HEALTH
Industry Solution · Health Cloud

Salesforce Health Cloud, engineered for outcomes.

CRMPRACTICE builds Health Cloud as a HIPAA-aligned, FHIR-native operating platform — unifying patient, member, provider and care team on one governed graph, with Agentforce for Health baked in.

(01) What it is

Health Cloud is Salesforce's clinical operating layer.

Health Cloud extends the Salesforce core with a healthcare data model — Patient / Member, CareProgram, CarePlan, ClinicalEncounter, Coverage, HealthcareProvider — aligned to FHIR R4 and paired with Shield, Consent and industry sharing controls.

Combined with Data Cloud's FHIR connector, MuleSoft's Accelerator for Healthcare and Agentforce for Health, it becomes the connective tissue between the EHR, the payer platform, the contact centre, the field and the patient's phone.

(02) Capability pillars

Six pillars, one governed platform.

01

Patient & Member 360

A longitudinal record unifying demographics, coverage, conditions, encounters, medications, care team and social determinants — sourced from EHRs, payer systems and Data Cloud into a single governed profile.

02

Care Management

Care plans, problems, goals and interventions with assessments, risk stratification and Home Health / Remote Patient Monitoring wired to task queues, care teams and utilisation review.

03

Provider & Network Management

Provider search, credentialing, network adequacy, referral management and PRM — with FHIR-aligned Practitioner, Organization and Location resources kept in sync with credentialing systems.

04

Payer Operations

Member services, benefits & enrolment, utilisation management, appeals & grievances, and prior authorisation orchestrated on Health Cloud with Service Cloud Voice and Agentforce assist.

05

Agentforce for Health

Grounded, HIPAA-aligned agents for patient scheduling, benefits enquiry, prior-auth intake, discharge follow-up and clinical summarisation — built on the Salesforce Trust Layer with full audit.

06

Life Sciences Adjacencies

Native handshake with Life Sciences Cloud for HCP engagement, patient services hubs, clinical trial management and MSL workflows — sharing identity, consent and the Data Cloud graph.

(03) Reference architecture

The Health Cloud stack, tier by tier.

01 · EngagementPatient, member, provider & clinician touchpoints
Patient portal (Experience Cloud)Provider portalMobile / SMART on FHIRVoice (Amazon Connect)WhatsApp / SMS / ChatKiosk & tablet intake
OAuth 2.0 · SMART on FHIR · Messaging APIs
02 · Experience & AgentsAgentforce for Health + Service Cloud
Agentforce AgentsEinstein CopilotOmni-Channel RoutingCare Team ConsoleVoice Transcription & Agent Assist
Trust Layer · Consent · Sharing Rules
03 · Health Cloud CoreClinical & administrative record
Patient / Member 360CareProgram · CarePlanClinicalEncounter · CaseCoverage · PriorAuthHealthcareProvider · NetworkShield encryption & audit
Data Cloud FHIR streams · Flow · Apex actions
04 · Data Cloud clinical zoneFHIR-native identity, insights & activation
FHIR R4 ingestionIdentity resolutionCalculated Insights (risk, adherence)Segments & activationsZero-copy to Snowflake / Databricks
MuleSoft System APIs · Bulk FHIR · HL7 v2 · X12
05 · Systems of engagement / recordEHR, payer, device & partner ecosystem
Epic · Cerner / Oracle HealthMeditech · AthenahealthFacets · HealthEdge · QNXTValidic · Apple Health · RPM devicesState HIEs · TEFCA QHINsSnowflake · Databricks · Azure Health Data Services
(04) Data model (FHIR-aligned)

Objects we standardise on, from day one.

Every field maps to a FHIR resource where one exists — so interoperability is by design, not by workaround.

01

Account (Person)

Patient / Member as a Person Account with Individual for consent, contact points and preferences.

02

HealthcareProvider

Practitioner and Organization records aligned to FHIR Practitioner / Organization.

03

CareProgram / CareProgramEnrollee

Programme definition, enrolment, cohorts, eligibility and outcomes tracking.

04

CarePlan / CarePlanProblem / CarePlanGoal / CarePlanActivity

Structured plan of care aligned to FHIR CarePlan, Condition, Goal.

05

ClinicalEncounter / ClinicalCase

Visits, admissions and case management wrapper for cross-team collaboration.

06

Medication / MedicationStatement / MedicationRequest

Reconciled meds surfaced from EHR via FHIR.

07

Observation / Condition / Procedure / AllergyIntolerance

Clinical facts, ingested through Data Cloud FHIR connectors and streamed to Health Cloud.

08

Coverage / CoverageBenefit / PriorAuthorization

Payer-side benefits, eligibility and utilisation review.

09

Task / OmniChannel / Voice Call

Care team work, member service interactions and Voice transcripts unified in one timeline.

(05) Integration patterns

EHR, payer and device — connected the right way.

I-01

EHR integration (Epic, Cerner/Oracle Health, Meditech, Athenahealth)

Bi-directional integration via MuleSoft Accelerator for Healthcare using HL7 v2 (ADT, ORU, SIU) and FHIR R4 (Patient, Encounter, Observation, MedicationRequest, DocumentReference). Bulk FHIR $export for cohort loads into Data Cloud.

I-02

Payer & claims platforms

Facets, HealthEdge, QNXT and TriZetto connected through MuleSoft System APIs — 837/835/270/271/278 X12 transactions mapped to Coverage, Claim and PriorAuthorization objects.

I-03

Interoperability & CDS Hooks

SMART on FHIR launch, CDS Hooks and Bulk FHIR export/import aligned to ONC and CMS Interoperability rules (USCDI, TEFCA-ready).

I-04

Remote Patient Monitoring & wearables

Device streams (Validic, Apple Health, Fitbit, connected BP/glucose) ingested to Data Cloud, mapped to FHIR Observation and evaluated by Flow / Agent triggers for exception-based care.

I-05

Contact centre & voice

Service Cloud Voice with Amazon Connect / Genesys for member services; real-time transcription, Agent Assist and after-call summarisation via Einstein GPT and Agentforce.

I-06

Data Cloud clinical zone

FHIR-native ingestion, patient identity resolution across payer/provider identifiers, calculated insights for risk stratification and activation into Health Cloud, Marketing Cloud and downstream analytics.

(06) High-value use cases

Where Health Cloud pays back — provider, payer, life sciences.

U-01

Provider — Population health & risk stratification

Cohort build in Data Cloud, risk scoring, outreach orchestration through Care Programs, closed-loop referrals and quality-measure tracking (HEDIS / CMS Stars).

U-02

Provider — Access centre & scheduling

Unified access centre with intelligent triage, protocol-based scheduling, Agentforce for symptom intake and downstream Epic/Cerner slot booking via FHIR Appointment.

U-03

Payer — Utilisation management & prior auth

Prior auth intake (portal / fax OCR / Agentforce), clinical review workqueues, medical policy grounding and 278 response back to the provider EHR.

U-04

Payer — Member services & appeals

Voice + digital omnichannel on Health Cloud, benefits explanation, complaint & appeal workflows with SLA governance and CMS reporting.

U-05

MedTech & Life Sciences — Patient support programs

Copay & hub services, adherence programs, HCP interactions and patient consent — with Marketing Cloud journeys tied to CarePlanActivity outcomes.

U-06

Home Health & Post-acute

Field Service for visiting clinicians, offline mobile assessments, RPM-driven interventions and readmission-risk scoring surfaced on the care team timeline.

(07) Agentforce for Health

Five grounded agents we deploy first.

Every agent is scoped to a clinical or administrative topic, grounded in Health Cloud + Data Cloud, and governed by the Trust Layer with a full audit trail.

AF-01

Patient Access Agent

Grounded scheduling, insurance verification, pre-visit intake and reminders. Actions: EHR slot search (FHIR Appointment), eligibility (270/271), consent capture.

AF-02

Benefits & Coverage Agent

Explains coverage, out-of-pocket estimates and network status; hands off warm to a human on complex questions with full context.

AF-03

Prior-Authorisation Intake Agent

Reads referral packet, extracts clinical evidence, maps to medical policy, drafts submission and routes to a reviewer with an explainability trail.

AF-04

Care Team Copilot

Summarises the patient timeline, suggests next-best care plan interventions, drafts care notes, and creates tasks — every action logged for audit.

AF-05

Discharge & Follow-up Agent

Post-discharge check-ins, medication reconciliation prompts, RPM anomaly triage and escalation to the care coordinator when thresholds are breached.

(08) HIPAA, Shield & Trust

Security and consent, engineered in.

  • 01HIPAA-aligned build on Salesforce Health Cloud with signed BAA.
  • 02Salesforce Shield: Platform Encryption, Event Monitoring, Field Audit Trail across PHI fields.
  • 03Consent & Authorization model (Individual + Consent Management) governing every downstream use, including AI grounding.
  • 04Agentforce Trust Layer: zero data retention with LLM providers, PII masking, toxicity & prompt-injection defence, audit trail per agent action.
  • 05Regional data residency (Hyperforce), role-based access (Care Team + Sharing Rules), and break-glass logging.
  • 06ONC / CMS Interoperability & Patient Access Rule alignment: USCDI, Bulk FHIR, Provider Directory API.
(09) Implementation method

How CRMPRACTICE delivers Health Cloud.

01

Discover — Clinical & operating diagnostic

Two-week diagnostic across clinical workflows, EHR/payer landscape, PHI data flows, consent posture and prioritised use cases. Output: Health Cloud target-state blueprint, risk register and a phased roadmap signed by a Principal Architect.

02

Design — Reference architecture & data model

FHIR-aligned data model, MuleSoft Accelerator API contracts, Data Cloud clinical zone, identity & consent flows, Shield encryption scheme and Agentforce topic/action catalogue.

03

Deliver — Pods per capability

Parallel pods: (1) Patient/Member 360 & Care Management, (2) EHR/Payer integration on MuleSoft, (3) Agentforce for Health, (4) Voice + Digital Engagement, (5) Trust, Consent & Shield. Trunk-based delivery, clinical UAT and PHI-safe test data.

04

Evolve — Managed care platform

SRE-style ownership, agent evals with clinical SMEs, care programme experimentation, quality-measure dashboards and quarterly value reviews tied to STAR/HEDIS, LOS, denial rate and cost-to-serve.

(10) Technology stack

What sits under the hood.

Salesforce Health Cloud (Provider & Payer)Life Sciences Cloud (adjacent)Data Cloud — FHIR connector, Identity Resolution, Calculated InsightsAgentforce for Health — Atlas reasoning, Trust Layer, Agent ActionsService Cloud Voice + Digital Engagement (Messaging, Chat, WhatsApp)Experience Cloud — patient & provider portals (LWR)Field Service — home health, community careMuleSoft Accelerator for Healthcare — FHIR R4, HL7 v2, X12Salesforce Shield — Platform Encryption, Event Monitoring, Field Audit TrailSalesforce Identity — SMART on FHIR, OAuth 2.0, SSOHyperforce — regional residency (US, EU, UK, AU, JP, IN)
(11) Anti-patterns

What we refuse to ship.

  • 01Storing PHI in custom objects outside the Health Cloud data model — you lose sharing, consent and audit primitives.
  • 02Point-to-point EHR integrations without MuleSoft — every new use case rebuilds the same plumbing.
  • 03Bolting on generic chatbots instead of Agentforce with grounding, consent and Trust Layer.
  • 04Sending PHI to third-party LLMs directly, bypassing the Trust Layer and BAA boundary.
  • 05Ignoring identity resolution — duplicate patient/member records silently break every KPI.
  • 06Treating Data Cloud as an analytics sink instead of the clinical activation layer.
38%
reduction in average handle time (member services)
27%
faster prior-auth turnaround
22%
no-show reduction with agentic reminders
3.1x
care coordinator capacity
18%
readmission reduction in targeted cohorts
45%
self-service containment for benefits enquiries

Ready to modernise your Health Cloud programme?

Two-week diagnostic led by a Principal Architect. Clinical SMEs, reference blueprints and a signed roadmap before any build.

Book a Health Cloud workshop