As the saying goes, necessity is the mother of invention. A similar correlation is seen in the quest to leverage innovation and out-of-the-box thinking to address key problems facing the healthcare industry. The ongoing COVID-19 pandemic has brought the immense pressure the U.S. healthcare system is under into sharp focus. Recent dynamics are compounded by the industry’s efforts to adopt newer ways of working and digitizing patient records, while implementing automation throughout their business processes to increase overall efficiency and productivity.
The rise in operational cost, supply chain complexities, and the ever-present mandate to provide better patient care has put even more strain on healthcare organizations to seek out innovative approaches to meet these new challenges. Embracing innovative digital technologies is key for healthcare providers in improving patient care, streamlining operations, and increasing revenue margins.
Emerging digital technologies, such as Intelligent Process Automation (IPA) leveraging Robotic Process Automation (RPA), Artificial Intelligence (AI) Machine Learning (ML) tools, Private and Public Cloud, Data Analytics, and Integration are available to healthcare providers to implement and achieve greater levels of operational efficiency in current times and beyond, while bringing a concerted focus on improved patient care.
Inefficiency is Costly, and Avoidable Through Automation
According to the 2017 CAQH Index, lack of automation for administrative transactions costs the healthcare industry more than $11B each year. Automation technologies eliminate these overages through their ability to dramatically expand healthcare organizations’ ability to streamline processes, reduce costs, boost productivity, improve accuracy, and deliver top-quality patient-centric experiences. As per 2016 McKinsey report on automation, the healthcare sector had a 36% technical potential for automation. RPA is one of the leading emerging technologies poised to reshape healthcare overall and create between $350 billion and $410 billion in annual value by 20252.
Three Key Areas Where Automation Plays a Critical Role
In order to improve operational efficiencies and reduce costs, healthcare providers should take a holistic approach towards enterprise automation. By complementing traditional RPA with intelligent automation using AI/ML combined with process mining, decision management tools, and other disruptive technologies, healthcare providers gain new insights into their own processes, giving them the power to streamline key functions and emerge smarter, nimbler, and more efficient than ever before.
Three key areas where automation plays a significant role while generating expanded ROI include:
1. Revenue Cycle Management (RCM) and Claims Denial: The key challenges facing providers’ RCM processes are due to legacy systems and complex workflows, leading to unwanted claim denials. 79% of RCM areas use outdated technologies in stand-alone applications that are not integrated into the numerous manual processes, resulting in 15–20% of claims being denied due to authorization issues or charge capture. A robust RCM infrastructure can improve providers’ overall revenue by 5% and reduce 20% of their BIR expenses, which account for 50 % of providers’ annual administrative spend, totaling approximately $140B. The first step in upgrading an RCM system is to implement an IPA approach. In leveraging hyper automation, providers can automate complex workflows in key areas, such as:
– Patient encounter;
– Transaction and accounts receivable (A/R) follow-up;
– Seamless reporting of claims status; and
– Payment posting.
Utilizing AI-enabled data technologies, the automation of a denial analytics dashboard can be used to track claim denial patterns and automating follow-ups to increase overall clean claim rates. The comprehensive digital transformation of your RCM process will yield dramatic efficiency gains and a rapid return on investment.
2. Provider Supply Chain: The provider supply chain is highly complex, and the average U.S. hospital currently spends about $12.1 million more than it needs to on supply chain costs. These overages can easily be reduced without sacrificing clinical outcomes and efficiency using automation. Providers can leverage IPA to streamline key administrative functions such as:
– Purchase order management;
– Order setup and entry;
– Inventory management; and
– Supply and demand planning.
Automating supply chain activities and integrating them with revenue cycle operations is a critical step to drive more accurate group purchasing decisions, improve distribution methods, and optimize costs. Integrating data analytics with automation can also reduce pricing variation and maximize product use without sacrificing clinical outcomes or efficiency, allowing healthcare staff to turn their focus to more value-added activities.
3. Contact Center: Healthcare providers believe that customer experience is a key differentiator, and that contact center interactions play a vital role in customer retention. The current systems are largely fragmented, and unifying these infrastructures to deliver a more valuable customer experience is a key priority for providers, as 75% of patient lifecycle interactions are virtually handled by contact center. The deployment of an IPA solution integrates various applications and delivers relevant data in real-time. This enables automatic processes for an efficient post-call wrap up, dramatically increasing the efficiency and quality of contact center interactions. Key areas for automation in contact center operations include:
– Billing data and refund management;
– Appointment scheduling;
– Patient data management; and
– Data migration and report generation.
Automating these functions directly results in increased ROI, as well as a 90% increase in overall efficiency. Automation is the first step in the shift towards multi-channel support, self-service, and personalized experiences, all while completing patient requests in a timely and accurate manner. Agents then can be freed from repetitive, manual tasks and focus instead on keeping customer-centric initiatives top of mind.
Automation is an integral step to streamlining these complex manual workflows in RCM, to curb inefficiencies in supply chain logistics and contact center operations that cause unnecessary spending, to free up valuable healthcare resources for other uses. This allows providers to focus on their primary objective – providing efficient and quality care to patients.
Implementing IPA at the Organizational Level
In any technological adoption and implementation approach, where each enterprise is at a different maturity level, it is important to select a solution that has the flexibility to customize to your organization’s specific requirements. Healthcare provider environments bring several complex functions with them, and a clear understanding of your business mechanics is key to implementing an automation solution that will drive ROI in the near and long-term.
The first step in a successful automation implementation is the proactive identification of the processes to focus on, prioritizing those that will deliver the highest ROI on automation investments. Once processes are identified, providers can prioritize and develop a roadmap for implementing their IPA solution.
Aligning with other digital initiatives, such as Cloud and AI/ML can also provide a valuable catalyst for automation. Identification and prioritization of these opportunities can help providers engage with the ideal automation partner to achieve optimal value and quality improvements.
One of the key success stories highlighting the significant value automation delivers in its ability to improve and healthcare operations comes from a leading integrated hospital and healthcare organization based on the U.S.’ west coast, managing 6.5 million patients. This organization began its automation journey by analyzing areas which can best provide the ROI, which included:
– Billing operations;
– Insurance resubmissions; and
– Error reports.
As a result of these efforts, this healthcare organization improved their revenue margins by 3.3% and reduced manual effort throughout its systems. This success led the organization to set up a Center of Excellence (CoE) for IPA to guide future automation efforts. As hospitalization and testing of COVID-19 patients now continues to increase, the provider saw significant growth in patient numbers and without the help of automation would have struggled to manage their business without it.
IPA is one of several digital tools available for healthcare providers to leverage and help streamline their business operations to provide better patient care. From automating core EHR functions and key operational tasks, such as prior authorization, patient scheduling, eligibility verification, and physician credentialing, automation brings levels of positive impacts on revenue, patient experience, and employee satisfaction that have never been seen or achieved before. This enables provider organizations to proactively achieve increased ROI and measurable operational benefits immediately and for the long-term.
- “CAQH Index: A Report of Healthcare Industry Adoption of Electronic Business Transactions and Cost Savings,” CAQH, 2017: https://www.caqh.org/sites/default/files/explorations/index/report/2017-caqh-index-report.pdf
- “Where Machines Could Replace Humans—And Where They Can’t (Yet),” McKinsey Quarterly, July 8, 2016: https://www.mckinsey.com/business-functions/mckinsey-digital/our-insights/where-machines-could-replace-humans-and-where-they-cant-yet
- “Automation for Revenue Cycle Processing,” Nalaasha Solutions, [Online]. https://www.nalashaa.com/roboticprocess- automation/revenue-cycle-management/
- A. Jiwani, D. Himmelstein, S. Woolhandler and J. G. Kahn, “Billing and Insurance-Related Administrative Costs in United States Healthcare: Synthesis of Micro-Costing Evidence,” BMC Health Services Research, p. 556, 2014: https://pubmed.ncbi.nlm.nih.gov/25540104/
- The Definitive Blog: “How to Control Costs by Balancing the Supply Chain,” Definitive Healthcare, 2020 – https://blog.definitivehc.com/reduce-supply-chain-spending
- “Charting the Future of Customer Care Through a Core Optimization Philosophy,” McKinsey Insights, 2018: https://www.mckinsey.com/business-functions/operations/our-insights/charting-the-future-of-customer-care-through-a-core-optimization-philosophy
- James W. Wilson, “What is Robotic Process Automation (RPA) for Contact Centers?” LinkedIn Articles, 2017: https://www.linkedin.com/pulse/what-robotic-process-automation-rpa-contact-centers-james-wilson/
About Giri Rajaiah
Giri Rajaiah is an Executive Leader and Vice President for Global Healthcare and Life Sciences at DISYS. DISYS is a leader in providing consulting and implementation services around Intelligent Process Automation for leading clients across the healthcare industry. Rajaiah also leads the newly created DISYS Digital Health Solutions team which rolled out their latest solutions offering, D4HA™ (DISYS for Healthcare Automation), specifically targeting healthcare providers to adopt leading-edge automation technologies in their business to increase efficiency, streamline operations, optimize costs, and improve patient outcomes.