Automation: What The Doctor Ordered To Manage The Implications Of COVID-19 For Healthcare Payers

If there is an industry that does not consider COVID-19 a black swan event, it is health insurance. Pandemics occur about once in 30 years and have traditionally been important considerations in the internal stress scenarios, and the risk and capital management analysis of global payers. ¹What payers could not have predicted is the nature of this pandemic. The mortality and morbidity exposure are out of control, and the rise in claims can lead to a significant increase in workload. There is also an increase in the number of people signing up for health plans in the wake of COVID-19, adding to the workload. One study in India showed a 25% increase in the purchase of new policies. ² In addition, the pressure on hospitals to free up beds for COVID-19 patients has led to a decrease in elective procedures. For example, in the US, depending on the region, the drop has been between 44 and 73%, in comparison with the same period last year. ³When these patients return for elective procedures as the pandemic abates, the surge in claims will pressure payers. That means payers must focus on three aspects:

For payers, RoboticProcess Automation (RPA) provides a way to address all three challenges.

The healthcare industry is not a newcomer to RPA adoption. Payers have used the technology for a handful of tasks such as extracting structured and unstructured data, pre-authorization of services claims processing, and to exchange data with providers.

Now, in the shadow of COVID-19, there has been a rising demand for applying RPA to a wider range of processes. These include speeding up claims processing, enhancing customer care through chatbots, improving new enrollments through data enrichment and validation, renewing contracts, meeting regulatory requirements through data interoperability, and enabling a remote workforce by automating day to day IT tasks (for example, incident response) and administrative processes (related to finance, human resource,etc.). The range of use cases is wide.

The urgency for payers to deploy RPA implies that they need to be cautious as well. RPA can be applied in several areas — all with varying benefits—and evaluating and prioritizing the functions where the technology could deliver the highest and fastest ROI can be tricky. With the right decisions, RPA will deliver on its promise.

According to a report called “Intelligent Automation in Healthcare: Addressing COVID-19 Scenarios” published by global management and strategy consulting firm, Zinnov, the areas where RPA has proven ability include:

• Claims Adjudication
• Customer Support
• Regulatory Reporting
• Claims Data Management
• Interoperability

Once a payer has identified a business function wherein RPA can be applied, the next step is to implement the technology where it will result in cost reductions, productivity increase, risk reduction, and improved patient and employee experience, in the shortest possible time. ROI and time-to-value are important considerations. Both determine the amount and pace of investments the payer can commit to, on RPA. This is where ITC Infotech makes a substantial difference. Our team of healthcare technology experts has studied the impact of COVID-19 on payers and has created a Special Task Force with a single mandate: to identify critical pain points that payers need to address and provide cost-optimal, easy-to-implement, and high ROI yield solutions.

We execute leveraging our catalog of process frameworks that can be applied to IT and business along with a library of ready-to-use bots. These need minimal refinements and customizations (to align them with the goals and the needs of individual payers) to achieve a faster time to value. Our industry and processes mining expertise allow us to quickly identify the automation opportunities in a payer’s environment. We stitch the solution in line with enterprise mandated business outcomes ensuring that the business is ready for automation at scale. The automation can be for practically any process ranging from member enrollment to premium collection and from claims settlement to reporting.

RPA can be deployed by our experts quickly and precisely, to reduce the cost of claims processing that COVID-19 is bound to lead to, provide augmented support to producers/agents to improve and onboard new enrollments, and alleviate the pressure of claims management caused by the imminent spike in elective procedures. For a detailed examination of use cases where RPA can deliver an immediate impact, please download the Zinnov – ITC Infotech joint whitepaper.

Authors:

Manish Jaiswal
Vice President, ITC Infotech

Sanjana Bhattacharya
Principal Consultant, ITC Infotech

Nikhil Kulkarni
Principal, Zinnov

AV Ruchir
Project Lead, Zinnov

References:

1. http://pubdocs.worldbank.org/en/687971586471330943/COVID-19-Outbreak-Global-Policy-Actions-on-Insurance.pdf
2. https://www.financialexpress.com/money/insurance/insurance-trends-during-covid-19-health-in-high-demand-motor-lags/1996340/
3. https://blog.definitivehc.com/3-trends-in-healthcare-as-covid-19-cases-stabilize