By Preetpal Singh, Vice President Intelligent Business Automation at Persistent Systems
The world of healthcare payers was previously defined by miles of paperwork, signatures and regulations, with the massive file systems of doctor’s offices and hospitals representing complex administrative processes. In more recent years, the rise of digitalization has introduced a range of innovations to health administration, including for healthcare payers. At seemingly every step of the process, these large commercial insurance companies and private plan providers can choose to implement new technologies like bots and machine learning to simplify and accelerate otherwise tedious tasks.
The modern healthcare tech stack can include everything from optical character recognition (OCR) that interprets text on scanned files to more ambitious robotic process automation (RPA) platforms. Forward-thinking healthcare payers can automate nearly every step of the claims processing, all the way from the mailroom to adjudication. However, this transformation process can be overwhelming — leading some insurance companies wondering what to focus on as they try to keep pace with new technologies.
Healthcare payment’s digital transformation
For healthcare payers, deciding to transition to automated solutions has become less of a choice and more of a necessity. Increasing cost pressures and constantly changing economic factors are pushing players to make significant changes to their operations; what’s more, the impacts of the Covid-19 pandemic revealed the necessity for digital, cloud-based processes, as the use of telehealth increased dramatically in response to stay-at-home orders and concerned patients.
Growing automation use cases
Throughout the payer value chain, insurance companies have several opportunities to introduce machine learning and automation. In particular, these use cases are seeing dramatic increases in adoption:
- Policy enrollment: AI-driven algorithms can help facilitate policy selection, underwriting and real-time price updates. Tools developed using automation and natural language processing can answer customer questions and enable automatic plan enrollment with nearly zero human intervention.
- Claims adjudication: Through the combination of simplified processes and AI models, payers can automate the documentation and decision-making processes of claims adjudication. These enhancements lead to both faster results and more accurate performance.
- Prior authorization: Today’s healthcare payers can quickly navigate decision-making systems and automate authorizations through a combination of RPA, AI and key data drivers. This significantly reduces wait times throughout the patient journey, leading to improved economic and health outcomes.
- Medical record review: Intelligent document processing (including OCR) makes it possible for businesses to automate their medical record reviews. This increases the accuracy and speed of record processing and dramatically reduces the need for human intervention.
- Support functions ops automation: Innovations are extending beyond typical processing tasks to include support functions like HR onboarding, vendor onboarding and financial reports automation. This progress is supported by technologies like RPA, smart workflows, low code platforms and IPaaS tools.
The future of Insurtech
As healthcare payers contend with a whirlwind of change and technological developments, businesses are also considering how best to structure their new technology stacks. Center of Excellence (COE) frameworks for digital factories and automation offer much of the structure and reliability needed for businesses to experiment with and scale their tech strategies. In this structure, companies can pursue an innovation mindset while ensuring that consistency in technology, business and IT alignment will keep their efforts on the rails.
Healthcare payers work in an industry defined by bureaucracy, privacy regulations, and a legacy of complex paperwork. Perhaps more than most industries, healthcare’s digital transformation requires a tectonic shift in mindset and operations. The COE model helps companies develop and end-to-end vision for their transformation, defining the desired outcome, an overarching strategy for how to get there, and a detailed roadmap to keep them on track. As new technologies emerge, companies can decide whether and how to incorporate these into their existing plans. Those who can remain one step ahead of the industry will find themselves gaining market share in an increasingly dynamic environment.