Where is the Healthcare Industry Deploying Automation Today?

As healthcare organizations begin to launch automation programs, they have found it prudent to start by targeting functional verticals where inefficiency creates inordinate financial, customer-facing or clinical risk. The workflows within these functional areas tend to have a concentration of administrative and clinical waste, involve a high-volume of repetitive or iterative tasks, and often require misallocated, high-cost labor resources to perform some of these tasks.

We have highlighted some of these areas below and cite a number of vertical automation platforms gaining commercial traction by eliminating the inefficiencies inherent to these areas.

Billing and Payment Operations

Of the $765 billion spent by the healthcare industry on administrative activities each year, $400 billion is spent on the administrative transactions that govern billing and payment related activities between providers and payers.

It is estimated that anywhere from one-third to one-half of this spend can be saved through administrative simplification, in particular by digitizing and automating the nearly 43 billion inter-related steps that comprise these transactions each year. Billing and payment workflow optimization can also yield meaningful working capital and administrative efficiencies, particularly impactful to provider bottom lines and payer administrative cost ratios in light of the pandemic.

Provider revenue cycle and payer claims operations are therefore growing targets for automation efforts. As reimbursement increasingly becomes value-based and transparent, collaborative billing and payment workflows will be important enablers of this shift. As a result, solutions that automate billing and payment data capture, and facilitate bi-directional data sharing, will be best positioned to streamline payment cycles and enable more collaborative contracting.

A handful of automation platforms are focused on these opportunities today, including Olive AI, which is expanding upon its roots as a provider billing-workflow automation solution by automating clearinghouse and payer claims workflows in order to support more integrated billing and payment activity.

Akasa, meanwhile, is a Unified Automation platform that combines natively integrated cognitive automation with human decision support to automate the end-to-end provider revenue cycle process.

Veda is a data management automation platform that is focused on helping payers improve provider directory management, claims, and billing workflows by increasing data accuracy and usability.

Contact Center and Member Operations

Billions of phone calls flow in and out of healthcare contact centers in any given year, with patients, providers, payers and administrators calling one another to fulfill critical care needs, but oftentimes also to expedite basic informational inquiries.

Handling these calls takes more than 10 minutes, on average. In some cases just 20% of these calls are resolved on first touch, compared to an industry average of 74%, meaning this cycle is frequently repeated. To compound this problem, digital and phone-based care activity surged over the last year. This significantly strained healthcare contact-center capacity and also impacted downstream clinical staff, who are often the recipients of follow-up inquiries.

Missing or improperly handling these calls and the insights generated from them can adversely impact patient engagement rates, Star ratings and risk leakage, among other financial and operational ramifications.

As a result, healthcare organizations are prioritizing NLP-powered conversational automation tools to help them better manage contact center operations, given that this technology can save nearly four minutes per call and 50-70 cents per interaction. Solutions that are able to automate inbound and outbound phone calls, as well as enrich existing data with insights captured from this “off-screen” data, will be best positioned to drive more efficient and intelligent healthcare communication workflows.

Syllable AI is a conversational automation platform for healthcare providers that leverages voice and web-based digital assistants to intelligently fulfill patient inquires and create valuable contact-center capacity by saving contact center staff time.

Meanwhile, Infinitus is a voice-automation platform for pharmaceutical distributors and payers that automates and collects data from healthcare’s nearly 1.5 billion annual business-to-business phone calls, thus streamlining time-consuming eligibility and benefit verification workflows.

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By seohan