Intelligent Process Automation for Connected Health

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cloud computing in healthcare

By Giri Rajaiah, Executive Leader, Vice President, Healthcare & Life Sciences, DISYS

Digital technologies are reshaping connected healthcare and how well it operates and delivers quality care. It begins with how patients access it and providers deliver it, expanding into how life sciences and medical technology companies offer lifesaving procedures and prescriptions and the way payers and governments pay for it. More than ever, the healthcare ecosystem has significant potential to leverage advanced technologies, such as Robotic Process Automation (RPA), Artificial Intelligence/Machine Learning (AI/ML), cloud, big data analytics, chatbots, mobile apps, and more. These all serve the purpose of improving various functions, such as patient engagement, claims adjudication, billing management, inventory management, contact center operations, pharmacovigilance, and regulatory information management.

One such technology is Intelligent Process Automation (IPA), which is a fusion of managing structured documents using RPA and unstructured documents with cognitive tools, including AI and Machine Learning. IPA compliments process mining, decision management tools, and other disruptive technologies to provide healthcare organizations with the ability to gain new insights into their processes, streamline key functions, and emerge smarter, nimbler, and more efficient than ever before. 

IPA – Healthcare Payers

For healthcare payers, IPA can be leveraged in areas such as product development, member enrollment, managing provider network, claims processing, and care management. Below is a process map that depicts a comprehensive list of areas where intelligent automation can assist payer operations.

One of the key areas for IPA in payer operations is claims management. Failed claims require manual intervention to correct code exceptions and data errors, which costs the payer about $28 per claim. Bringing IPA to “error and edit” claims dramatically reduces claim processing turn-around time and sharply lowers operational costs. The provider network is another top candidate for intelligent automation, due to the increased product innovation and provider data accuracy issues that plague the industry [1]. Care coordination and benefit configuration processes is a top priority for automation and AI over the next two years. In the area of care coordination, IPA can help a registered nurse expedite the clinical claims review for Utilization management. When IPA is deployed in member enrollment, it is predicted that payers can reduce administrative efforts by 75% and AHT (Average Handling Time) by 35-45%.

IPA – Provider Operations 

According to the 2017 CAQH Index, lack of automation for administrative transactions costs the healthcare industry more than $11B each year. [2] Three out of four hospital and health system CEOs cite overall cost reduction and efficiency as one of their top two financial priorities [3]. Over the last decade, healthcare providers have been caught in a perfect storm of shrinking payments amid pressures to improve outcomes, enhance the patient experience, and bolster innovation credentials. These circumstances have been further exacerbated by the COVID-19 pandemic, as strain on the healthcare system continues to requiring hospitals to optimize costs and streamline increasingly scarce resources. For most providers, complex manual administrative and operation tasks take the focus away from their prime objective – patient engagement and care delivery. 

Revenue cycle management (RCM) and supply chain logistics represent a substantial part of the provider’s operational tasks and costs cutting into their profit margins. For example, billing and insurance (BIR)-related expenses accounts for 50% of providers’ administrative spend and costs them approximately $140B [4]. By leveraging intelligent automation, providers can automate complex workflows in key areas namely pre-claim, patient encounter, transaction and AR follow-up. Utilizing AI/ML based optical character recognition (OCR) technologies, providers can streamline the patient eligibility verification process to reduce manual effort, shorten billing cycles, and eliminate human error. Intelligent process automation can be used to drive seamless reporting of claims status and payment posting. Utilizing AI enabled data analytics, automation of denial analytics dashboard can be used to track claim denial patterns and automating follow-ups to increase overall clean claim rates.

Similarly, the annual overspend in the supply chain costs the providers an estimated $25.4 billion. This represents 30% of all hospital spending [5] [6]. 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. [7]

Contact center operations is another highly manual operation and it plays a vital role in customer retention. Key areas for automation in contact center operations include billing data and refunds management, appointment scheduling, and patient data management, data migration, and report generation. In fact, 90% increase in efficiency can be expected from automation [8]. 

IPA – Lifesciences

The Life Sciences industry is well past the golden age of blockbuster drugs and faces challenges of declining pipeline, R&D budget cuts, and more stringent regulations. The need for a solution to manage business operations efficiently, with greater speed and accuracy in a cost-effective manner has pushed the adoption of IPA. IPA not only helps eliminate repetitive, routine-based tasks, but also handles tasks with decision-making capabilities effortlessly. These allow organizations to realign their human capital for strategic initiatives. 

IPA has expanded its footprint within the Life Sciences space through the automation of the processes in the peripherals such as finance, sales inventory, and supply chain, and is now finding acceptance in core areas, such as R&D, regulatory and post marketing activities such as pharmacovigilance. The list below provides key areas for Lifesciences companies to use IPA: 

Domain AreasKey Functionalities
Clinical development: facilitating faster Clinical trials and drug approvalsProcessing pharmacovigilance (PV) cases processing
Managing trial master process
Supporting regulatory submission process
Sales force operations: amplifying  responsiveness & relevance of sales repsRecording sales activities and processes
Retrieving accurate and timely sales data anytime
Precision marketing: personalizing customer engagement and experienceProviding real-time tailored knowledge to customers
Acting as a virtual medical companion to patients
Regulatory Information ManagementManaging Regulatory documents
Streamlining GLF checklist
Financial ManagementImproving Account payable process

IPA can be a key technology for life sciences companies in enabling them to reach new heights in their digital transformation journeys. By streamlining operations, compiling research and consumer feedback, and collecting data from clinical trials, intelligent automation can reduce the time and cost it takes to develop pharmaceutical drugs.

Implementing Intelligent process automation: As with any technology adoption and implementation process where each enterprise is at a different maturity level, it is important that the solution has the flexibility to fine tune to meet specific requirements. To successfully adopt IPA, healthcare organizations should first identify the processes best suited for automation. This should be rule-based, requiring readable input types, including text-based data, user interface (UI) activities, and OCR. In fact, processes that require a high degree of manual input in a structured and repetitive format are more susceptible to human error and should not be prioritized. Once processes are identified, organizations along with the technology provider can prioritize and develop a roadmap for implementing IPA. Healthcare organizations can synchronize automation with other initiatives, such as cloud and AI/ML to enhance their digital transformation. Identification and prioritization of these opportunities can help them partner with the ideal automation partner to achieve optimal value and quality improvements.

Conclusion: 

IPA is a key digital tool available for healthcare companies to leverage and help streamline their business operations and operate at the most optimal performance. Intelligent Automation is a critical part of the digital transformation of connected healthcare operations to optimize processes, strengthen business resilience, reduce risk, and generate useful business insights. Intelligent Automation has immense potential and the outcome of implementing Intelligent Automation will not only provide cost savings but also improve consumer engagement and enable the delivery of higher-quality care.

Giri Rajaiah is an Executive Leader and Vice President for Global Healthcare & Life Sciences vertical at DISYS. DISYS is a leader in providing consulting & implementation services around Intelligent Process Automation for many leading healthcare clients. He 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 with ready to use templates.

References

[1] “Online Provider Directory Review Report – CMS,” 2017.
[2] “CAQH Index: A Report of Healthcare Industry Adoption of Electronic Business Transactions and Cost Savings,” CAQH, 2017.
[3] J. Dias, “6 Big Benefits of Applying Automation to Healthcare,” HIT Consultant, 2014.
[4] A. Jiwani, D. Himmelstein, S. Woolhandler and J. G. Kahn, “Billing and insurance-related administrative costs in United States’ health care: synthesis of micro-costing evidence,” BMC Health Services Research, p. 556, 2014. 
[5] “Improving Data Integrity Leads to Lower Supplies Costs,” Health Catalyst, 2019.
[6] “Healthcare Insights: Top Hospitals by Medical & Linen Supply Costs,” Definitive Healthcare, 2019.
[7] The Definitive Blog: How to Control Costs by Balancing the Supply Chain, Definitive Healthcare, 2020. 
[8] Evolve, “Contact center trends and Market survey Landscape,” 2017.

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