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Bots and Healthcare: Better Outcomes for Patients, Payers and Providers (Part 3 of 4)


New automation technologies are rapidly changing the industry as organizations embrace not just “systems that do,” but also “systems that learn” and “systems that think” to improve and even save lives. Here's how emerging automation tools and techniques are changing healthcare for the better. (Part 3 of a four-part series)

State-of-the-art. That’s the best way to describe the medical technology that U.S. physicians use every day in treating patients.  But if there’s one area where healthcare has potential for innovation when compared to other industries, it is in the use of information technology.

The complexity of the healthcare system along with rising demand for services and staffing shortages has left a gap that only technology can fill. The situation, however, is changing for the health insurance side of the industry as organizations are starting to embrace new automation technology solutions to reduce cost and improve member and employee experiences.

Care Delivery Organizations Leveraging Automation Tools and Technologies

On the care delivery side, many start-ups (e.g., HealthTap, Babylon) are leveraging automation tools and techniques to create new care delivery models, and many traditional care delivery organizations are using emerging automation technologies for clinical care processes. But operational processes and administrative activities are not receiving the same attention. Given that these organizations are still coping with the aftermath (including elusive ROI) of costly electronic health record (EHR) implementations, cyber security concerns and limited capital, this is not surprising.

The benefits of automation are significant and very much needed. Aside from the more intuitive advantages such as reduced waste, lower labor costs and improved accuracy, quality and consistency, automation makes scalability and the use of data-driven insights possible — both essential for cost-effective “high-tech, high-touch” approaches.  This means improved care and an improved patient/member experience with better insights, less paperwork, coordinated care delivery, faster recovery rates and faster payments, to name a few.

Reduced Pended Claim Inventory by Over 30%

We recently worked with a leading regional payer in the Northeast to address a growing pended claims backlog that had been slowly increasing over a period of months. This backlog had resulted in several million dollars in late payment penalties, increased provider calls and dissatisfaction and strained employee morale. After assessing the root cause and developing a solution roadmap that was primarily focused on leveraging automation tools, the team decreased the backlog by reducing the pended claim inventory by over 30% in two months. The team is currently ahead of schedule to reduce the remaining backlog to less than 15%, thereby avoiding adding staff and improving provider satisfaction. 

Reduced Claims Backlog by 65%

In a similar example, a large health system was able to accommodate a new business unit without increasing their existing workforce. Not only did automation help the claim examiners to manage new work in addition to existing work, but it also helped reduce the claims backlog by 65% within a single week while also substantially reducing provider payment turnaround time.

Additionally, we are currently working with a leading regional payer in piloting a virtual agent program for the plan’s providers and members. The goal of the program is to reduce member and provider service costs and drive a higher degree of constituent satisfaction. The initial pilot group is focused on a select group of providers and allows them to use Cognizant’s Virtual Agent to quickly check routine items such as claims status, enrollment, prior approvals and benefit coverage. The initial user response has been positive and the program is being expanded to include a broader selection of services for both providers and members.

Increased Nurse Efficiency by 45%

Automation has not only increased the efficiency of administrative operations, but has also shown significant potential to improve medical outcomes. In one instance, a large hospital chain increased nurse efficiency by 45% and reduced ICU stays by 15% by automating its clinical processes around patient monitoring in the ICU including providing automated alerts and reminders to physicians, nurses and other clinical staff.

Enhanced Outcomes Across the Board

In another example, a large health system on the east coast wanted to solve communication challenges between its hospital and community physicians by enabling consistent and proactive patient engagement. We helped deliver an automation solution to raise engagement levels as well as facilitate more effective communication and coordination among primary care physicians, hospital physicians and system facilities to deliver the following outcomes:

  • 350% increase in incoming patient transfer volume.

  • 15% reduction in no-show appointments through improved care coordination.

  • 100% patient follow-up post discharge within 48 hours.

And even more powerful applications of automation technology are being evaluated. For example, intelligent systems have been able to interpret X-rays 30 times faster with 99% accuracy compared to physicians. In another example, Chat bots outperformed doctors in terms of both speed and accuracy in identifying medical symptoms.  While these innovations remain to be commercialized and scaled, they show the promise and disruptive power of automation.

Business and IT Alignment: Key Consideration in Developing Automation Strategies 

With change comes challenges: first, in many organizations there is a question about which part of the organization should own the automation initiative — business or IT.  This is no different to other initiatives involving technology; business and IT alignment should be a key consideration in developing an automation strategy as should alignment with the organization’s business, operational and technology strategies. Automation initiatives require a governing enterprise automation strategy supported by a “future-ready” technology architecture in order to maximize the benefits.  

Second, there is often the challenge of where to start.  Is there enough potential benefit to justify a broad, enterprise-wide approach or should we start with a proof of concept or pilot in a sub- process? Where are the areas of greatest potential? Should we take a process-centric, function-centric or customer-centric approach? Which automation tool should be selected and will it take more than one (i.e., a “platform of platforms”) to handle different types of automation? What are the order of magnitude benefits we can expect? In our experience, these questions can be addressed by developing and executing a robust automation strategy. 

Third, there is organizational buy-in. With the perceived fear of job loss, middle management can be especially reluctant to consider automation initiatives. Our experience shows, however, that most organizations are planning to re-deploy their workforce to jobs that require a specialized skill and a human touch.  A robust change management plan is required to address workforce strategy questions and concerns and to help employees to adopt the new, reimagined or modified process.  

As an example, one of our clients used automation to reduce overall call wait times.  They successfully deployed “bots” to answer up to 70% of patient questions before speaking with a live agent. This improved the customer experience by moving routine work to the bots to eliminate wait time and increased the time live agents had for dealing with more complex situations. 

The above challenges can be mitigated and managed by developing a cogent automation strategy that aligns expectations, clarifies accountabilities and defines the measures of success. The strategy should include the following described in the interactive graphic below:  

Figure 1

Intelligent automation is a game changer. Healthcare organizations cannot afford to miss this opportunity to automate not just middle- and back-office operations, but front-office processes as well. While challenges do exist, organizations that have overcome these and deployed intelligent automation solutions have realized value in the relatively short term. Winners will be those who start early, develop a comprehensive strategy and work methodically on focused automation initiatives and investments.

This article was written by Patricia Birch, a Senior Vice President in Cognizant’s Healthcare Consulting Practice and Sudhakar Pemmaraju, an Associate Vice President in Cognizant’s Digital Operations Practice. To learn more, please read “How New Automated Tool Can Cure Healthcare Time Drain,” or visit the intelligent automation section of our website. 

In our final installment, we’ll examine how bots are impacting the insurance industry. To learn more, please read our first installment Bots Promise a Better Enterprise and our second installment “Bots and Banking: Staying Ahead of the Innovation Curve”, or contact us with any questions.

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Bots and Healthcare: Better Outcomes for Patients, Payers and Providers (Part 3 of 4)