Author: Braden Decker, Alpha Health

To say that the last three months have thrown an unprecedented amount of change to revenue cycle leaders would be a pretty significant understatement. Now, more than ever, is the time to look for ways to harden the revenue cycle against events like a pandemic. We are at an inflection point where artificial intelligence (AI), machine learning and robotic process automation (RPA) can provide healthcare organizations with the capabilities needed to better weather these events. Obviously, computers don’t need to be furloughed when volumes drop and they also do not need lengthy onboarding when volumes return. Ultimately, automation solutions can help drive down the cost-to-collect.

The Current Approach to Automation

Many revenue cycle leaders have already started to embrace RPA technology. There are a multitude of RPA providers in the market who are more than ready to sell you some technology. However, there are some major considerations organizations need to keep in mind before investing in RPA.  The licenses can be expensive. RPA technologies require significant time and IT resources during implementation and to maintain. RPA requires constant monitoring for changes to all of the applications where they are deployed. Every upgrade and process change will also require updating your RPA bots. This is a significant, long-term resource commitment. And, because software and business process changes are often impossible to anticipate and plan for, budgeting and planning for RPA maintenance expenses is likewise often impossible to estimate. Ultimately, broken bots blindside both your operations and your budgets.  

The Challenge with the Current Approach

When considering how and where to apply technology, we need to look for ways to provide automation without disrupting staff or requiring a massive overhaul of business processes. In order to deploy RPA, organizations will either hire new staff who are tasked with developing the bots or they will hire outside consultants. Then, these teams will invade the business office to “watch and learn” the processes that need to be automated. Process maps are then generated, standard workflows are modified, and finally the bots are created and deployed. Unfortunately, even after these herculean efforts, a significant portion of work will remain undocumented and numerous exceptions will require on-going intervention from staff. A research report released by Forrester in July of 2019 indicated the service-to-license ratio for a single bot is 3.4 to 1 – that’s $3.40 spent on consulting services for every $1 spent licensing RPA technology. 

There is a Better Way 

Alpha Health has created a new approach to automation that has been purpose built for healthcare revenue cycle operations called Unified Automation. This approach is built on three pillars:

  • First, instead of relying upon armies of consultants and engineers distracting your staff to watch what they do, we have created the ability to autonomously perform the observation and documentation process. Our proprietary software captures multi-modal data to get a 360 degree view of all workflows, not just a fraction of them. 
  • Next machine learning is used to construct complex scripts and workflows that are impossible to code by hand. Further eliminating the need to invest in additional hires or consultants for this work. Broken or inefficient workflows are corrected and unnecessary work is eliminated. 
  • Finally we combine the automation with our revenue cycle experts who step in when the system encounters an exception or something new, this includes changes in business processes and outlier cases. The system learns from the actions these experts take so it can autonomously complete this work going forward.

Unified Automation seamlessly brings these three elements into a single solution. Unified Automation provides an unbreakable solution that does not disrupt staff and enables teams to focus on the work that returns the greatest value to their organizations. Because our solution works out of existing work queques, reassigning the work it can complete to itself, the only adjustment teams may notice is that their work queues grow smaller and smaller over time. Alpha Health acts as a remote employee that works out of the existing EMR and billing solutions following the same processes that are already in place.  

We’ve developed special machine learning algorithms to automatically detect and learn to be robust to outlier data. We’ve found that machine learning can actually achieve superhuman accuracy by detecting and ignoring bad data, and by combining good data from different sources. In this way, our Unified Automation solution provides revenue cycle leaders with super powers when it comes to accuracy. And, with continuous learning built in, Unified Automation provides peace of mind, always. 

How to do More with Less

Navigating the COVID-19 pandemic is clearly going to have lasting impacts on just about every element of our lives. How we approach the revenue cycle is necessarily evolving as well. We expect patient volumes to continue to be very volatile, as patients come back for various services in waves. We have seen any number of experienced revenue cycle team members simply retire instead of trying to figure out how to work at home. While much of our future may be difficult to predict, staffing challenges, volatility in work volumes and significant shifts in the payer mix are likely to continue for the foreseeable future. These dynamics are in many ways serving as an impetus to invest now in new solutions – solutions that can scale up and down as business demands. There has never been a more critical time to leverage what AI and machine learning can do to drive down the cost-to-collect and infuse your revenue cycle operations with resiliency and flexibility for the future.

Learn more about Alpha Health’s unique approach to automation here.