Article
How healthcare providers can benefit from intelligent automation
Aug. 22, 2019 · Authored by Claudio Garcia
Successful use of intelligent automation by healthcare providers is a combination of developing the right strategy and then deploying the appropriate tactics to support and deliver that strategy in the most effective and cost efficient way. Intelligent automation is an approach to the use of technology that effectively automates a manual, standardized process, according to Claudio Garcia, director, Enterprise Transformation Services. While “automation for automation’s sake is fun,” said Mike Duke, partner, Healthcare Consulting Practice, its best use by a healthcare provider is to reduce risks associated with human error, increase efficiency and enhance the outcomes for the overall organization.
Automation can be attended where the technology is integrated with and dependent on human interaction, or unattended, where the technology can perform complete tasks without any human intervention. Automation also can be rule-based, which is particularly effective when deployed to take over repetitive, manual, large volume processes; or cognitive, where it is deployed to take on non-routine tasks that require some judgment.
Automation use cases
Process automation is a journey with standard, intermediate and advanced stages. Duke provided examples of how this journey might look in a healthcare provider organization.
One example related to a standard use case focused on rules-based, routine business processes. Providers have been using forms of standard automation for years to review claims. The technology and software, like robotics process automation (RPA), gets more sophisticated every year, so now an automated program can gather real time claims data from payer portals and determine if a claim will be paid or denied, and then route that information to a human knowledge worker for appropriate next steps. Providers “get significantly more detailed information, and by knowing more, they can make their FTEs more effective,” Duke said. RPA utilization in some instances can replace up to 70 percent of a manual process.
The intermediate stage incorporates technology to automate tasks that are more complex. A practical application for healthcare providers is obtaining authorization for treatment. What previously required back-and-forth phone conversations between provider and health plan might be streamlined in part by an automated program, operating 24/7. Duke said this automation “helps with bottom line revenue, because if a provider has a tool in place that can obtain those authorizations, we should see a reduction in authorization denials.” The tool can also provide valuable information for the provider about why authorizations are denied in real time, which the provider can incorporate into its training and processes.
The advanced stage of intelligent automation incorporates machine learning and artificial intelligence to initiate actions that are more sophisticated, such as building a case to appeal a claim denial. If a claim is denied, an automated program could grab the electronic medical record (EMR) related to the patient and automatically submit it to the insurance plan. It also could deliver the EMR to a provider employee to approve before submission to a health plan. Either way, the provider is saving time and money by not needing an FTE to do the manual work of finding and forwarding an EMR.
