Over the past few years, the healthcare insurance industry has been the focus of a tidal wave of changes — regulations, new market challenges, open enrollment, labor challenges with business process outsourcing, and a significantly more complex operating environment. More than ever before, healthcare insurance companies can benefit from robotic process automation (RPA). Interestingly, the question we get the most is: “Where do we start?”
While we and other vendors can help you discover the processes in detail (for example, please see our complete-package solution), perhaps we can start with identifying the operations areas that will net the most significant ROI. OpenConnect has been helping healthcare insurance companies automate for over 12 years, and here are the top four areas where we have seen our customers derive the most significant benefits from automation:
- Claims adjudication
- Enrollment and membership services
- Provider data services
- Revenue cycle management
Each of these operations has a complex need for both human and robot interaction, due to the challenge of data management. If the data is incorrect or not normalized, core systems begin to create exceptions, which drives up the need for more human labor interaction. Even worse, the patient experience suffers.
For many companies, these menial tasks and other routine data-entry processes continue to be handled manually. The cost for maintaining that status quo can be steep: it costs $57,725 to hire and employ just one data entry worker (this figure is based on data gathered from the U.S. Bureau of Labor Statistics and the Center for American Progress).
Working the plan — but staying flexible
Let’s consider the game of football (for our friends outside the U.S., we mean what you call “American football,” not what we call “soccer”). In football, the quarterback’s job is to direct his team down the field. And, although the team has a game plan, the coaching staff isn’t afraid to have the quarterback “call an audible” to adjust to the opponent’s constantly changing defensive “looks.” Using his vision of the whole playing field, the quarterback’s situationally responsive selection could be either running the ball or throwing a pass – each of which may deliver a successful outcome. In fact, the so-called “run/pass option” play has become increasingly popular, precisely because of that flexibility it gives teams.
Much like a football team’s need to change things on the fly as they see new and shifting challenges looming ahead, healthcare insurers also need the flexibility RPA can provide in their strategy. While claims tend to be the first focus, we see customers identify sub-processes every day that can change the outcome of the game — in this case, a correctly paid claim. Think back to the “top four areas” we identified earlier. We have many customers who are attacking claims adjudication and seeing trends in provider data inconsistencies. This new knowledge allows our customers to pivot and begin pointing robots at cleaning provider data, which results in improvement to all claims adjudication rates.
This is the benefit you achieve when robots are implemented based on detailed analysis performed before the implementation. Even when employees are buried in manual data entry work, they’re hard-pressed to raise the level of the team’s or company’s performance. Starting an automation strategy opens the lens to “calling audibles” for your operational performance. Just like a team that sticks to a game plan even after it’s become clear the other side has overcome it, an annual business plan that involves throwing more human labor and overtime at a problem doesn’t work anymore.
So, as you embrace automation for all the benefits it can and will bring you, be sure to choose not only a vendor but also a plan that will give you maximum flexibility to meet your challenges — both the ones you can see now and the ones you can’t quite see yet.