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.
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
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RCM processes are due to legacy systems and complex workflows, leading to unwanted claim denials. 79% of RCM areas use outdated technologies in stand-alone applications that are not integrated into the numerous manual processes, resulting in 15–20% of claims being denied due to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.
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.
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.