How Healthcare Workflows Can Use Intelligent Automation for Better Care

For payers to help drive down healthcare costs and drive up member outcomes, they must harness the power of a unified data platform that quickly turns information into action. Intelligent automation is vital to reducing friction and improving operational efficiency across payer organizations in key areas, such as interactions with members and providers, care coordination and management, closing gaps in care, and prior authorization.

Intelligent Automation Enables Predictive Insights  

“Intelligent automation is the true union of data science, advanced analytics, and execution,” explains Vital Data Technology President & CEO Matt D’Ambrosia. “This includes supporting predictive and prescriptive modeling, natural language processing, OCR, and impactful interventions – directed to the appropriate people – all under one roof." 

The payer industry is increasingly showing interest in automation to improve workflows and their “speed to act,” as D’Ambrosia puts it. However, for intelligent automation to succeed, the data must be vital, accurate, fast, and abundant. In other words, payers need to get all of the data, process it, and put it immediately into action.

“The thinking around intelligent automation has generally been from a very siloed or one-dimensional perspective – ‘I need X, so I’m going to do Y’,” he continues. “Payers are not taking into consideration that the data is 60-90 days old at best, and by then it’s not very actionable. On top of that, it shouldn’t require a heavy technical lift to make the data functional and operational so it can be coordinated across all stakeholders.”

What’s more, should the age of data vary across stakeholders, it can disrupt important decisions at the point of care, among other places. Wide variations create “a big window to act and affect the trajectory of what’s happening,” D’Ambrosia adds.

A Dynamic, Real-Time Technology Architecture

The benefits of intelligent automation speak for themselves. A large health plan responsible for nearly two million lives implemented an intelligent automation solution and, within one year, saw significant improvements to their care management performance:

• 60% reduction in time to open a case
• 87% increase in care management referrals
• 30% increase in new cases
• 9% increase in active cases managed

“Whenever you are actively able to open and manage more cases, that has an outsized impact from a dollar perspective as a result of operational efficiency,” says D’Ambrosia. “But more importantly, the speed to act on information has a direct impact on health outcomes for members because now, care teams are reaching out to the right people with the right intervention. And there’s a lower cost per case because payers don’t have to increase their staff to accommodate.”

D’Ambrosia points to Vital Data Technology's ability to successfully identify pregnancies at risk for preterm birth by utilizing data science models that predict cases at 20 weeks, versus the industry benchmark of 28 weeks. The result is that payers can intervene sooner and avoid medical complications and associated costs. A win-win for payers and members. And that success is rooted in the immediacy of actionable information since it’s not just the real time data, it’s also the real time processing and computing of predictive models.

“For payers to act in a timely manner, they need to have the technology infrastructure to enable that kind of dynamic, real-time environment,” D’Ambrosia maintains. “If health plans are still using data warehouses for analytics, then they’re acting on old data that becomes nearly useless, making their interventions less impactful. And whether they’re just looking at adjudicated claims versus pre-adjudicated claims, that could delay action further. The importance of a dynamic real-time technology architecture to enable that to happen is a huge deal.”

While the pandemic has placed tremendous strain on the healthcare system, it has also proven to be a catalyst for accelerating the adoption of new technology. Today, health plans can put in place solutions capable of meeting their current needs, while also laying the groundwork for what lies ahead.

“We can meet health plans where they are today, help them connect the dots, help them work with pre-adjudicated information, and to use predictive data science to automate important functions,” D’Ambrosia adds. “It also moves them closer to where they need to go and what they need to be doing in the future. Now that they’ve got that core technical backbone or architecture, we can talk about extensibility — the ability to integrate with third-party technology or improve access to intelligence by specialists.”

Ultimately, intelligent automation improves operational efficiency and helps payers maintain the maximum value of their interactions with all stakeholders, therefore reducing member and provider abrasion. The velocity of actionable information makes all the difference in allowing teams to work faster so members can receive appropriate care quickly. There’s no question that if health plans operate on a singular, real-time system that allows for true extensibility, they can put highly useful data in the right hands at the right time, with only increasing opportunities for improvement.