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 2025.

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:
  • Pre-claim
  • Patient encounter
  • Transaction and accounts receivable (A/R) follow-up
  • Seamless reporting of claims status
  • 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.

  1. 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
  • Supply and demand planning
  1. 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.

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.