During his recent Senate confirmation hearing, prospective HHS Secretary Dr. Tom Price recounted a startling epiphany from his days as an orthopedic surgeon.
Looking around his office, Price realized “there were more individuals within our office who were dealing with paperwork, insurance filings and government regulations than there were individuals actually seeing and treating patients.”
It's almost certain Price wasn’t exaggerating. The administrative work of healthcare has become so complex it racks up an incomprehensible--but very real--$480 billion a year in costs. That’s not even taking into account the hidden costs of clinician burnout, or the biggest cost of all, the impact these administrative burdens place on patient care.
As Price went on to describe, that moment in his office crystalized for him “that our health care system was losing focus on the number one priority, the individual patient.”
Given his conservative politics, the current nominee to head up Health and Human Services, Tom Price isn't likely to mandate use of any more healthcare technologies. But if he had to pick one to mandate, something that does away with the need for armies of staff to communicate with commercial and government payers would be his most likely candidate.
Of course, it’s not just payer administrative rules that obstruct this focus. Technology can get in the way, too, like the years-long shift to electronic health records. Yet ironically, a certain technology may be the answer to the problem that Price so succinctly named. It’s called a “web bot”—and when applied to the right tasks, these invisible little algorithms are a potent defense of the provider’s own lifeblood: getting paid for services rendered, but also focus on the patient, as Price put it.
Essentially, these bots do the tedious, unending work of communicating with payers about price estimates, prior authorization for services, insurance eligibility and claim status that otherwise requires dozens or even hundreds of staffers—often with little to show for it. That’s because even once a staffer has the attention of someone at the payer organization, they rarely are given clearance to get status on more than a handful of transactions.
Web bots, on the other hand, can process a staggering number of transactions from different payers at once. Using the provider’s credentials with the payers, the bots automate the entire process of querying the payer for information – allowing for efficiencies to be gained by both providers and payers who would otherwise have staff on the phone or retrieving web data.
They don’t always work alone--other technologies utilize the retrieved data to perform complex business problems like producing a patient estimate, obtaining authorization and claims status and even identifying denial risk. But as the primary “communicator” with payers, these bots do the bulk of the work that Price was referring to, larger health systems typically see the greatest lift through the use of this automated web bots due to the sheer volume and through-put required to make these large systems run.
Does sending faceless bots out to communicate with payers sound like a rather cold way to do business in healthcare? Perhaps it is. But it may also be the best avenue for connecting providers back to their patients again.
Jay Deady, CEO of Recondo (www.recondotech.com), has been a leader, product visionary, and innovator in healthcare information technology for more than 25 years.
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