Tackling the Complexity COVID-19 Has Created for Healthcare

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An infected patient in quarantine lying in bed in hospital, coronavirus concept.

By Kelli Bravo

The COVID-19 pandemic has not only devastated and disrupted our lives, it’s wreaked havoc on the entire healthcare industry at a scale we’ve never seen before. 

Call volumes have surged. People want to know if they should get tested, and where, and if it’s safe. Patients have had to postpone non-emergency surgeries – a major revenue driver for hospitals. And critical patients – such as cancer patients – still need to continue with their care programs.

Among all this chaos, healthcare professionals are working longer hours than ever before and many are putting their own lives at risk. They’re trying to deliver the same quality of care often in person and sometimes remotely, while following safety protocols and grappling with the sick, stress, family issues, kids at home, and their own worries.

Dealing with the crisis at hand has required the industry to start looking for alternative solutions that can go beyond addressing today’s challenges, but also prepare for tomorrow. Here’s how those in the industry can maintain business continuity without compromising patient/member standards:

Automate responses to inquiries

Having empathy for patients and members is always important, but even more so given the stress people are feeling during a pandemic. Making them wait for answers to their urgent questions only increases anxiety levels. Patients and members need the ability to contact their care teams through their channel of choice and cut through the red tape to get answers faster. On the other side, healthcare workers should be empowered to proactively respond to patients as quickly as possible – even when working from home. But in many cases, the reality can be quite different.

To manage the surge in patient and member inquiries, some healthcare organizations are turning to automation tools. With natural language processing, instead of canned, robotic responses, more than 75% of inbound emails can instantly be read, classified according to urgency, and assigned to cases so patients and members get the answers they need quicker, which reduces call volumes. In cases where an agent or care professional does need to intervene, automation can be an essential tool in properly starting and routing the work to the right person to get patients and members the vital information they need more quickly.

Keep your workforce safe and healthy

No industry is at greater risk of contracting COVID-19 than healthcare workers on the frontlines who are caring for patients. In order to stem the spread of the virus, it’s critical for organizations to know at a glance who in their distributed workforce has been exposed, who is recovering, and who is healthy. Managing staff safety may present even more scheduling challenges as more states begin to reopen unless organizations have a way to keep track of everyone and make informed decisions about their workforce and the impact on operations in real-time. A healthy staff census will allow organizations to schedule in-person, telehealth, and phone consultations to drive better patient outcomes.  

Streamline claims processing

During a pandemic, claims numbers spike, and trying to keep up with increased volume and rapid policy changes is not only overwhelming, it can negatively impact bottom lines – especially since payers often offer additional benefits during a crisis, such as waiving telehealth copay costs and costs for COVID-19 tests. 

Automating the intake, validation, and orchestration of claims processing can lift a tremendous burden off staff and accelerate much needed revenue. To keep pace with increased volume and rapid policy changes, and to make processing faster and easier, automation can be used to enhance current claims processing solutions. And to do their jobs more efficiently, remote workers need online access to all the information at their fingertips instead of having to cobble together information from legacy systems. This will significantly reduce the amount of time it takes to reach resolution and help employees make better, more informed, and more empathetic decisions for members. 

Preparing for tomorrow

When we return to some sense of normalcy, it will be important to prepare staff for what to expect. What protocols will change to make staff and facilities safe? Will patients be screened differently? How will patient needs be prioritized? How will organizations address scheduling challenges when scheduling staff have been furloughed? How will employees be approved to return to work?

The COVID-19 pandemic has forced the healthcare industry to transform to a more digital approach, and organizations need to be agile to accommodate both current challenges and those yet to come. While many organizations had previously taken many of the necessary steps to accelerate digital transformation, the current crisis has shined a spotlight on the critical need to fill remaining gaps, break down silos, drive more compelling engagement, and complete those transformations.

About the author: As Global Vice President of Healthcare and Life Sciences at Pega, Kelli Bravo helps healthcare and life sciences organizations develop digital transformation and engagement strategies that build relationships, simplify operations, and improve the way healthcare is delivered. 

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