Robotic Process Automation (RPA) is adopted by many health plans as a way to increase productivity, improve quality and reduce cycle times. RPA is most commonly applied in back-office, transactional-type processes, such as simple claims edits, transferring enrollment information from paper applications or Excel sheets into the membership system, and other non-complex tasks. Check out this video to learn more:
When looking for processes to automate, plans usually focus on processes that are high-volume, simple, and can be automated from beginning to end. It’s been successful, and many of the clients I’ve worked with have seen productivity gains of over 50 percent, quality scores of 100 percent and reduced FTE counts. New technologies, like intelligence and machine learning, will be applicable to more complex work in the future, but what additional productivity and quality gains can you achieve right now, with the automation tools you already have?
Automate the simple steps, not just the simple processes
The current focus on simple processes causes most clients to cross complex tasks off their list early in the selection process. But what if you could automate the simple steps in high-value, complex processes being performed by high-dollar resources? You could experience significant gains in productivity, quality, and cycle time. So think about this: What if instead of just using RPA, you also build robotic process assistants?
Think about it this way: You have processes, (maybe in the front- and middle-offices, not just the back-office), that have as many as 20 steps. Of those, steps 1 through 3 can be automated, and steps 10 through 20 can be automated, but 4 through 9 need a claims analyst who can make complicated decisions about COB. Pair up your claims analyst with a robotic process assistant and she can send her automated assistant off to start a single transaction, or the whole set of transactions assigned to the analyst for the day. The robotic assistant then goes off to pull down the EOB, put all the claim notes into a single document, and add any claim attachments it finds in the document repository. The assistant then hands it all back to the analyst, who now has all the info she needs to do her analytical steps. Once her work is complete, she passes the transaction back to her assistant to complete the final steps.
Or how about care management nurses? They’re highly skilled, highly paid, highly sought-after. and hard to keep around. Most would love to have an assistant to take care of the tedious, repetitive parts of the job. For example, a care management nurse might need to call 10 patients a day. Before each call, she spends a half-hour collecting data (information from the authorization system, notes in the claims system, documents from the repository, medical records in the EHR, and so forth). Then she reviews the data for another 5 minutes. It is only after all that preparation that she gets to do the part of her job she loves — providing quality care. A robotic process assistant can do that first half-hour of data collection. Now the nurse now can spend nearly her whole day doing what she loves.
She’s also much more productive. The assistant gives her an extra 5 hours per day, allowing her to reach 20 of health plan members, not just 10.
This delivers a 50 percent improvement in productivity in a process, which can cost a health plan $100 an hour, as compared to simple claims edits, which cost maybe $20 an hour! That makes each hour of work by a robotic assistant five times as valuable as an hour of work by a robotic process automation system performing simple tasks. And plans now have staff members who love their automated assistants, rather than fear them, because the staff gets to focus on the part of the job they love.
So next time you’re contemplating automation, take a look at those complex processes that have simple steps within them. And start thinking assistants, not just systems.
Post Date: 4/26/2017