5 Innovations Moving Care Out Of The Hospital

5 Innovations Moving Care Out Of The Hospital

For years now, care has continued to shift out of the hospital to various, lower cost sites of care. A recent study even projected a 2% decline in inpatient discharges over the next 10 years while they forecast 15% growth in outpatient volumes.¹  Surgery centers, hospital outpatient departments, telemedicine, walk-in clinics, and home health care all continue to grow, driven by consumers’ demand for convenience, advancing technologies, and health systems and payers’ need to lower costs. 

At Olive, this shift in care is especially exciting as it will help improve the quality and quantity of life for many Americans across the country. Alongside technologies like artificial intelligence, process automation, and other emerging technologies, these advances help make care more affordable and accessible to all. 

Let’s look at some of the new innovations that are helping healthcare providers care for patients out of the hospital:

 

Improved Surgical Techniques

While it’s not a new innovation, continued surgical and anesthesia improvements have allowed more procedures to move from inpatient to outpatient settings. Surgeries that once required long hospital recoveries are now able to be done in Ambulatory Surgical Centers (ASC), office-based surgical practices, and Hospital Outpatient Departments (HOPD). 

Examples of surgeries that have been able to transition to out of home facilities are spine fusions and disc replacements, total joint replacements, retina procedures and more. Even cardiovascular procedures are beginning to move out of the hospital.

A study performed by the Ambulatory Surgery Center Association found that Medicare would save over $2.4 billion per year if half the eligible surgical procedures shifted to the ASC setting (as opposed to taking place in a HOPD).² And with the ongoing success of these surgeries in other settings, CMS has begun removing procedures from its in-patient only list, such as knee replacements, which will help speed up the shift to other sites of care.

Telemedicine Appointments

Remote doctor visits, commonly known as telemedicine, have increased tremendously in recent years, but there’s still room for continued growth. Telemedicine’s potential is largely due to improved communication technologies. Studies show that 77% of U.S. adults now have a smartphone. And with more access, higher-resolution video capabilities, and better security, doctors are able to have meaningful conversations and evaluations via video. This innovation is particularly important in rural areas where patients often have to drive hours to be seen by a provider.

While still mostly used for common illnesses such as pink eye, rashes, or an ear infection, telemedicine also has the potential to reduce readmissions, especially when combined with other technologies such as remote patient monitoring.

 

Remote Patient Monitoring

Remote patient monitoring (RPM) is a key piece of technology that will help telemedicine reach its full potential. RPM uses at-home sensors or tests to remotely transmit health data to healthcare professionals, where it is reviewed to detect potential health problems. 

RPM is especially important for managing chronic conditions, which affect six in ten American adults.4 Due to the high number and costs of visits required to monitor these patients, many routinely miss appointments and do not do schedule proper follow-up care. With RPM, these patients can be monitored more regularly without the burden of having as many in-person visits. The data can also identify potential problems so intervention can occur sooner, improving outcomes.

RPM is already being used for people with diabetes, heart failure, atrial fibrillation, pacemakers, and women with hypertension during pregnancy. But with new developments in consumer wearables and wireless technology, the possibilities of RPM will surely expand.

Remote Lab Tests

We’ve already seen direct-to-consumer sites like 23andMe and EverlyWell begin offering genetic testing and panels for thyroid, hormones, and food sensitivities. These companies send a testing box requiring the consumer to send back blood, saliva, or urine that is then analyzed at the company lab. 

Although these aren’t in the same category as actual health care at the moment, they are a glimpse into what could be possible in the future, as companies have proven that there is a demand for at-home testing options. They have also paved the way for improved testing by making consumers more comfortable with the idea of having lab work done at home. Currently, telemedicine companies are looking to add lab services to their offerings, for example an at-home test kit for strep throat or UTIs.

In the meantime, home health care patients are already benefiting from more sophisticated remote lab testing. For example, LabCorp’s Lab-in-a-Box and Lab-in-an-Envelope offerings allow home health care providers to collect blood samples for a variety of tests at the patient’s home and send to LabCorp via FedEx.

 

At-Home Care

There has also been a growing interest in more at-home primary care, especially for patients with severe chronic conditions who have trouble leaving the home. These patients are often the highest users of healthcare services, but their limited mobility makes it difficult to see a doctor regularly. Instead, they often resort to using ambulances and emergency rooms to access care. Because of these factors, this patient group has extremely high rates of hospitalization and hospital readmission.

Similarly to telemedicine, primary care house calls for those with chronic conditions could help manage these conditions better and preemptively identify problems sooner, leading to lower rates of hospitalization. It’s a shift towards prevention-based care instead of intervention, and so far, the numbers appear to support this approach. In the Independence at Home Project, 17 practices providing home-based primary care all saw reduced ER visits, hospitalizations, and 30-day readmissions during the five-year project period.5

There are also companies looking to bring urgent-care type services to the home, such as Heal. Their app enables physician house calls for conditions commonly treated at the emergency department or urgent care, such as sprains and ear infections. On another front, Mercy Care and Philips have teamed up for a pilot study with seniors that can provide home health care for urgent care using the Lifeline medical alert system. The program is trying to reduce readmissions and improve patient quality of life. As programs and companies such as these continue to emerge, it seems likely that more and more care will take place at home.

The Future Potential

It’s exciting to see innovations happening in the medical field, especially in the other sites of care. And as the industry as a whole moves to value-based care and preventive medicine, these fields become increasingly more important to connecting the entire continuum of care. We’ve already seen hospitals building, acquiring, and partnering with ASCs, outpatient facilities, and home health providers, which leads to an interesting question about the future: how can all of these points of care help integrate care for the patient and the providers to improve care?

Connecting health at home to the hospital and every other point of care in between is a huge opportunity for consumers and providers alike – it would improve engagement, cost, and outcomes. As patient care continues to move to a broader set of care sites, the need for interoperability will increase, as well – an area where many emerging technologies like operational AI will have an enormous impact. Together, AI and the data provided by home health providers and remote patient monitoring devices could hold the key to unlocking health and wellness insights that will improve care for everyone.

 

Sources:

  1. https://www.sg2.com/health-care-intelligenceblog/2017/05/sg2-2017-impact-change-forecast-finding-growth/
  2. https://ankura.com/insights/healthcare-outlook-2017-ambulatory-surgery-centers/
  3. https://www.pewinternet.org/fact-sheet/mobile/
  4. https://www.rand.org/pubs/tools/TL221.html
  5. https://www.iahnow.org/
Cost Containment is a Top Priority in 2019 For Healthcare Executives

Cost Containment is a Top Priority in 2019 For Healthcare Executives

 

In the past few years, healthcare annual expenses have continued to outpace revenue growth, spurring increased interest in cost containment strategies from hospital leaders across the country. And in 2018, The Advisory Board’s Annual Health Care CEO Survey even found that cost control had jumped to the number one priority for healthcare executives as reimbursement dollars continue to shrink. 

During the 2019 Annual Becker’s Hospital Meeting, the Olive team heard leading healthcare executives discuss how rising costs are forcing their organizations to drive greater efficiencies with the same level of resources – all while organizations manage increasing complexity and dwindling reimbursement rates.

So, where can healthcare organizations have the biggest impact on cost containment as they plan for the future?

Today, many traditional cost containment strategies have focused on cutting overhead like human capital, facility, and supply chain costs. But supply and facility costs can only be cut so far, and cutting wages and employee hours is short-sighted, as these strategies contribute to employee burnout and increasing staff turnover rates across the industry. 

If hospitals truly want to reduce waste and contain costs, they need to look to the real source of the problem: operational inefficiencies.

Operational Inefficiencies Are The Leading Cause Of Waste

One out of every three dollars spent on healthcare each year is spent on the repetitive, high-volume tasks that make up the administrative side of healthcare. Increasing regulatory requirements are only adding to the burden – an American Hospital Association study found that an average size hospital today dedicates 59 full time employees to regulatory compliance alone, over a quarter of which are clinical staff. 

Interacting with health insurance plans is also puts pressure on a hospital’s time and resources – from authorizations, formularies, claims and billing, credentialing, contracting, and data quality review, the process is time-consuming and requires many manual steps that are prone to costly errors. Today, flaws in registration and eligibility processes are cited as the primary cause of insurance claim denials – an analysis found that $262 billion of the estimated $3 trillion in claims were initially denied due to errors, translating to an average hospital risking $4.9 million of lost revenues. 

As operational inefficiencies continue to drain valuable resources, it’s easy to see that the never-ending flux of data entry comes at cost – an even bigger cost when you consider the expense of re-work.

At the heart of these process inefficiencies is the lack of interoperability between systems. Data has to be manually pulled and entered from one screen to another, over and over again, making human error inevitable. And with increasingly complex regulatory needs and requirements, an overhaul of the entire system is far-fetched. Hospitals need solutions that work with the systems and processes they already have in place – and this is where organizations have a tremendous opportunity to create financial impact with artificial intelligence. 

 

How Artificial intelligence is Tackling The Problem

Artificial intelligence and robotic process automation have gone from a futuristic buzzwords to real-world solutions providing enormous value at health systems across the country. And while the innovative technologies are being explored for multiple areas, from AI-assisted surgeries to diagnostics, they’re uniquely positioned to solve many of the administrative flaws and headaches that cause so much waste.

Experts anticipate AI for the Healthcare IT market to surpass $1.7 billion by the end of 2019, and through AI and automation, healthcare systems have already begun to reduce expenses and increase revenue recognition. In turn, they’ve been able to take an impact-driven approach to AI implementation, providing both immediate and long-term value to their organizations.

Olive deploys a digital workforce to “shift” these operational inefficiencies from healthcare employees to artificial intelligence as a cost containment strategy. A digital workforce provides operational AI to improve the cost, capacity, and efficiency of administrative business processes by alongside healthcare employees to handle the large amounts of data and repetitive tasks that are draining the industry of resources and revenue. 

Olive saves healthcare organizations time and money by automating some of the most common process bottlenecks like claim status checks, prior authorizations, eligibility verification and more. She has a proven track record of working down massive backlogs of work, allowing organizations to really “catch up” on critical processes, reducing the expense of hiring more (and more) people to handle the work. 

Olive is trained to emulate all of the manual steps associates do – only smarter, faster and more accurately –  reducing costly errors and increasing operational efficiency. Best of all? Our AI-as-a-Service model means there is one simple subscription price and an all-in-one approach to implementing AI, so hospitals can quickly see a positive ROI

To learn more about Olive and how to hire a digital workforce, schedule a demo with us today.

How Burnout is Killing The Healthcare Industry

How Burnout is Killing The Healthcare Industry


Many healthcare leaders today know that labor is the leading cost driver in the industry – the cost of healthcare staff turnover is estimated to be 38% of annual salary expense per employee. And as labor continues to be many organizations biggest expense, employee retention is a critical component to the financial success of any healthcare organization.
But with the industry’s frustrating lack of interoperability, employees have taken on the job of the data processor, shifting the hours spent by employees from being in front of patients, to being in front of computer screens, logged in to disparate EMRs, EHRs and other interfaces shepherding patient data into the right fields. The consequences have manifested in the form of burnt-out employees, skyrocketing administrative costs, and less time spent with each patient – but how big is the problem, and how can we work to solve it?

EMPLOYEE BURNOUT CONTINUES TO INCREASE
  • Employee burnout is growing: studies show that nearly three quarters of healthcare leaders report feeling burned out.¹
  • Employee loyalty is fading: 37% plan to leave their current hospital within the next two years and almost 69% plan to leave within five years.²
  • Burnout is increasing turnover: Average turnover rate in healthcare is 20% and has risen nearly 5% – across all jobs in the industry – over the last decade.³
As this trend continues to grow, it’s no question that employee burnout and staff turnover come with a hefty price tag. The yearly hard dollar cost to recruit and train employees is already high, but when you add in the soft costs, you start to really see the bigger implications – it lowers morale and productivity, which in turn impacts patient care and patient outcomes. Additionally, costly staffing gaps put more pressure on the remaining employees, causing the problem to grow and compound.

Because of these issues, the average hospital has turned over 85.2% of its workforce since 2013, and with 31% of hospitals struggling to find candidates to fill open positions5, solving this growing problem is a top priority for healthcare organizations. To combat these challenges, health systems need a multi-faceted employee retention strategy – one that includes the expected perks like great compensation, benefits, and opportunities for advancement – but most importantly, one that addresses the root of the problem: process inefficiencies that are bogging down healthcare workers across the entire continuum of care.

In healthcare today, employees are suffering a “death by a thousand clicks6” because most hospitals use 10 or more various EHRs, EMRs and other user interfaces, sending employees toggling back and forth between various screens, playing “button Olympics.” 

Aside from being stressful and burdensome to healthcare employees, these administrative inefficiencies result in a trillion dollar spend across the industry.

Working to reduce this burden has a huge impact on a hospital’s bottom line, but retaining top industry talent goes far beyond the numbers. A solid employee retention strategy needs to also consider factors like employee engagement and opportunities to do more meaningful work – this is where organizations have a tremendous opportunity to create both financial impact and increased employee satisfaction with artificial intelligence. 

Artificial intelligence can take robotic tasks off the employee’s to-do list, allowing them to focus on higher-level tasks and initiatives. For front line staff, this means more time to spend with patients, which improves the patient experience and employee satisfaction. For back-office staff, this means more time spent on strategic initiatives and problem-solving, instead of mundane manual data entry.

Innovative health systems across the country are already using artificial intelligence and robotic process automation to alleviate employee burnout and staff turnover. And at Olive, we’re deploying a digital workforce to help “shift” these burdensome workflows from stressed healthcare employees to artificial intelligence. Olive is not another platform, another software, or another process to learn – Olive is the first digital employee built specifically for healthcare to replicate the robotic functions of a human employee, so healthcare employees can focus on more human-like initiatives.

“With Olive, we were able to reallocate 20 full-time employees to meaningful work, not the hours spent in front of their screens. There were no layoffs because there was so much work to do in the billing office that we just weren’t getting to before. Now these employees handle more fulfilling, complex tasks that require a human touch, and Olive takes the robotic workflows.” -Senior Director or Revenue Cycle, Midwestern Hospital

As your organization tackles the growing burnout that’s crushing the healthcare industry today, ask yourself these questions: What could your hospital do with more time? How many employees could Olive help focus on more meaningful work? How would those changes impact employee satisfaction and staff turnover at your organization? What would the financial impact be to your bottom line?

View our recent case study to see how Olive transformed this hospital’s administrative operations, allowing their employees to focus on higher-value initiatives that boost morale, patient outcomes, and overall revenue recognition.

How Four Healthcare Complexities Are Driving Up Claim Denials

How Four Healthcare Complexities Are Driving Up Claim Denials

 

Today, 90% of insurance claim denials are avoidable1, yet they’re still occurring on a massive scale at healthcare organizations across the country – many times for simple reasons like missing patient identifier information or spelling errors. And given the ever-changing complexities around claims management and processing, it comes as no surprise that approximately 9% of insurance claims submitted are denied, costing health systems as much as 3.3% of net patient revenue.²  And that’s not considering the expense of rework –  this added effort also drives up hospitals’ total cost to collect.

Although a large portion of these denials are preventable, only about two-thirds are recoverable – that means gaining real traction in reducing claim denials rests heavily on denial prevention. According to research from the American Medical Association, the industry could save $15.5 billion each year if companies processed claims correctly the first time.³ Despite that, prevention has proven extremely difficult, resulting in increasing denial write-offs from 2011 to 2017.4

If we know claim denials are draining the industry of resources, why haven’t we solved the problem?

Today, the claims management process is far too complicated for any one solution to solve alone – continual changes in payer policies create an added level of complexity, claims management processes are too decentralized, human error and process inefficiencies are plaguing the industry… so on and so on.  

Because of this complexity – and despite being largely preventable – denials are a growing problem that still costs hospitals $262 billion annually5 – making it one of the most talked about challenges facing healthcare today. Hospitals and other health systems simply don’t have the people, the process or the time to solve for the complexity afflicting our claims management processes – from workflow inefficiencies and lacking resources, to overly complicated claims management policies among payers.

1. Resources Are Stretched Thin And Processes Are Wrought With Error

Although accuracy and thoroughness are critical when managing claims processes, the resources required to manage them are often stretched too thin to handle the large volume of work. That’s because healthcare employees are often overworked with multiple competing priorities, and many hospitals lack sufficient resources — such as staff, time or budget — needed to touch each and every patient account. 

That’s partially because today, providers can choose from an almost never-ending list of technologies and tools to help manage their business operations, yet 31% are still using manual claims denial management processes.6 Let’s look at eligibility and authorization processes, for example: 

Manual data entry contributes to the staggering fact that 23.9% of claims are denied due to eligibility and registration issues7 and another 12.4% are caused by incomplete or missing authorizations.8Aside from being time-consuming and burdensome to healthcare employees, providers and clinicians, manual claims processes are incredibly susceptible to human error – errors that cost healthcare organizations time and money. 

However, understanding the problem and being able to solve it are two different things.  Unfortunately, most organizations don’t have additional labor to dedicate to more frequent checking – whether that be the status of the authorization, the status of the claim or the most up to date eligibility information.  To help quantify the problem, it takes a staff member around 10 minutes on average to manually check one patient’s eligibility9 and 14 minutes to check a claim status10 – at that rate, even entire teams of healthcare employees dedicated to these tasks don’t have the capacity to keep up with the influx of work, leaving money on the table for services rendered by healthcare organizations across the country. 

Because of these time and capacity constraints, many organizations focus their time and resources primarily on the high-dollar accounts. That means low-dollar accounts are often outsourced to a third-party vendor – reducing a hospital’s visibility to the causes behind their denials – or they slip through the cracks altogether. 

Unfortunately, all these missed payments from low-dollar accounts add up – and accounts that are worked are often plagued with errors due to the unmanageable, complicated claim process. Healthcare employees just aren’t humanly capable of handling the high volume of manual data entry necessary to submit clean claims 100% of the time. The result? Burned-out employees and downstream denials costing healthcare organizations millions of dollars in lost revenue that could have been avoided.

2. Denials Management And Financial Clearance Processes Are Too Decentralized

Organizations can get ahead of many denials with a proactive approach to claims management and a dedicated team focused on denials prevention. Unfortunately, the process today is often too decentralized for many hospitals to manage efficiently and thoroughly. One best practice healthcare organizations are using is to centralize these processes, helping to build an infrastructure of dedicated teams and accountability among those handling their claims.

Building a centralized denials team helps create accountability and allows organizations to focus not only on claims management, but claims prevention. This is important because finding and preventing the root cause of denials has a much larger financial impact on their bottom line than working to overturn denials. Unfortunately, staff  today don’t always have the bandwidth. 

When it comes to financial clearance, for instance, one of the biggest issues is that the process is often handled by employees wearing multiple hats with many competing priorities. For example, the employees handling insurance eligibility are not only checking for eligibility, but also gathering patient demographic information, providing pre-service instructions, answering questions, handling financial counseling, answering phone calls, and more on any given day. The result? There’s often not enough time to handle the volume and collect the necessary information for reimbursement. That leads to an increased amount of patient balances to be collected at a later point in the revenue cycle – and we know that’s not always an easy task. Today, 85% of healthcare organizations say that collecting payment from patients after they’ve already left is incredibly difficult.10

Lack of transparency and sharing of data between the various teams handling denials is another result of this decentralization. Today, many hospitals still have separate reporting by entity and don’t always share critical data. Despite that, most healthcare executives agree that a proactive denial prevention process should be grounded in analytics, using data to determine and solve the reason for recurring denials. Transparent reporting and sharing of data helps organizations uncover these insights and trends to prioritize the denials work. Increasing transparency internally and externally helps hospitals share important data to find the root cause behind their denials, allowing them to see the bigger picture.

3. EDI Transactions Are Complex And Imperfect

EDI transactions are used by many healthcare organizations to handle large volumes of information and expedite reimbursement. For instance, electronic eligibility checking is the most widely adopted electronic transaction today. So, why are 23.9% of claims still denied due to eligibility and registration issues?7 That’s partly because of a broken billing process across the revenue cycle and disadvantages that come with the current electronic data interchange options.

Let’s look at the current options around eligibility and authorization for this example, 270/271 and 276/277. Prior to a patient’s visit, the 270/271 inquires and identifies the health care benefits and eligibility associated with a patient, but often times the responses have a lack of complete information, causing an additional touch for staff to fix the missing information from the front end. There are limitations with EDI transactions after a patient has received care, too. The 276/277 options are also limited by the information they return – organizations may know a claim was rejected because of missing information, but won’t necessarily know what information is missing. We can tell the industry is still struggling with this issue, because many inquiries about status are still done outside of the EDI transactions. And manual checking of each claim requires exponentially more staff than most organizations can hire, not to mention added room for human error and the added cost to collect.

Reprocessing claims drives up labor costs as billing staff are forced to devote more time to unpaid claims. We see the capacity constraints show up in the numbers, too – only around ½ of denials are appealed11 and it’s estimated that up to 90% of those should have been paid.1 Another 4% don’t get paid just because they’re too late.12

These denied claims trigger effects that spill over to disrupt other aspects of the hospital’s finances, too. For example, after a payer denies a claim, administrators are forced to chase the denial, which often requires multiple calls to the ordering physician and working closely with the payer. We all know this is time-consuming and may not always lead to reimbursement. The claim then sits in accounts receivable until it is adjudicated, which can take weeks – even months. Not knowing where claims stand in the adjudication, and for what reason, has a negative impact on days in A/R and contributes to writing off accounts as uncollectible. To have a significant reduction in these uncollectible claims and improve an organization’s overall cash position, organizations need to know more information, sooner.

4. Payer Complexity Continues To Increase

Payer complexity is nothing new – it’s a moving target that organizations need to have a proactive process in place to stay on top of their denials. Unfortunately, there’s not always someone assigned to the task of reviewing and keeping up with payer policies. And as commercial and public payers are now denying about 1 in every 10 claims submitted today,13 it’s clear why denials are on the rise. The Doctor Patient Rights Project even found that insurance companies are increasingly leaning on utilization management techniques like prior authorization to avoid payment,14 and even after patients receive authorization, their insurers may still refuse to cover treatment costs right away. All of these additional touches to patient accounts are increasing the overall cost to collect for hospitals across the country.

Submitting clean claims – or claims that were accurately processed and reimbursed the first time it was submitted to the payer – significantly reduces denial rates, but is increasingly challenging due to complex and changing payer reimbursement policies and procedures. 

That’s partly because authorizations vary by payer, so hospitals are constantly battling denials as payers require authorization for more types of procedures, or adjust policies without any notification to providers. That’s not including the large volume of claims that end up not requiring authorization at all – today, 30% of services don’t require prior authorization, yet organizations still waste time by checking their necessity.15

Of the services that do require prior authorization, many include high-cost services or procedures, or services that may be considered unnecessary all together, making the authorization window a critical time period for preventing rejections and denials. But with increasing regulatory requirements and the added complexity of value-based care coming into play, claims management has only become more complicated for healthcare providers to manage. And as these value-based care models begin to replace traditional fee-for-service structures, healthcare organizations are anticipating added strain on their already-declining claim reimbursement rates.

Tackling the Problem: Hospitals are optimizing the process with AI and Automation 

Human error, payer complexity, broken processes and strained resources – all of these tangled challenges contribute to the fact that hospitals across the country are losing the war against denials. And as reimbursement dollars shrink and complexity continues to increase, more and more healthcare organizations are considering a different approach to tackling the claims denial challenge. 

 

Meet Olive, the only AI-powered digital employee designed specifically for healthcare.

Olive was designed to interact with EMRs, insurance portals, and other healthcare applications the same way a human would – only faster, smarter, and more securely. 

The best part? Olive automates common claims management processes 24/7, never fatigues, and is less error-prone than a human. 

For instance, at one midwestern hospital, Olive was trained to access the EMR/EHR work queues and automate claim status checks, emulating all of the manual steps associates had once done – only smarter, faster and more accurately – checking the status of their claims 7x faster than their human employees. That means one Olive does the work of about 9 full-time employees per week – if they could work non-stop for 40 hours like Olive.

In addition to giving you significantly more capacity, leveraging Olive in your claims management processes helps centralize your efforts and uncover valuable data and insights into your denials problem. That’s because Olive provides better and faster information that will reduce your denials – and the reason for denials – by identifying trends and issues with claims that need to be solved before submission. 

Olive was built to handle payer transactions with speed and ease. For instance, if Olive doesn’t find eligibility information on her first check, she deploys a search for benefits among other health plans commonly serviced by the health system to uncover the necessary information to prevent a denial. 

And by checking eligibility, authorization and claim status early, frequently, and more thoroughly than your human employees have the bandwidth to, Olive accelerates cash flow and increases successful appeal efforts, impacting organization’s revenue recognition and resolving recurring denials.

The growing administrative burden in healthcare is costing the industry over $1 trillion annually – download this free eBook to learn the 6 approaches healthcare organizations are taking to tackle the problem.

Sources:

      1. https://www.advisory.com/research/revenue-cycle-advancement-center/at-the-margins/2014/12/denials-management
      2. https://www.beckershospitalreview.com/finance/denial-rework-costs-providers-roughly-118-per-claim-4-takeaways.html
      3. https://www.reuters.com/article/doctors-insurers/corrected-us-doctors-say-1-in-5-insurance-claims-mishandled-idUSN1422071220100615
      4. https://www.prnewswire.com/news-releases/hospital-revenue-cycles-showing-strength-but-risks-include-denials-300555731.html
      5. https://www.modernhealthcare.com/article/20170627/NEWS/170629905/insurance-claim-denials-cost-hospitals-262-billion-annually
      6. https://revcycleintelligence.com/news/31-of-providers-still-use-manual-claims-denial-management
      7. Change Healthcare Healthy Hospital revenue cycle index
      8. www.caqh.org/sites/default/files/explorations/index/report/2018-index-report.pdf
      9. 2018 Council for Affordable Quality Healthcare Index 
      10. https://revcycleintelligence.com/news/5-most-common-hospital-revenue-cycle-management-challenges
      11. www.himss.org/news/how-improve-your-clean-claims-rates?ItemNumber=6527
      12. www.healthfusion.com/blog/2014/practice-management/denialmanagement-can-afford-throw-away-25-denial/
      13. https://www.advisory.com/research/revenue-cycle-advancement-center/at-the-margins/2017/12/revenue-cycle-benchmarks
      14. http://doctorpatientrightsproject.org/wp-content/uploads/2017/10/Access-Denied_How-Utilization-Management-Protocols-Can-Block-Access-to-Life-Saving-Treatments.pdf
      15. https://www.businesswire.com/news/home/20170626005391/en/Change-Healthcare-Analysis-Estimated-262-Billion-Healthcare

Heathcare is Ripe for Disruption

Heathcare is Ripe for Disruption

In the past decades, technology has changed how consumers – and companies – think about almost every aspect of our lives. From AirBnB to Uber, Amazon to WiFi thermostats, consumer behaviors and expectations have changed drastically, and companies have been born or evolved to meet them.

However, due to conflating factors like ever-changing compliance and regulatory requirements, complex infrastructures, and the lack of interoperability to name a few, healthcare has digitally lagged behind. But perhaps nowhere else is disruption needed more than the healthcare industry.

We’re all well aware of the problems we’re facing in healthcare today: it’s too expensive, complicated, and time-consuming for patients and providers alike. It’s why consumers, employees, the government, and employers are all looking for solutions to solve the industry’s most costly and burdensome challenges.


As industry disruption becomes top of mind for healthcare leaders, the question now is where will they have the biggest impact?

To answer that question, we must first look at one of the most pressing challenges today: trying to reduce costs while improving the patient experience.

Process inefficiencies are one of the leading reasons healthcare has become unaffordable for many Americans, even with insurance – consumers, payers, and the government are all putting pressure on health systems to cut costs. And it’s why healthcare systems across the country are leveraging technology and complex software purchases to increase efficiency and revenue recognition.

Additionally, there are the added pressures of value-based care and community health initiatives pushing healthcare organizations to figure out how to provide better care and improve outcomes in their communities. Big data and analytics have promised to help in these areas, but with cost constraints increasing, physicians and nurses are being squeezed to do more and see more patients during their work hours, meaning less time with each individual. So, how are doctors, PAs, and nurses supposed to improve patient outcomes and experience if they don’t have adequate time to spend with them? And which disruptive technologies are positioned to create the biggest economic impact on healthcare organizations bottom lines?

The Tech Giants: Google, Amazon, Apple Are Looking to Make In-Roads

At Becker’s 10th Annual Hospital Review in April, we heard how Google, Amazon, and Apple all hope to be the next big innovator in healthcare. each has a different approach for how they could revolutionize the industry and what challenges they want to tackle. But are these disruptors uniquely positioned to transform industry inefficiencies, or will they only make a marginal impact on improving care?

Let’s take a look at each:

In Google’s case, it and its parent company, Alphabet, have invested in various health companies as well as its own platform developments, across the spectrum of care. But at its core, what it really wants is data. Storing data is the first step, and Google believes that whoever has all of the data will be able to have the biggest impact. That will be their play.  

Amazon is leveraging its unique capabilities in a different way: size and supply chain. Taking over the hospital and pharmacy supply chain is an obvious potential disruptor, but Amazon also recently formed an independent healthcare company with Berkshire Hathaway Inc and JPMorgan Chase & Co for their combined 1.2 million employees. They’re currently developing their own primary care clinics, which while originally for their own employees, could signal a move into the larger primary care market.  With supplies being a large part of the healthcare spend, it is an interesting way to think about care delivery and controlling cost.

Apple has yet another approach, based on its unique consumer presence. Their Health app comes preinstalled on iPhones, which means 140 million Americans already have access to the app. By creating, and imbedding this app, into their ubiquitous solution, Apple has the opportunity to more seamlessly connect consumers with their medical information – potentially increasing interoperability and placing the patient in the center of their care.

These industry giants could fundamentally change the manner in which care is delivered.  However, they fail to address the back-office challenges that sources estimate could result in $1 trillion dollars wasted  on process inefficiencies.

So, what will?


RPA & Artificial Intelligence: The Disruptive Technologies That Will Change The Game

One of the most impactful technologies for the administrative side of operations is artificial Intelligence and robotic process automation, which are estimated to save healthcare $18B by 2026.¹ The technologies are widely used in other industries, as well – robotic accounting, for instance, is an increasingly popular solution used in finance and accounting operations to streamline operational efficiency, reducing data transcribing tasks by 80% in accounts payable, financial close, tax accounting and more.²

We are starting to see more and more people in healthcare familiar with the concept of RPA. And with the addition of other technologies like Computer Vision and Machine Learning, the potential impact to organizational efficiency is huge. This is game-changing in healthcare, because although other industries are faced with process inefficiencies, it is hard to argue that few are as crippled with the  deluge of difficult-to-use yet business critical software programs like healthcare.

With healthcare’s frustrating lack of interoperability, employees have taken on the job of the router – or data processor – shifting the hours spent by humans from being in front of patients to being in front of computer screens, logged in to disparate EMRs and EHRs, shepherding patient data into the right fields – and the consequences come in the form of burnt-out employees, skyrocketing administrative costs, and less human-to-human experiences decreasing the quality of care.

Operational AI provides improve the speed, cost, capacity, quality, and consistency of care today. It works alongside human employees to handle the large amounts of data and repetitive tasks that are bogging down the healthcare system, reducing errors, speeding up processing time, and increasing operational efficiency. This not only reduces costs, but also allows employees to get back to higher-level, more meaningful work. Work that drove many to choose a career in healthcare in the first place.

And that’s really what it comes down to: bringing humanity back to healthcare. An industry where workers spend more time in front of screens than they do in front of patients.

Here at Olive, we believe that a digital workforce is the disrupter that healthcare has been waiting for. Olive uses her healthcare-specific skills to address common bottlenecks when it comes to time-consuming, error-prone workflows that result in process inefficiencies and costly denials. And she does it with unrivaled security measures built specifically for healthcare, working seamlessly with your existing processes, technology, and current systems you already have in place. The best part? Olive works 24/7, doesn’t get fatigued, never resigns and is less error-prone than a human, so healthcare organizations can refocus their employees to more meaningful work.

Today, Olive is focusing on improving business operations inside and outside of the healthcare revenue cycle, but her capabilities go far beyond that. Using Machine Learning, Olive uses algorithms to find patterns in data without instruction, giving her the ability to learn and improve from each task, uncovering insights and new opportunities to optimize workflows and hospital processes. Through continued adoption, AI will continue to innovate and improve how healthcare does business across the entire continuum of care.

If you want to learn more about how Olive can help your organization, contact us today. Our automation experts can help you understand how Olive is addressing healthcare’s biggest challenges and can help drive your healthcare system forward.