Oncology Provider Enhances Compliance and Patient Care Through Salesforce-Enabled Utilization Management

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Product to Use

Health cloud

Health Cloud

Experience Cloud

Executive Summary

A leading oncology care provider operating under a capitated payer model faced mounting challenges in chemotherapy utilization management. Manual reviews for payer alignment, FDA indication validation, and biosimilar preferences slowed down authorization cycles and increased administrative burden.

Through its partnership with GetOnCRM, the provider embedded utilization management directly into salesforce health cloud/ chemo authorization workflows. This transformation automated contract checks, streamlined FDA and regimen validations, and standardized biosimilar review processes. The outcome: faster turnaround times, consistent compliance, and reduced manual effort, enabling providers to focus more on patient care while ensuring financial and regulatory alignment.

Client Background

A US-based oncology care provider, operating under a capitation-based payor model, required a stronger foundation for managing chemotherapy utilization management (UM) cases. The existing CRM setup lacked structured workflows, making it difficult to track authorizations, coordinate with providers, and ensure compliance.

The organization turned to salesforce healthcare solutions to establish a scalable, standardized UM process aligned with its strategic priorities, particularly Salesforce Health Cloud utilization management and Salesforce Experience Cloud healthcare integrations.

Challenges Faced

The client’s utilization management process for chemotherapy was heavily spreadsheet-driven, leading to inconsistencies and delays

These challenges created longer turnaround times, increased administrative work, and limited visibility for clinical reviewers—directly impacting efficiency in oncology patient care Salesforce workflows.

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Challenges Faced

GetOnCRM implemented Salesforce Health Cloud oncology solutions combined with salesforce experience cloud services to streamline utilization management for chemotherapy cases.

Key Components

Centralized Case Management

All UM requests, status updates, and review history tracked in one system.

Dynamic Knowledge Objects

Automated updates for payor drug lists and switch crosswalks.

Decision Support

Capitation-specific biosimilar references surfaced during case reviews.

Faster Reviews

Role-based dashboards provided physicians with timely data.

User Experience Enhancements

Simplified review processes for better efficiency.

Compliance & Security

Audit-ready workflows and regulatory-grade protections improved trust.

Results & Outcomes

Operational Efficiency

Faster Case Reviews

Improved Capitation Management

Compliance & Audit Readiness

Why Salesforce Matters for Oncology Providers

Oncology care demands precision, compliance, and efficiency. Leveraging Salesforce for oncology care management with Salesforce Experience Cloud healthcare portals ensures providers have the right data at the right time while keeping patients engaged.

Patient Engagement

Secure self-service portals support oncology patients.

Scalability

Supports scaling personalization in healthcare through dynamic workflows.

Integration

Salesforce Health Cloud and Experience Cloud integration for oncology enables seamless coordination.

Referral Management

Built-in referral-management-system and behavioral health referral management salesforce features ensure care continuity.

Interested in building a compliant, scalable, and secure healthcare platform?

Frequently Asked Questions

By embedding Health Cloud utilization management workflows into their systems, oncology providers automate payer checks, biosimilar validations, and FDA regimen compliance, reducing errors and meeting audit standards.
Best practices include designing rule-based dashboards, automating payer drug list updates, and using dynamic biosimilar references for decision support.
Salesforce Experience Cloud patient portal enables secure communication, self-service features, and compliance tracking, improving patient engagement in oncology.
Salesforce Health Cloud and Experience Cloud integration for oncology allows care teams to connect utilization management workflows with patient-facing portals, ensuring compliance, coordination, and transparency.

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