Artificial intelligence (AI) has received a lot of buzz and been positioned as the central healthcare technology needed to solve many financial challenges and digitally transform internal operations. However, if you’re looking for practical solutions that can address variable activities and complete work with a high level of quality, today, healthcare organizations should look to intelligent automation.
Here’s why: True AI attempts to mimic human cognition. As such, AI remains in its infancy, especially in healthcare. By contrast, intelligent automation leverages data sets and existing technologies such as self-service platforms, cognitive automation, natural language processing, web service integration and robotic process automation (RPA). The aim of intelligent automation is to build a better workforce — enhancing both human workflows and digital ones.
Intelligent automation is typically applied to large-scale activities or groups of repetitive tasks that interact with multiple systems. That’s why mundane, inefficient and transactional RCM assignments make ideal use-cases. Because intelligent automation is utilizing and connecting data sets to execute work faster, better and cheaper, it frees staff members for more strategic activities. Overall, that means greater RCM accuracy and efficiency, as well as improved satisfaction among staff, providers and patients.
Here’s a look at three core RCM challenges, and how intelligent automation can help healthcare organizations address them:
Hospitals and health systems depend on RCM technology to deliver substantial, enterprise-wide results. That’s why few organizations can afford to invest in “science-fair” technology; that is, RCM tools that provide interesting concepts but have limited utility. RCM technology must be purpose-built to handle variable tasks, for example, automating a typical claims denial workflow, at scale.
In the past, efforts to automate the revenue cycle had a hard time accomplishing those objectives. Scalability was a problem because any variation in the work could cause systems to “get stuck.” Intelligent automation can be trained to evaluate and accommodate variation, then finish the job at hand.
For example, we have been able to establish over 1,000 RCM use cases that can be automated at scale and have activated over 160 digital workers that are the equivalent of 700-1,000 full-time employees. These digital workers are now performing over 4.5 million transactions annually representing over 15.6 million tasks over 30 EMR platforms and 100 locations.
There’s no doubt that automation can make significant business impacts; however, today there are many vendors claiming that they can solve hypothetical scenarios that are built for simply showing off capabilities and not addressing real problems. Be on the alert for that type of “science-fair” technology vs. purpose-built applications with the efficacy to work at scale. And if a vendor claims its technology can, for example, predict denials with 98 percent accuracy, the question to ask is whether that predictive power scales to a broad range of “real-life” claims scenarios, or only applies to a limited set of claims.
“Frustrating” is the word many patients use to describe all of the manual, fragmented touchpoints in their healthcare experience. They often ask, “Why can’t the registration process at my doctor’s office be more efficient—like when I check-in for a flight?” It’s an appropriate question to pose.
Through intelligent automation, it’s possible for healthcare organizations to remove highly manual, disconnected processes and create more positive, personalized patient financial experiences. For example, consider digital self-service applications such as registration kiosks or online platforms. Digital self-service platforms like these, in hospitals and physician offices, empower patients with a fresh, retail-like financial experience standardized across multiple points of service. Intelligent tools such as out-of-pocket cost estimators offered at the time of scheduling a procedure or appointment, for instance, can enable patients to make more informed healthcare choices. Likewise, data-driven algorithms that help predict patients’ ability to pay their bills can be used to appropriately tailor payment options and financial assistance to better fit each person’s needs and preferences.
Both patients and healthcare organizations benefit from this sort of intelligent automation. One organization, for example, recently saw an 80 percent increase in the number of patients using digital check-in solution. As a result, it experienced a 50 percent decline in front-end manual work, a 20 percent increase in patient yield, and a 40 percent improvement in patient satisfaction scores.
“Do more with less” is a mantra for nearly every healthcare organization these days. In a tight labor market, the ability to create cost-efficient capacity with a digital workforce has become a strategic value proposition — and one that intelligent automation is uniquely suited to meet.
Denials management workflows offer a perfect illustration. Most health systems currently employ staff to review claims at risk of denial, then route them to the right resources for resolution. Intelligent automation can perform the same tasks faster and more effectively, without large numbers of people. This not only speeds cash flow and reduces staffing constraints, but it also frees existing staff to work on more challenging and engaging responsibilities. Thus, organizations can cost-effectively improve workflows and optimize their human talent.
There is also an additional human resource benefit to consider: leveraging intelligent automation reduces the amount of time and effort human resources departments must spend recruiting and training business office support staff such as schedulers, check-in clerks, coders and billers. Their attention instead can be turned toward attracting and retaining physicians, nurses, technicians, and other mission-critical clinical staff.
In the hands of experts who understand the intricacies of healthcare RCM, intelligent automation can help provide scale advantage, improve the patient financial experience and reduce costs. When considering an automation partner, avoid vendors that heavily market their technology capabilities and instead look for a vendor that clearly states how they will address your RCM challenges and accomplish the work at hand. Technology alone will never solve all the friction in the healthcare revenue cycle. However, working with a partner with the right expertise and knowledge of intelligent automation can help you start to see compelling results.
About Joe Polaris
Joe Polaris is the senior vice president of product and technology for R1 RCM, a leading provider of technology-enabled revenue cycle management services across hospitals, health systems and physician groups. Follow him on Twitter @R1RCM.
As R1 RCM’s Senior Vice President of Product and Technology, Joe Polaris leads the company’s product strategy development and roadmap execution. He has been with R1 RCM for 12 years and has developed deep front-line revenue cycle expertise holding positions such as Revenue Cycle Site Lead and Director of Operations, where he built innovative end-to-end processes that have increased the financial stability for hospitals and health systems.