By Mark Halford, Senior Vice President, Client Services, Life Sciences and Health Care for WNS
From start to finish, Artificial Intelligence (AI) can significantly assist healthcare providers in unifying the clinical patient experience. This includes everything from financial and administrative aspects of Revenue Cycle Management (RCM) to improving compliance, speeding up payment times, and making information available to patients in real-time. These are important outcomes and assume even greater significance during a crisis, especially during the ongoing COVID-19 pandemic.
Undeniably, the pandemic has had an adverse impact on the healthcare industry. Many private practice providers are facing an uphill struggle to make ends meet due to declining patient numbers. On the other hand, hospitals and healthcare insurers have found it extremely difficult to deal with the sizable increase in patients and claims. COVID-19 has firmly put the spotlight on consumerism in healthcare and emphasized the need for healthcare companies, at all levels, to think about the best possible ways to improve patient experience. It has also highlighted glaring deficiencies in healthcare systems, bringing to the forefront complexities associated with backlog management.
That said, there as several applications healthcare providers can implement to improve patient experiences using AI.
Improving Compliance & Accelerating Payments
AI and analytics can ensure healthcare providers achieve compliance with the quality measures of Centers for Medicare & Medicaid Services (CMS), as well as meet payer standards to accelerate payments. With new CMS regulations leading to an increase in clinical documentation requests and healthcare claim denials, there is a continuous demand from the industry to perform and produce more value. By enabling the automated integration of CMS standards into the RCM process, AI and analytics can improve the accuracy of medical coding for billing and compliance – effectively rooting out human error. Embedding CMS standards ensures completeness, uniformity and compliance – both in terms of driving process steps as well as data entry (via a convenient method). This standardized and compliant data helps everyone from individual providers to CMS analysis efforts for national programs.
This would be especially ideal in scenarios where most physicians are grappling with a considerable surge in the number of patients, and insurers are complicating reimbursement guidelines to lower payments. The end result: faster payment, lower exceptions, patients billed correctly, and time saved both at the provider and insurer ends.
Ensuring a Superior, Personalized Patient Experience
As Accountable Care Organization (ACO) and Value-based Care gather fresh momentum with the change in US administration, the need to integrate systems and be ‘future-ready’ significantly heightens. A patient-first approach, underpinned by digitization and automation, is required to improve patient experience at all levels. Standards of care and medications are becoming increasingly personalized from patient to patient. This process can find support by integrating systems that capture and analyze data, leveraging AI to drive insights and interventions. Patients will always find frustration by claim denials, which delay care and often give them an administrative burden at an inopportune time. AI can be used to embed accepted and advised care pathways for automated processing and exceptions highlighting. This can significantly improve the efficiency and speed of payer-provider collaboration – resulting in enhanced and timely patient care, and reduced administrative burden on all parties.
There is also an imminent need for healthcare companies to deploy next-generation call centers driven by AI-led smart automation. This would provide a pragmatic solution to organizations that are inundated with patient calls. While helping them navigate the challenges of resource crunch and increasing cost burden, AI-powered contact centers can drive empathetic patient responses through emotion detection and other means.
Healthcare providers will only continue to be heavily impacted by COVID-19. Even with the vaccine implementation, infection rates are going up and physicians are in dire need of assistance to streamline workflows supporting operations and clinical care. It’s time the healthcare industry integrates innovative technologies such as AI into their processes and digital practices. Ultimately, integrated and intelligent systems will be the cornerstone of integrated care delivery.
Mark Halford is the Senior Vice President, Client Services, Life Sciences and Health Care for WNS, a leading provider of global Business Process Management (BPM) services.