The Transformative Potential of RPA for the Healthcare Industry

Do you have a healthcare story to tell? My guess is ‘yes.’

We all seem to be experiencing different levels of frustration getting to see a doctor that is in our health network or that is taking new patients, or repeating answers over and over again to different staff members when we go in for an appointment.  

There is a similar frustration on the inside of the health provider’s office. When the administrative staff has to repeatedly ask for information or finds that one system does not talk to another or populate known information, they are re-keying and spending a lot more time on these and other administrative tasks.

Given this state of affairs, it probably comes as no surprise that a McKinsey & Company study of 2,000 work activities across 800 occupations found that healthcare was the top industry that could benefit from automation. And it is happening. The healthcare industry’s adoption of robotic process automation (RPA) is expected to increase dramatically, from 5 to 50%, from 2020 to 2023.

RIPE FOR RPA

The high level of manual work and repetitive tasks that bog down the healthcare system and add to the inefficiency of the workers has not gone unnoticed. Industry analysis from AHA Trustees Services notes in their Top 10 Emerging Trends in Healthcare for 2021: The New Normal that “Artificial Intelligence and automation are taking hold in healthcare at an accelerated rate as they have in other fields such as banking, media and retail.”

One example that they cite is “Quality and Efficiency in Radiology.” Healthcare organizations can increase efficiency, reduce patient risk and expedite time to diagnosis and treatment by eliminating reading errors, identifying data patterns in images and enhancing workflow processes once the diagnosis is made. 

Imagine the vastly better patient outcomes that would result in more accurate and rapid diagnoses and immediate treatment follow-up. Our Intelligent Information Management (IIM)  practice has observed similarly transformative impacts for its healthcare clients when RPA has been applied to medical supply management and inventory optimization, revenue cycle operations and customer service.

RPA AS A STRATEGY FOR ADDRESSING LEGACY SYSTEM CHALLENGES

Many healthcare providers find that the transaction volume increases and greater patient demands are overwhelming their legacy systems. If they have not digitized their patient records and adopted automation strategies, they are stuck with many systems that don’t talk to each other. Automation is thus becoming a deployment criticality for the healthcare industry because new challenges, such as increasingly complex health plans, are an additional strain that makes the situation untenable.

Bots reduce the impact of legacy systems in several ways, such as serving as a “poor man’s integration” between systems that don’t talk to each other, reducing the number of steps a human has to perform across systems and handling high volume transactions – which preserves humans for high-value tasks and patient interaction.

HEALTHCARE STORIES

According to McKinsey, automating tasks on the Payer side can enable the redeployment of 43% of human effort, while 33% can be redirected on the Provider side. Administrative complexity, such as billing and coding, represents the most significant source of waste in the healthcare industry. Following are examples of how bots have been used to address them.

Claim Processing¹ – Bots can be used to collect data from disparate systems required for claims processing. 

• A US national health and wellness enterprise was able to automate claims processing in four days and subsequently scale to 12,000 claims per day.
• A European hospital was able to reduce claims processing costs by 75% from $4 per claim to $1.

Data Integrity²–  Bots can be used to centralize data from disparate systems to one, transfer data from the old legacy system to a new system, or handle daily data transfers to avoid the ‘swivel chair syndrome’ of human workers rekeying information from one system to another. The work gets done quickly and error-free as bots don’t get fatigued.

• A family medical center deployed a bot that executed an error-free transfer of 30 years of patient data (64,000 records) from one hospital system to another in 24 hours.

Patient Onboarding³– Sometimes bots take on an assistant role. With a “human in the loop” automation, a bot executes a process and prompts a human worker only when a task requires human input. This enables the automation of processes that have a percentage of exceptions or are too complicated to automate.

• A large, midwestern healthcare provider deployed attended robots to add new patients, accurately record their data and report it to the CDC, saving eight to nine minutes per patient and completely eliminating data transcription errors.

Provider: Supply Management⁴– Unused inventory does not last forever; it expires. It is wasteful if discarded and unproductive as it sits waiting to be used. Bots can help to better manage supplies.

• A UK hospital reduced supply chain costs by using a bot to pull the data necessary to set optimal inventory levels.

Medical Billing⁵– Process errors cause havoc, especially when there are dependent,  downstream processes for providers and payers who want bills to be accurate. Fraudulent claims are complex for humans to detect and can be rampant in certain pockets of the healthcare ecosystem. 

• A New York hospital used bots to scan through bills and records about patient encounters to ensure pricing accuracy, and to speed up bill payments and claims follow-up.
• A healthcare payer used a bot to compare data across claims evaluation, processing, assignment and reporting to flag fraudulent claims.

Insurance Authorization⁶ – With the greater complexity of insurance plans, more time is needed to authorize services for a patient. However, authorization is often urgent for non-routine medical services. Bots enable claims to be submitted more rapidly, and payers to provide authorization in a fraction of the traditional time.

• A midwestern hospital system used RPA to check payer sites for authorization requirements and status, reducing manually processed accounts by 20%. 

IN SUMMARY

Healthcare providers and payers have a tremendous opportunity to meet the demand for better, faster, more accurate and cost-effective administration processes to sustain the ever-increasing transaction levels for their services. With adoption approaching 50% by 2023, they are clearly seizing the opportunity.

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¹  UI Path. “Cure Healthcare Inefficiencies with RPA,” 2020, https://www.uipath.com/solutions/industry/healthcare-automation

²   Automation Anywhere. “RPA in Healthcare,” 2020, https://www.automationanywhere.com/solutions/healthcare.

³   Daniel Pullen. “Robotic Process Automation in Healthcare,” Hospital Healthcare, September 14, 2020

⁴  UI Path. “Cure Healthcare Inefficiencies with RPA,” 2020, https://www.uipath.com/solutions/industry/healthcare-automation.

⁵   Laura Dyrda. “Telemedicine, AI and Robotic Process Automation: How New York Presbyterian is Equalizing Access to Care,” Becker’s Health IT, May 30, 2019.

⁶  Laura Dyrda. “8 Finance Execs Reply: What Revenue Cycle Change Worked?” Becker’s Health IT, July 20, 2020,https://www.beckershospitalreview.com/finance/7-finance-execs-reply-what-revenue-cycle-change-worked.html.