What can ‘The Office’ teach us about the US Healthcare System

Author: Daniel Vachoo, Director, Customer Success

 

Like most Americans who are sheltering at home during the ongoing coronavirus pandemic, I’ve been spending more of my life online. It’s no surprise that video streaming services such as Netflix have seen a 16% increase in their daily average users in recent months. Personally, I’ve found myself binge-watching more episodes of ‘The  Office’ in the last 6 months than ever before. I’ve tried to draw inspiration from my compulsive TV viewing to make more sense of the world around me.

In Season 1, Episode 3 of ‘The Office’ titled Health Care, Office Manager, Michael Scott (Steve Carell) leaves subordinate, Dwight Schrute (Rainn Wilson) in charge of selecting a new healthcare plan for the paper company staff of Dunder Mifflin. No spoilers but it ends disastrously. Humor aside, this episode, highlights 3 important facts about the US healthcare system:

    1. Employer-sponsored healthcare covers more than 55% of the US population
    2. Administrative costs make up about 34% of total health care expenditures in the United States (Here’s a link to an earlier blog from our CEO, Malinka Walaliyadde that provides an excellent breakdown of growing US healthcare costs)
    3. Applying Unified Automation™ across the entire revenue cycle process can help healthcare organizations save millions of dollars in recovered revenue annually which will result in a lower cost of care for the patients


At Alpha Health we believe every dollar spent on healthcare matters because healthcare matters to everyone. We believe complexity in medical billing and reimbursement in the United States drives up hidden costs that we all pay, both in terms of dollars and in the erosion of trust people have that our healthcare system will serve them well. 

For instance, the Claim Status function in healthcare revenue cycle operations entails complete follow up to claims filed by the health system or provider that have not received a response from payers or insurance companies. This is done by checking the status of each individual claim on payer websites, pulling back relevant information into electronic health record (EHR) or Patient Accounting Systems (PAS), and prioritizing the need for escalation with the payer. This process is largely a manual exercise at most healthcare organizations today. 

As an industry average, each manual claim status inquiry takes 9 minutes of provider staff time which translates to an annual potential savings opportunity of $3.6 billion for our healthcare industry. With the backdrop of a global pandemic, thinning hospital margins,  V-shaped recovery of hospital claim volumes, and an ever-changing set of payer rules, this is simply not the best use of our hospital resources, period. The revenue cycle is ripe for automation and we need to empower our peers in these functions to work on the top of their license with a core focus on patient experience. 

The current manual claim status efforts have netted in subpar results with providers always playing catchup with their outstanding claims. A/R has piled up while cash flow streams have stayed stagnant. 

At Alpha Health, we’ve helped several organizations tackle administrative time sinks across the revenue cycle leveraging the true power of Unified Automation™. Unified Automation™ observes actions, learns them, and performs them faster and more accurately than is possible through manual processes. We start by deploying proprietary software that captures multi-modal data to get a 360-degree view of current workflows and processes. Our team then discretizes this data to train our machine learning algorithm. Our algorithms then automatically construct complex flows that would be impossible to script by hand. Our model also identifies broken workflows, corrects them, and learns from them, often eliminating unnecessary work. Finally, our AI then gets to work performing claim status checks 24/7. 

Unified Automation™ is particularly well suited to healthcare revenue cycle management functions such as claims status because it is antifragile, which extends beyond simple resilience or robustness and creates a system that actually improves in response to variance and constantly changing variables – a critical capability for any automation system in the revenue cycle. 

Antifragile and Unified Automation are not just a ‘buzzwords’, it actually elevates the revenue cycle automation to a whole new level.  If a Health System upgrades its EMR, there is no impact on the automation output. If a payer website goes through a drastic facelift, there is no need to spend hours re-writing RPA bot rules. We don’t just put things in a queue for a human to review and tell us what to do next, we complete the full workflow by specifying the exact next action.

Case in point, at a large health system in the midwest, in less than 6 months, our Unified Automation™ solution has contributed to the equivalent of 15-17 full-time employees checking claim statuses 24/7.  This has saved the organization 6,000+ staff-hours to date, allowing them to refocus their staff on true revenue-generating activities. 

Dwight Schrute’s dilemma to choose between the health of his colleagues vs. profit margins of his employer is not unique to Dunder Mifflin and it’s a story we see playing out across the country. We wholeheartedly believe that automation across the entire revenue cycle process can help healthcare organizations save millions of dollars in recovered revenue annually which will ultimately result in a lower cost of care for everyone.