Revenue cycle management requires a coordination of multiple tasks and stakeholders for a health system to get paid in an effective and timely manner.
Because of their highly structured nature, revenue cycle processes are often ideal candidates for artificial intelligence (AI) and automation.
In a September Becker's Hospital Review webinar sponsored by Janus, Brendan Downing, co-founder and CEO of Janus Health — which believes in the power of technology to make revenue cycle workers' lives better — and Sarah Knodel, Senior Vice President at Baylor Scott & White Health (BSWH) in Dallas, discussed the necessity of transforming the industry’s cost structure and how AI and automation can help, using BSWH's experiences as an example.
Four key takeaways were:
1. Increased margin pressure requires cost structure transformation. "We need a fundamental transformation in order to preserve the financial stability within our health system structure," Mr. Downing said. "Providers are facing tremendous pressure on the input costs of care due to rising wages, which have gone up more than 19 percent in the last two years. We're also finding a tremendous amount of job vacancy; nearly half of all revenue cycle operations are experiencing a severe labor shortage. Couple with those challenges, we still have a ton of payer abrasion, with a 20 percent increase in claim denials over the last five years. As a result 75 percent of CFOs report they're planning to reduce their operating budget in the next fiscal year."
2. AI and automation can reduce the cost to collect and increase revenue. Because revenue cycle processes are highly structured and have very clear outcomes, they are excellent candidates for AI and automation. "The revenue cycle has a tremendous amount of well-labeled, structured data," Mr. Downing said. "Harnessing that data allows us to build really impactful machine learning models and automations. Even RCM unstructured data is relatively easy to codify and label. The outcomes are also explicitly known - we want to get paid on claims, which makes it easy to determine what we need to optimize for.
"Finally, there's a high value for success," he continued. "McKinsey reported that about $265 billion annually is wasted through redundant administrative processes. We have to use technology, AI and automation to drive efficiency."
3. BSWH plans to continue using AI and automation technology to further transform its revenue cycle. Over the last decade, BSWH has used robotic process automation to emulate repetitive tasks and workflows, machine learning (ML) to predict correct actions based on prior experience and natural language processing to complete computer-assisted coding. Ms. Knodel shared one past result: "It used to take us seven minutes to create one estimate for a patient. By enabling technology and continuing to optimize that process, we've gone from a 100 percent manual process to one where 70 percent of our estimates are completely automated."
During the next five years, BSWH plans to leverage a cohesive, holistic, end-to-end revenue cycle technology platform that uses ML and AI to keep up with the evolving nature of healthcare, leverage process intelligence to understand the current state and opportunities for improvement across processes and workforce, and leverage rapid automation processes to create bandwidth so staff can focus on highly complex and nuanced tasks.
4. BSWH is partnering with Janus Health for the next phase of their revenue cycle transformation. Janus Health’s domain expertise, and comprehensive end-to-end solution with connectivity to thousands of payers. "It's important that your partner understand the complexity and nuances within the revenue cycle," Ms. Knodel said. "They also need to recognize that sometimes automation is not necessarily the best solution or that only one component of the process should be automated. A partner should be able to provide that comprehensive end-to-end solution that looks at every step to enable you to get paid."
Given consistently increasing margin pressure, it’s imperative that organizations adopt technology solutions that can reduce costs associated with collections and increase net revenue.
To learn more about Janus Health, visit Booth #1611 at the Beckers HIT + RCM Conference or janus-ai.com
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