Today, the US healthcare industry continues to grapple with rising costs, resource scarcity and intensifying competition. Responding to the challenges demands up-skilling the current workforce to create a ‘lower-cost, lower-maintenance, higher-throughput’ workforce for tactical, but necessary tasks. This is what the industry refers to as ‘Intelligent Ops powered by Cognitive Automation’. Cognitive Automation (CA) happens when Robotic Process Automation (RPA) is combined with cognitive technologies to go beyond automation of repetitive tasks, enabling self-reporting, self-assessment and self-improvement over a period of time.
Thanks to its benefits, several healthcare providers are already applying CA across a variety of clinical and administrative functions to improve the quality of care and increase the focus on patient outcomes. In a provider set-up, several processes make for great candidates for CA application. These include revenue cycle management, ICD-10 coding automation, clinical data documentation and abstraction, utilization management, care coordination, case management, patient scheduling and denials management (see Figure 1). Let’s deep dive into each of the four major operational processes to explore further.Figure 1: Operational processes in a healthcare provider environment that can leverage CA
Revenue Cycle Management (RCM)
RCM is one of the most critical processes in any healthcare organization. In our opinion, almost 80% of RCM processes lend themselves to limiting human involvement to improve the cost and performance profile of the process. Examples of such processes include patient scheduling, no-shows or missed appointments, eligibility verification, charge capture, denials management, billing creation and management, collections, etc. Several large healthcare players are adopting CA to intelligently automate RCM processes.
Clinical Processes and Care Delivery
CA offers significant benefits in managing medical records. It can help digitize patient paper records, automate the creation and generation of status reports and supplementary communication to keep patients in the loop, and provide analysis and data based on a patient’s condition and progress. CA can also support clinicians by providing relevant information when required, through rules-based decision-making and case integration. With case management automation, healthcare providers can significantly improve the care delivery process as cognitive tools help streamline their work and improve the overall patient experience.
Claims and Finance
Providers can also automate repetitive manual processing of billing and claims and enable auto-approval of direct debit instructions to bank to cut down on cycle time. This can help move a significant portion of paper billing onto an automated electronic document exchange platform. Automating patient follow up and communication regarding claims processing and financial information can significantly improve customer service. Bots can drive improvements in billing efficiency, leading to a reduction in accounts payable and receivable write-offs.
Automation can play a major role in how healthcare organizations manage their human capital function. Automating repetitive, rules-based hiring or administrative processes can reduce errors and facilitate streamlined communication within the recruitment team. Take, for instance, processes such as interview scheduling and tracking, as well as the handling of personnel documentation in case of offer management and case tracking.
What should your CA approach look like?
For a healthcare company to effectively implement CA, the process needs to begin with the identification of repetitive tasks in their business. Identifying non-revenue generating functions, documenting each workflow in detail, eliminating non-value adding tasks and processes, and determining a clear roadmap for the company are the recommended steps for embracing CA. At AiRo Digital Labs, we recommend creating an automation and opportunities roadmap, followed by the development of a proof of concept (PoC). Once the organization becomes comfortable with the idea of automation, a broader deployment of CA across the enterprise can begin.