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How artificial intelligence, analytics and automation are reshaping the hospital revenue cycle

The 'accelerating challenge around patient needs' calls for new technology and automation, but on a personal level.

Susan Morse, Senior Editor

As hospitals turn to technology to overhaul the patient experience and improve profits, a range of vendors are bringing new products and outsourced services to meet that demand with artificial intelligence, data analytics and natural language processing as well as cognitive and process automation.

Let's take a look at the cutting edge technologies available to help hospitals modernize revenue cycle management.

ROBOTIC PROCESS AUTOMATION

Robotic process automation and cognitive automation are the basis for revenue cycle transformation, according to Joe Polaris, senior vice president of product and technology at R1 RCM in Chicago, which provides technology- enabled revenue cycle solutions.

"Different providers are experiencing different headwinds. Bad debt is through the roof," said Polaris. "The big systems, they're realizing strategically their focus should be on great patient care. They're becoming more interested in outsourcing the cafeteria, outsourcing revenue cycle."

Since health systems can transition their entire revenue cycle operations, or parts of it, to RI RCM, Polaris said they are seeing a lot of activity geared toward improving key performance indicators and business objectives.

In 2018, the company began offering robotic process automation to automate mundane business processes. It uses an AI-driven digital workforce platform consisting of RPA, cognitive automation and built-in analytics for front-end scheduling, check-in, bill pay, collections, and other functions. RPI has the ability to communicate with other digital systems.

Use cases include scheduling an appointment, managing bill pay or a payment plan. Patients can ask a question about a bill and can complete forms and paperwork.

Revenue cycle departments have realized an increase in revenue, efficiency and the patient financial experience, and reductions in operational costs and denial rates, according to Polaris.

"It opens up the door for transformative investments to be more ROI positive," Polaris said. "On the bill pay side, utilization of these electronic self-service tools is great and takes waste out of the system. The other thing we're able to do really well is personalize the experience based on consumers' personal information. We're able to categorize a patient's lower ability to pay. We're now able to chip away at the problem."

OUTSOURCING IT ALL

Optum and Dignity Health formed Optum360 in 2013 to combine data, advanced analytics and AI for revenue cycle management services.

Every provider is looking to modernize operations, said Mark Morsch, vice president of Technology for Optum360.

"Providers are looking at revenue cycle to improve performance, manage costs and ensure they're keeping up with regulatory changes and revenue leakage," he said.

But there's significant investment required to keep up. Some systems choose to outsource their entire revenue cycle operations, end-to-end, in which case many of those rev cycle employees join Optum 360.

"One of the more significant activities is the outsourcing of revenue cycle operations within provider operations and taking over that responsibility,"  Morsch said. "We've had a lot of conversations with health systems. It is an executive level thought process. It is a big investment and commitment from both sides. Typically, these are long-term relationships."

The end-to-end solution may not work for every system, but all providers are looking to modernize. Some do it through Optum products such as computer assisted coding technologies with natural language processing baked in.

Using partner Quest Diagnostics, Optum360 can predict patient responsibility at the  point of service.

Optum360 boasts a 26 percent increase in average cash collections since the company was founded and a $49.6 million increase in revenue recovery due to additional eligibility screenings on self-pay accounts.

"The goal is to ensure that no claim is ever denied, by aligning all trading partners around a common, connected and transparent financial exchange," Morsch said. Providers ask, he said, "We know what high level performance can look like. How can we get there?"

VOICE AI

Voice technology has suffered a bad rep, but new design interfaces have made the resource user friendly, according to Shara Cohen, vice president of Customer Experience for Clinical Effectiveness at Wolters Kluwer Health, which offers voice user interface, or VUI Emmi.

"I think there's a perception (with) robo calls that you pick up the phone and get a commercial spoken to you," Cohen said. "There's much discussion now about about voice technology, but very little discussion about the quality of the conversation. Does it sound like a robot? Does it come from a trusted source?"

Emmi is personalized and interactive. Consumers on the other end of the phone know they're not speaking with a real person, but that can sometimes be an advantage.

"What we've found is patients are willing to disclose embarrassing or sensitive topics to a voice that's not going to have a reaction," Cohen said.

In the case of one provider, 83 percent of patients who disclosed depression to Emmi hadn't discussed this with their physician, she said. Asked by Emmi if they wanted more outreach, more than half opted for that.

Emmi's voice design combined with AI is able to flag for nurses patients who need a follow-up call with a clinician. AI can also go deeper into analytics through subsets of information, such as length of time on a call, to predict readmission risk.

For one provider, patients engaged with Emmi had a 10.7 percent readmissions rate compared to the 13 percent across all populations.

"The AI is looking at all of the patients and data," Cohen said. "A willingness to engage is its own predictor of a health outcome."

However, she added, "We didn't want to replace that clinical judgement. The next layer of intelligence, we give to care managers."

Many hospitals and health systems use such engagement for post-discharge calls. One provider was able to reach 80 percent of the discharge population, Cohen said.

Emmi is able to ask critical questions, to mimic real interaction.

Emmi begins by saying, "I'm calling on behalf of (the provider.)" It asks about scheduling a follow up appointment, whether the patient has a ride.

If voicemail picks up, Emmi will leave a message or call back. If a patient returns the calls and gets a recorded message, he or she is interacting with a recorded voice, but it's responsive to what the patient is saying.

VUI offers scale nurses and clinicians do not have.

For instance, projections show that the population of patients who have multiple chronic conditions will double over the next 30 years, to 87 million by 2050. Clinicians alone can't serve that size of a population, Cohen said.

"The premise was that we have an accelerating challenge around patient needs," she said.
 

 

Twitter: @SusanJMorse
Email the writer: susan.morse@himssmedia.com

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