Intelligent Automation for Healthcare Industry: Overview & Use-Cases

The healthcare industry processes around $250 billion worth of transactions each year. The total number of transactions lingers around 30 billion. The ratio between the number of transactions and the associated cost is disproportionate, because they are processed manually. Not only does this eat up operating margins, but it also indirectly affects the quality of patient care.

To address this pain point, healthcare providers around the world are increasingly leaning toward Intelligent Automation (IA), which is a combination of Robotic Process Automation (RPA) and Artificial Intelligence (AI). IA can automate complex, end-to-end workflows precisely and can also handle multiple decision points along the way, provided there are clearly defined rules.

The monetary benefits of well-groomed Intelligent Automation incorporation are evident. IA minimizes manual work, cuts costs, and eliminates human errors. A recent survey states that, across industries that have IA in place, the ROI has increased by 250%, while another leading IT firm states that almost 48% of healthcare companies now use IA for their IT processes, and 47% use it for client-facing operations.

Use-Cases of Intelligent Automation in Healthcare

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Below are a few elaborations of how Intelligent Automation (IA) might assist the healthcare industry.

Patient-Physician Appointment Scheduling

Scheduling a patient-provider meeting is critical to a healthcare system’s smooth operation. While websites and applications provide an interface for arranging appointments (day, time, and physician availability), intelligent bots give a more personalized experience. They can make recommendations based on symptoms, list relevant physicians who are available and nearby, and collect information to arrange an appointment and more. Patients can communicate with the bot at any time to reschedule appointments and enquire about insurance benefits, location, and prices, among other things. Essentially an IA-integrated appointment scheduling system alleviates the challenge of patient no-shows and manual data entry.

Procedures for Discharge Automation

Discharge procedures usually take a long time and are arguably one of the most frustrating phases a patient must go through. Using a patient management system (PMS) can simplify and make this less time-consuming. IA can be deployed to automate the discharge cycle, including transcribing post-discharge instructions such as prescriptions, follow-ups, recommendations, and getting approval from hospital staff and more, based on the patient information collected in the PMS. Overall, IA reduces the efforts of administrative staff and increases the ability to manage patients more eficiently.

Management of Insurance Claims and Billing

Processing and settling insurance claims is a regular occurrence and requires precision. Manual processing is prone to an error rate of at least 10%, which requires additional rework. Although an employee of the insurance provider might take just 5–10 minutes to verify the claim status of each applicant, it adds up to a considerable number which is eventually reflected in the amount that healthcare providers and patients pay as premiums. Because most of the tasks involved in claim management are rule-directed, it is the best candidate for Intelligent Automation. The following tasks can be performed by a bot used to automate claim processing:

1. A bot can harvest claim data from a variety of sources and in a variety of formats.

2. A bot can be trained to spot exceptions such as incomplete claims or validate assertions through configurable rules.

3. Payments can be processed once a claim has been accepted by integrating the automation system with the proper departments.

In its recent report, a leading market research firm states that IA can help insurance providers shed up to 30% of the costs associated with processing claims.

Management of Inventory

Intelligent Automation can help in the management of non-clinical operations too. Gloves, medication, needles, syringes, and their supply are typically kept track of by payers. Backed by ML-driven data analytics, Intelligent Automation can accurately forecast demand and supply patterns and can assist in maintaining an ideal inventory level. Aside from inventories, an automated rule-based engine can also handle hospital rooms and other resources.

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Management of Regulatory Compliance

Compliance is always a top priority for healthcare companies. Non-compliance will cost healthcare providers dearly. Ensuring that all regulatory requirements are met, especially concerning Patient Health Information (PHI), is critical for legal, regulatory, reputational, and financial reasons. Intelligent Automation can implement role-based access controls (RBAC) to ensure unauthorized personnel do not access patient data. Intelligent bots collect data to the granular level, making it much easier to generate reports that need to be submitted for audits.

Payment Processing

Intelligent automation can improve coordination between healthcare and insurance providers and aid healthcare providers reimburse faster and more seamlessly. The reimbursement journey collates various data from disparate sources such as patient medical history, premium payment history, diagnostic codes and multiple other factors. IA can also automate the extraction and aggregation of data, format it as required, and submit claims for processing in no time.

Clinical Workflows and Patient Journeys

The main aim of automating clinical processes is to provide respite to physicians and other hospital staff from the rigor of repetitive tasks, which significantly erodes the time they spend attending to patients. IA is more than capable of performing these essential routine tasks for positive patient outcomes. It gathers data from multiple sources and instantly transfers them from one application to another. It makes all of the required data in a particular location, providing easy access and eliminating the scenario where physicians need to wait for information from different departments, which in turn helps them make informed decisions faster.

Organizing the movement of patients from one phase of care to another requires data coordination from multiple departments, which are often siloed in traditional healthcare systems. IA can extract, move, integrate and make accessing patient data easy, helping hospital staff to help patients sail through the different stages.

Also Read,
Pharma Analytics: Optimizing the Pharmaceutical Value Chain with Big Data Analytics

Healthcare Insurance Personalization

Data collected through automation assists payers in making better healthcare decisions, allowing them to provide better patient care. Automation can be used for patient segmentation based on the data collected. This allows insurance providers to create personalized healthcare plans that help them serve their patients better.

Payoda as your Automation Partner

Intelligent automation is a successful recipe for healthcare organizations to mitigate costs and improve the quality of processes, such as developing and maintaining provider networks, supply chain prices, risk management, marketing and sales, patient journeys, and claims and billing processing. Our IA techniques are efficient and precise, can work 24/7, increase productivity and free up healthcare staff to provide excellent experiences for patients.. Talk to our experts at Payoda to learn more about how to accelerate your healthcare digital transformation through automation services.

Authored by: Sritharan Chellachamy and Mohan Bharathi

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