (Stakeholder):

Ensures smooth integration between Health Cloud and external systems like billing platforms or insurance providers.

Why Other Options Are Incorrect:

A: Care coordinators are not directly involved in patient-initiated contact center interactions. Tableau developers focus on reporting, not operational processes.

C: MuleSoft developers are not primary stakeholders for contact center operations.

D: General physicians and Marketing Cloud administrators do not contribute directly to Contact Center workflows.

References:

Health Cloud Contact Center Overview

Integration Architecture Guide

To enhance the performance and scalability of the Provider Search feature in Salesforce Health Cloud, particularly for a pharmaceutical company aiming to assist patients in locating nearby infusion clinics, leveraging the Data Processing Engine (DPE) is essential.

Data Processing Engine (DPE):

The Data Processing Engine is a robust tool within Salesforce Health Cloud designed to efficiently handle and transform large datasets. In the context of Provider Search, DPE plays a pivotal role by:

Data Transformation: DPE processes and transforms provider data into a structured format, making it readily searchable. This transformation ensures that complex datasets are optimized for quick retrieval during user searches.

Performance Enhancement: By pre-processing and indexing provider information, DPE significantly reduces the time required to execute search queries. This leads to faster response times, enhancing user experience.

Scalability: DPE is designed to handle large volumes of data, ensuring that as the number of providers or clinics increases, the system maintains optimal performance without degradation.

Implementation Steps:

Enable Data Pipelines: Assign the Data Pipelines Base User permission set to the Health Cloud user responsible for enabling Provider Search. Then, activate Data Pipelines in the system settings.

Salesforce

Configure Provider Search: After enabling Data Pipelines, set up the Provider Search feature by defining the necessary parameters and ensuring that the provider data is correctly mapped and transformed using DPE.

Salesforce

Data Synchronization: Ensure that provider data is regularly synchronized and updated to reflect any changes, maintaining the accuracy and reliability of the search results.

Salesforce

By integrating the Data Processing Engine into the Provider Search setup, the pharmaceutical company can offer patients a swift and reliable tool to locate nearby infusion clinics, thereby improving patient satisfaction and operational efficiency.

References:

Enable Performance and Scalability for Provider Search

Set Up Provider Search in Health Cloud

To integrate an electronic health record (EHR) with Salesforce Health Cloud and display key clinical data, leveraging a middleware integration solution is the most appropriate approach. This setup ensures compatibility with FHIR R4 standards and handles any required data transformation effectively.

FHIR R4 Standards Alignment:

The middleware can interpret and process data formatted to FHIR R4 standards, enabling seamless integration with Salesforce Health Cloud's FHIR-aligned data model.

Data Transformation Capability:

Middleware solutions like MuleSoft (a Salesforce product) provide tools to transform data structures, ensuring compatibility between the EHR system and Health Cloud.

Scalability and Maintainability:

Middleware solutions simplify complex integrations by abstracting point-to-point connections, allowing for easier scalability as additional systems are integrated.

Error Handling and Monitoring:

Middleware platforms include error-handling capabilities, ensuring data integrity during the transformation and transfer processes.

A. Scheduled Batch Job: While useful for static data transfers, batch jobs are not ideal for real-time or near-real-time clinical data exchange required for EHR integrations.

B. "Swivel-Chair" Procedure Document: This refers to manual data entry or cross-referencing workflows, which are inefficient, error-prone, and not scalable.

C. Point-to-Point API Connection: Though feasible, this approach lacks the flexibility and transformation capabilities provided by middleware solutions. Point-to-point integrations are difficult to maintain as systems evolve.

Use a middleware solution like MuleSoft to connect the EHR system and Health Cloud.

Set up FHIR R4-compliant data mappings between the EHR and Salesforce.

Configure and test the data transformations required for specific Health Cloud objects (e.g., medication, encounter, and condition data).

Salesforce Health Cloud FHIR Integration

MuleSoft for Healthcare Integration

Why Middleware Integration is the Best Approach:Why Other Options are Less Suitable:Implementation Steps:References:

In Salesforce Health Cloud, Identity Verification Processes allow you to configure how patient or contact identities are verified during interactions. The requirements from the call center team involve modifying the verification process to:

Include "Bloomington ID":

This custom field should be added as a required verifier and also included in search results.

Modify "Birth Date":

Remove it as a required verifier while keeping it available as an optional verifier in the process.

Steps to Implement the Solution:

Add Two New Identity Verification Process Field Records for ‘Bloomington ID’:

Field Type: Result Field: Ensures the field appears in the search results.

Field Type: Required Verifier: Makes this field mandatory for identity verification.

Modify Birth Date Record:

Update the existing record for Birth Date by changing its Field Type from "Required Verifier" to "Optional Verifier." This adjustment makes the field optional in the verification process.

This approach ensures the flexibility and compliance requested by the call center manager while aligning with Salesforce Health Cloud's configurable Identity Verification features.

References:

Administer Health Cloud

Flow Builder Documentation for Identity Verification

Action Plan Templates in Salesforce Health Cloud are designed to support care coordination by automating the creation of dependent intervention tasks. These templates allow administrators to define a set of tasks and their dependencies, ensuring that tasks are completed in a specific sequence or based on predefined criteria.

How Action Plan Templates Work for Dependent Tasks:

Task Sequencing: Enables the creation of dependent tasks that are triggered when prior tasks are completed.

Reusable Templates: Action Plan Templates can be reused across different care plans, ensuring consistency in intervention management.

Flexibility in Task Configuration: Includes options to assign tasks to specific team members, define due dates, and set task dependencies.

Why Other Options Are Incorrect:

Intervention Templates: Focused on creating reusable intervention definitions but lack task dependency configuration.

Industry Template Library: Provides predefined templates for healthcare workflows but does not directly address task dependencies.

Care Plan Task Templates: Define standalone tasks but do not support task dependencies or automation.

References:

Action Plan Templates Documentation

Integrated Care Management Overview

When an end user is unable to view certain data on the Enhanced Timeline for Contact Center during User Acceptance Testing (UAT), the primary step in troubleshooting should be to verify that the user possesses the appropriate object permissions.

Understanding Object Permissions:

Purpose: Object permissions determine a user's ability to create, read, edit, or delete records of a particular object within Salesforce.

Types of Permissions:

Read: Allows users to view records.

Create: Permits users to add new records.

Edit: Enables users to modify existing records.

Delete: Grants users the ability to remove records.

Troubleshooting Steps:

Verify User's Profile and Permission Sets:

Profiles: Check the user's assigned profile to ensure it includes the necessary object permissions for the data intended to be displayed on the Enhanced Timeline.

Permission Sets: Review any permission sets assigned to the user that might grant additional object permissions.

Ensure Field-Level Security:

Confirm that field-level security settings permit the user to access the specific fields associated with the timeline data.

Check Sharing Settings:

Assess the organization's sharing rules and settings to ensure the user has the requisite access to the records in question.

References:

Salesforce Security Guide: For detailed information on configuring object permissions and ensuring proper access controls, consult the Salesforce Security Guide: Salesforce Security Guide

Conclusion:

Ensuring that users have the correct object permissions is crucial for accessing data on the Enhanced Timeline. By verifying and configuring these permissions appropriately, administrators can resolve visibility issues and enhance user experience during UAT.

When deploying the Enhanced Timeline in Salesforce Health Cloud, administrators must ensure that all necessary objects, including custom objects, are properly configured and added to the Timeline. For tracking caregiver preferences, the steps include:

Add the Custom Object to the Timeline (Option A):

After the Enhanced Timeline is deployed, administrators must add the custom object (e.g., Caregiver Preferences) to the Timeline configuration.

This involves mapping the fields and interactions from the custom object to the Timeline's data source, ensuring they appear in the Enhanced Timeline.

Steps to Add Custom Objects to the Timeline:

Navigate to Setup > Timeline Configuration.

Select the desired Timeline view or create a new one.

Add the custom object as a Timeline Entry Type and configure the relevant fields.

Save the configuration and ensure it is applied to the Enhanced Timeline component.

Option B: The Timeline component must already be added to the Lightning page before additional configuration steps.

Option C: Permissions to view the Timeline are set up earlier during deployment, not as a post-deployment step.

Option D: The Timeline component activation occurs during page configuration and deployment.

Key Actions Post-Deployment:Other Options Reviewed:References:

Enhanced Timeline Configuration Guide

Customizing Timelines in Salesforce Health Cloud

In Salesforce Health Cloud, granting access to patient data for healthcare providers or supporting personnel is efficiently managed through Care Teams.

Key Details:

Care Teams in Health Cloud:

A Care Team represents the group of professionals supporting a patient.

Access levels (Read or Read/Write) can be explicitly granted to Care Team members.

Implementation Steps:

Navigate to the patient's record in Health Cloud.

Open the Care Team section and add the respiratory therapist.

Assign the appropriate Role (e.g., Respiratory Therapist).

Specify the required access level (Read or Read/Write).

Why Care Teams Are Preferred:

Specific Roles: Clearly defines the roles of individuals supporting the patient.

Access Flexibility: Provides fine-grained control over access to patient data.

Why Other Options Are Incorrect:

A and C (Account Team): Account Teams are not designed for patient care management and lack the granularity required for healthcare scenarios.

D (Care Team with Default Access): Default access is not automatically granted; permissions must be explicitly defined.

Supporting Documentation:

Manage Care Teams in Health Cloud (help.salesforce.com)

Role-Based Access in Health Cloud (developer.salesforce.com)

By leveraging Care Teams and assigning appropriate permissions, administrators can efficiently manage access to sensitive patient data while maintaining compliance with privacy regulations.

Salesforce Health Cloud provides a robust data model for tracking insurance details and plans, aligning with healthcare industry standards. The specified objects—Payer, Plan Offering, Coverage Benefit, and Member Plan—allow the company to model insurance-related data effectively.

Key Objects:

Payer: Represents the payer organizations (insurance providers) offering health plans.

Plan Offering: Defines the various insurance plans offered by a payer organization.

Coverage Benefit: Details the benefits available under a specific plan, such as covered services and limitations.

Member Plan: Tracks individual patient enrollment details in a specific insurance plan, including policy numbers, start/end dates, and other specific data.

This combination of objects ensures all requirements are met:

Tracking payer organizations via the Payer object.

Managing plans offered by each payer through Plan Offering.

Defining standard benefits under a plan via Coverage Benefit.

Linking a patient to their specific plan and details through Member Plan.

Why Other Options Are Incorrect:

Option A, B, D: These combinations include objects like Purchaser or Plan Benefit, which are not standard objects for insurance tracking in Health Cloud. The provided data model specifically supports the objects in Option C.

References:

Health Cloud Insurance Data Model

Health Cloud Documentation

Migrating from Service Cloud to Health Cloud requires several prerequisites to ensure successful installation and functionality of the Health Cloud managed package:

Log a Support Case to Enable Person Accounts (Option B):

Health Cloud relies on Person Accounts to manage patients as individuals.

Administrators must contact Salesforce Support to enable Person Accounts in the org since this cannot be activated through Setup.

Enable Contacts to Relate to Multiple Accounts (Option C):

This functionality allows a contact (e.g., a patient) to be associated with multiple accounts, such as primary care providers, specialists, or insurance entities.

Navigate to Setup > Account Settings, and enable Contacts to Multiple Accounts.

Enable Chatter Settings (Option E):

Chatter is used in Health Cloud for collaboration and real-time updates.

Administrators must ensure Chatter is activated to support case discussions, timeline sharing, and other collaborative features.

Option A: While enabling data protection is important, it is not a prerequisite for installing Health Cloud.

Option D: Enabling Person Accounts is correct, but it is done via a support case (Option B).

Key Prerequisites:Other Considerations:References:

Health Cloud Installation Guide

Enabling Person Accounts

Contacts to Multiple Accounts

A Conditional Block in an Integration Procedure allows you to execute a group of actions based on specific conditions. This means that certain steps within the procedure will only run when predefined criteria are met, enabling dynamic and context-sensitive processing.

Implementation Steps:

Identify the Condition:

Determine the specific condition under which the email with the new address should be sent. For instance, if the appointment is booked at the new location, the condition could be based on the location ID or name.

Configure the Conditional Block:

Add a Conditional Block: Within your Integration Procedure, insert a Conditional Block where you want the conditional logic to apply.

Set the Execution Conditional Formula: Define the condition that evaluates to true when the email should be sent. For example, if the new location has an ID of 'New_Location_ID', the formula might be:

shell

Copy code

%AppointmentLocationId% == 'New_Location_ID'

Add Actions Within the Conditional Block: Inside this block, include the necessary actions to send the email. This could involve:

Set Values Action: To define the email content, including the new address.

Email Action: To send the email to the patient.

Test the Integration Procedure:

Ensure that when an appointment is booked at the new location, the condition evaluates to true, triggering the email. Conversely, verify that appointments at other locations do not trigger this email.

Benefits of Using Conditional Blocks:

Dynamic Processing: Executes specific actions only when certain conditions are met, enhancing efficiency.

Simplified Logic Management: Organizes conditional logic within the Integration Procedure, making it easier to manage and maintain.

Improved Performance: By executing only necessary actions, it reduces processing time and resource consumption.

References:

Create a Conditional Block Example with If-Elseif-Else Logic: This Salesforce Help article provides a detailed example of configuring a Conditional Block within an Integration Procedure, demonstrating how to execute actions based on specific conditions.

Salesforce

Group Integration Procedure Steps Using Blocks: This resource explains how to group related steps in an Integration Procedure using blocks, including Conditional Blocks, to execute them based on defined conditions.

Salesforce

By adding a Conditional Block to the Create Appointment Integration Procedure, you can ensure that patients receive an email with the new office address only when they book an appointment at the new location, thereby enhancing communication and patient experience.

To enable viewing medication data from Salesforce Health Cloud while leveraging FHIR standards, the Clinical Data Model is the correct data model to use.

Purpose and Design:

The Clinical Data Model in Health Cloud is specifically built to represent patient health data, including medications, allergies, conditions, and other clinical information.

It adheres to FHIR (Fast Healthcare Interoperability Resources) standards, which are widely used to facilitate the exchange of electronic health information between systems.

Medication Data Representation:

The Clinical Data Model contains FHIR-compliant objects, such as MedicationRequest and MedicationStatement, to store and retrieve information about prescribed medications, their dosages, and administration details.

FHIR Integration:

Health Cloud's Clinical Data Model supports RESTful FHIR APIs, allowing external systems to access medication data seamlessly.

FHIR compatibility ensures that medication data can be shared with third-party EHR systems and healthcare applications.

Configuration of Medication Records:

Populate the FHIR-compliant objects with medication data, ensuring adherence to the FHIR R4 resource structure.

Use of FHIR APIs:

Enable the Clinical Summary Healthcare API or specific Medication APIs (e.g., GET /MedicationRequest) to fetch and display medication details.

Integration Testing:

Validate the FHIR-based data exchange with other systems to ensure seamless interoperability.

Why the Clinical Data Model?Implementation Steps:References:

Salesforce Health Cloud Developer Guide: Clinical Data Model

FHIR Resources for Health Cloud

The FHIR R4 (Fast Healthcare Interoperability Resources) standard is the most suitable industry data standard for designing interoperability with Electronic Health Record (EHR) systems in Salesforce Health Cloud.

Widespread Adoption:

FHIR R4 is the industry standard for modern EHR systems, supported by regulatory bodies like the ONC (Office of the National Coordinator for Health IT).

Compatibility:

Salesforce Health Cloud’s Clinical Data Model and FHIR-compliant APIs are built to align with FHIR R4 standards.

Data Interoperability:

Facilitates seamless exchange of clinical data (e.g., medications, conditions, and encounters) between Health Cloud and EHR systems.

A. Clinical Data Acquisition: A generic concept rather than a specific standard.

B. Personal Health Record (PHR): Focuses on patient-controlled data, not interoperability.

C. HL7 v1 Messaging: An outdated standard superseded by FHIR for modern systems.

Why FHIR R4?Why Other Options Are Less Relevant:References:

Salesforce FHIR Integration Guide

To automate the capture of data from faxes for clinical reviews and manage the approval process in Salesforce Health Cloud, the following capabilities are recommended:

Utilization Management in Health Cloud supports the payer's clinical review process by enabling workflows for reviewing medical necessity and care appropriateness.

It provides structured workflows for processing clinical documents, making it ideal for end-to-end determination and approval processes.

Features include care authorizations, review tracking, and decision management.

Intelligent Document Automation extracts data from documents (e.g., faxes, PDFs) and populates corresponding Salesforce records.

This capability reduces manual data entry, improves accuracy, and ensures data is automatically captured from the faxes received.

Paired with Salesforce workflows, it can trigger approvals or further reviews based on extracted data.

1. Utilization Management (A):2. Intelligent Document Automation (C):Why Other Options Are Incorrect:

B. Integrated Care Management: Focuses on patient care plans and coordination, not clinical review or payer processes.

D. Care Authorizations: Handles care approvals but does not support document data extraction or end-to-end review processes.

References:

Utilization Management in Health Cloud

Intelligent Document Automation Overview

The Benefits Verification component in Salesforce Health Cloud is designed to help agents respond to member inquiries regarding benefits coverage. This feature integrates seamlessly with Health Cloud objects and data, offering agents real-time access to benefit information.

Key Features of Benefits Verification:

Real-Time Verification: Displays benefits data retrieved through integrations, allowing agents to answer member questions promptly.

Comprehensive Coverage Details: Includes plan benefits, covered services, and limits.

Customizable Layout: Can be configured on the record page to provide relevant benefit details in a user-friendly format.

Why Other Options Are Incorrect:

A. Eligibility Validation: Focuses on determining program eligibility rather than detailed benefits coverage.

B. Benefits Coverage: While related, it is not the specific tool designed for verifying benefits inquiries.

C. Coverage Confirmation: Typically used for confirming specific services under a plan, not general benefits questions.

References:

Benefits Verification in Health Cloud

Advanced Therapy Management (ATM) in Salesforce Health Cloud is specifically designed to support complex workflows and scheduling requirements, particularly for therapies involving multiple interdependent appointments. For a gene therapy program, ATM provides these features:

Reschedule Part of the Appointment Chain (Option A):

In complex workflows where multiple steps are involved (e.g., collection, processing, infusion), ATM allows administrators to reschedule individual appointments within the chain without disrupting the entire workflow.

This flexibility is crucial for accommodating unexpected delays or changes in the therapy process.

Book Multi-Step Appointments (Option B):

ATM supports the scheduling of interdependent, multi-step appointments that are a common feature of advanced therapies such as gene therapy.

For example, steps like apheresis, manufacturing, and infusion can be scheduled in sequence, ensuring coordination across various stakeholders.

Optimize Appointment Chain with Einstein (Option C):

While optimization using Einstein is a broader Salesforce capability, it is not directly tied to Advanced Therapy Management's out-of-the-box scheduling features.

Schedule a Telehealth Appointment (Option D):

Telehealth appointments are not the focus of ATM, which is designed for in-person and complex therapy workflows.

Key Scheduling Capabilities of ATM:Other Options:References:

Advanced Therapy Management Overview

Scheduling in Advanced Therapy Management

To efficiently track a series of problems, goals, and interventions (PGIs) in a repeatable way, Action Plan Templates in Health Cloud are the recommended approach. These templates allow care coordinators to define and automate tasks associated with PGIs.

Benefits of Action Plan Templates for PGIs:

Task Automation: Automatically generates a series of tasks for care coordinators based on predefined templates.

Customization: Templates can be tailored for different care scenarios or patient needs, ensuring consistency across cases.

Efficient Tracking: Allows care coordinators to monitor progress on PGIs and ensure timely interventions.

Why Other Options Are Incorrect:

A: Checklists are manual and lack the automation and repeatability provided by action plan templates.

B: Care program templates are used to define overarching care programs, not detailed PGI tracking.

D: PG libraries provide reusable PG definitions but do not automatically create tasks or track interventions.

References:

Action Plans in Health Cloud

In Salesforce Health Cloud, modeling patients effectively is crucial for maintaining accurate and comprehensive healthcare records. For large provider systems, the recommended approach is to utilize Person Accounts to represent individual patients.

Understanding Person Accounts:

A Person Account in Salesforce is a special type of account that combines the characteristics of both an Account and a Contact into a single record. This structure is particularly beneficial in healthcare settings where the patient is both the individual receiving care (Contact) and the primary account holder (Account).

Advantages of Using Person Accounts in Health Cloud:

Unified Patient Representation:

Person Accounts provide a consolidated view of patient information, eliminating the need to manage separate Account and Contact records for the same individual.

Alignment with Healthcare Data Models:

Salesforce Health Cloud's data model is designed to work seamlessly with Person Accounts, ensuring compatibility with healthcare standards like FHIR (Fast Healthcare Interoperability Resources). This alignment facilitates interoperability with Electronic Health Record (EHR) systems and other healthcare applications.

Enhanced Data Management:

With Person Accounts, healthcare providers can efficiently manage patient demographics, contact information, medical history, and other critical data within a single record, streamlining administrative processes and improving data accuracy.

Implementation Considerations:

Enabling Person Accounts:

Person Accounts must be enabled in your Salesforce org. This process is irreversible and should be carefully planned. Consult Salesforce documentation and consider involving a Salesforce administrator or consultant to ensure proper setup.

Data Migration:

If transitioning from a system that uses separate Account and Contact records, plan for data migration to consolidate existing patient records into Person Accounts.

Customization and Integration:

Ensure that customizations and integrations within your Salesforce org are compatible with Person Accounts. Some third-party applications may require adjustments to work effectively with this data model.

References:

Patient Resource Mapping: Salesforce Health Cloud maps the FHIR Patient resource to Person Accounts, reinforcing the suitability of Person Accounts for patient representation.

Salesforce Developers

Clinical Data Model: Salesforce's Clinical Data Model aligns with FHIR standards and supports the use of Person Accounts for patient data management.

Salesforce Developers

By leveraging Person Accounts, large provider systems can achieve a streamlined and standardized approach to patient data management within Salesforce Health Cloud, enhancing care coordination and supporting interoperability across healthcare platforms.

Utilization Management is a critical component in healthcare that focuses on ensuring the appropriateness, necessity, and efficiency of healthcare services. For payers working with plan members and medical providers, the case-by-case review of care appropriateness requires thorough processes to streamline authorization and review tasks.

Designing Care Requests to Seek Authorization (Answer B):

Purpose: The Care Request object in Health Cloud is essential for seeking authorizations from a health plan for specific healthcare services, drugs, or admissions. This object ensures that requests are appropriately documented and tracked.

Functionality:

It allows users to create and manage care requests linked to plan members.

Integrates with payer systems to capture critical details for authorization, such as service codes, plan information, and medical necessity documentation.

Supports automation through workflows and approvals, speeding up the decision-making process.

Relevance: By designing efficient Care Requests, the consultant ensures that all required details for preauthorizations or service reviews are captured seamlessly, meeting regulatory and operational needs.

Considering Request Review Types (Answer C):

Purpose: UM processes in Health Cloud must address the three primary types of reviews:

Prior Authorization Review: Conducted before the service is provided to determine medical necessity.

Concurrent Review: Evaluates the necessity of ongoing care during hospitalization or service delivery.

Retrospective Review: Analyzes the appropriateness of care after it has been delivered.

Implementation in Health Cloud:

The consultant must design workflows and data models to capture the details of these review types, including timestamps, reviewer notes, and outcomes.

Health Cloud supports tracking and documenting these reviews within the UM module, ensuring compliance with healthcare regulations.

Relevance: These review types allow the payer to influence decisions by ensuring appropriate care is provided while managing costs and maintaining high-quality outcomes.

Why the Other Options Are Less Relevant:

A. Designing Next Best Action and Recommendations for the Care Management Team: While recommendations and next-best-action features are beneficial for care management, they are not directly tied to the case-by-case review process of Utilization Management, which focuses more on care appropriateness and authorizations.

D. Considering the Number of Intake Agents Using Health Cloud: While operational considerations like staffing are important, this is not a Utilization Management process. It's a broader organizational concern unrelated to the core functionality of UM in Health Cloud.

References:

Utilization Management Overview: Salesforce documentation outlines how to handle prior authorizations, service approvals, and related processes within Health Cloud. (help.salesforce.com)

Care Requests and Authorizations: Details on managing care requests and integrating with payer systems for streamlined authorization workflows. (developer.salesforce.com)

UM Process Design in Health Cloud: Guidance on implementing request review types and managing data models to support UM. (architect.salesforce.com)

By addressing Care Requests and Request Review Types, the consultant ensures a robust Utilization Management setup, enabling effective collaboration between payers, providers, and members while optimizing care delivery and compliance.

Using External Objects is the most efficient integration pattern for managing large volumes of data, such as claims. In this scenario, the claims data resides in an external system, and fetching 10 million records annually into Salesforce is neither scalable nor cost-effective. External Objects allow Salesforce users to access the data on demand without storing it in Salesforce.

Key Features of External Objects:

Real-Time Access: Fetches claims data directly from the external system when a patient’s record is accessed.

Storage Efficiency: Avoids consuming Salesforce storage limits by not importing the data.

Flexible Integration: External data sources such as OData can be configured to integrate with Salesforce.

Why Other Options Are Incorrect:

A. Nightly Job: Importing all claims into Salesforce daily would require excessive storage and processing resources.

B. ESB Load: Loading claims into Salesforce via an ESB introduces similar storage concerns as Option A.

C. Callout on Demand: While possible, storing claims data in Salesforce after a callout defeats the purpose of on-demand integration.

References:

External Objects in Salesforce

Integrating External Data with Salesforce Connect

Tracking socioeconomic and cultural barriers that could hinder a patient's progress requires Salesforce Health Cloud’s Social Determinants of Health (SDoH) capability.

Comprehensive Patient View:

Captures data on factors like income, education, housing, and transportation that influence health outcomes.

Risk Identification:

Identifies potential barriers and integrates them into care plans, enabling proactive intervention.

Care Coordination:

Helps care teams design support services and interventions tailored to individual patient needs.

B. Clinical Barriers: While useful, this focuses on clinical obstacles rather than broader socioeconomic factors.

C. Utilization Management: Centers on managing care authorizations, not patient barriers.

D. Care Blockers: Not a formal Health Cloud capability; overlaps conceptually with SDoH.

Key Features of Social Determinants of Health:Why Other Options Are Less Suitable:References:

Salesforce Social Determinants of Health Overview

When configuring security for patient lists in Salesforce Health Cloud, administrators must consider object-level, field-level, and list-level access to ensure data privacy and compliance with regulations like HIPAA. Below are the key considerations:

HCPatientListSecurity Custom Setting (A):

This custom setting allows administrators to define and restrict access to patient lists at a granular level. For example, administrators can control which users can view or interact with patient lists based on their role or department.

Field-Level Security Impact (C):

If a user’s field-level security restricts access to a field included in the patient list’s display columns, the column will not appear in the list. This ensures sensitive data is protected and only accessible to authorized users.

Object Access Restrictions (E):

Users with restricted object-level access (via profiles or permission sets) cannot create or view lists that utilize those objects. This ensures that unauthorized users cannot access or manipulate sensitive data.

Why Other Options Are Incorrect:

B: Restriction rules in Salesforce are used to provide additional access beyond organization-wide defaults (OWDs), not for patient lists.

D: Patient list access is managed through specific Health Cloud mechanisms, not standard Salesforce sharing settings.

References:

Health Cloud Security Overview

Field-Level Security Documentation