Reducing Healthcare and Insurer Burdens With Digital Workers

The healthcare industry has traditionally been constrained by how rapidly it can adopt new technologies. But with growing patient numbers and a lack of skilled workers, it’s now racing to embrace new solutions in digital healthcare.

According to the American Hospital Association, there will be a shortage of 3.2 million healthcare workers by 2026. Ultimately, every health system needs their clinicians practicing at the top of their license – not tied to their desks sifting through administrative paperwork.

With the proliferation of investments in Electronic Health Records (EHR) and other technologies, administrators and clinical teams are inundated with dashboards and reports. Despite having all the information, they’re often forced to make crucial operational decisions without complete insight. Luckily, digital transformation is possible with healthcare automation; it bridges system gaps, supports teams and assists in patient care.

Healthcare organizations are looking for digital health solutions that will help accelerate workflows and business processes, reduce manual tasks and, ultimately, improve patient care.

What Is a Digital Healthcare Solution?

A digital health solution employs technologies such as intelligent automation (IA) and artificial intelligence (AI) to develop and automate new care delivery models. These models are designed to address clinical pain points and help health systems use their staff’s time more efficiently – thereby improving care.

IA, which combines robotic process automation (RPA) with AI and machine learning (ML), deploys digital workers to mimic human actions and streamline processes, working without breaks and with 100% accuracy.

How Does Automation Deliver Digital Healthcare Solutions?

Central to improving patient care and clinical processes is freeing clinicians from repetitive, non-patient-facing tasks. Let’s look at some examples of Intelligent Automation in healthcare, specifically for clinical and administrative staff.

Administrative processes

• Appointment scheduling: IA enables patients to book appointments online, reducing phone calls and manual scheduling. Digital workers can send reminders to patients and reschedule as necessary to reduce the number of no-shows.
• Patient onboarding: Registration forms can be filled out online, including all medical data, demographics and insurance information, then automatically updating the patient’s records accordingly.
• Patient reminders: Digital workers can improve patient engagement by sending them reminders about screenings, vaccinations and preventative care.

Clinical processes

• EHRs: Patient records are digitized so they’re more accessible to authorized healthcare professionals, ensuring patient data is accurate and up to date.
• Medication management: Digital workers can alert healthcare providers and patients about medication schedules to reduce the risk of missed doses or adverse reactions.
• Telemedicine and remote consultations: Automation enables virtual consultations so patients can connect with healthcare providers remotely, saving time for both parties and ensuring faster patient care.
• Diagnostics and testing: ML algorithms use evidence-based approaches to analyze patient data and support healthcare professionals. For example, digital workers can read images such as X-rays and CT scans and detect anomalies a human clinician might miss.

Read about all 22 use cases of IA and RPA healthcare, or take a deep dive into these case studies on transforming patient experience with IA for real-world evidence of how it works.

How Can Automation Help With Digital Healthcare Payer Solutions?

Healthcare payers currently struggle to keep up with the vast number of administrative tasks overwhelming their people. Claims filing, data extraction from internal and external systems, adding medical codes, retrieving prior authorization and validation, and submitting claims to the payer are all processes that need streamlining.

Prior authorization

Before care can be given, prior authorization requires payers and/or benefits managers to approve the necessity of a care plan and whether they’ll reimburse it. Without automation, prior authorization is a lengthy process that delays patient care.

Prior authorization automation can kickstart the authorization process at the initial point of service when a clinical first assesses a patient. A digital worker can immediately check the recommended procedure or medication against the relevant payer’s database or by logging into the payer’s portal.

Following that, digital workers can make the necessary applications, locate any documentation gaps, perform eligibility and benefits checks, and provide all the required clinical documentation for creating and updating a patient’s EHR.

Insurance claims automation

Payer organizations handle thousands of medical claims daily, and the majority still rely on manual processes for prescriptions, prior authorization and claims adjudication. Healthcare insurance claims automation can help streamline these processes and reduce human errors.

Digital workers can perform claims management tasks by scanning claim statuses and automatically updating the organization’s revenue cycle management (RCM) system to reflect the gathered data. From there, they can sift through payer checks and balances to determine whether a prescribed medication is medically necessary and appropriate. If data is missing, digital workers trigger a request for that information.

What To Do Next

Digital healthcare is the future of the healthcare industry, ensuring better care delivery, patient engagement and improved staff satisfaction. IA streamlines processes for clinicians, administrative staff and healthcare insurers to save time and get patients better care, faster.

To find out how you can benefit from healthcare automation, contact an expert at SS&C Blue Prism today.