While it’s true that the healthcare industry is witnessing a record-breaking year in digital health investments, the AHA simultaneously projects healthcare’s financial losses at more than $300 billion in 2020. Due to the pandemic, healthcare institutions are increasingly turning to digital and artificial intelligence (AI) solutions that streamline behind-the-scenes functions and alleviate administrative and operational spending.
Many hospitals are seeing immediate results from such investments in departments and functions that involve error-prone, repetitive, time-intensive tasks. And one function fraught with such tasks is claims processing and reimbursement. It involves a myriad of stakeholders and steps, such as validation, justification, authenticity, and payment. Each step of the process is just as crucial as the last, making efficient and accurate communication critical for success.
It is no surprise that the reimbursement and claims processing work stream primarily consists of high-volume and repetitive tasks, such as collecting and inputting patient and provider data. When a mistake in the process is made, such as incorrect billing or erroneous patient documentation, the process is further delayed. Payers, providers, and patients alike are faced with extra back-and-forth communication to reconfirm details for the medical claim.
This issue transcends the billing cycle and can directly impact payers, as well. Continually delayed claims can make hospitals leery of accepting certain plans or even entire carriers. A lower number of accepted plans results in benefit brokers only being able to offer a small range of options to their clients. Ultimately, this leads to employers providing health plans for their employees only having a limited number of options to choose from.
As more and more hospitals understand the magnitude of these issues, they are implementing AI solutions to help streamline the claims processing and reimbursement process. AI automates these critical but repetitive tasks to reduce mistakes, enhance workflows, and let hospital staff focus on tasks that require a human touch.
AI is also being used to minimize the hefty costs associated with insurance claim denials. With AI, providers are able to identify and mitigate erroneous claims before the insurance company denies payment for them. Not only does this streamline the process, but it also saves hospital staff the time it would take to work through the denial and resubmit the claim. With faster payments and greater accuracy, hospitals are more willing to accept a wider number of plans, which means benefits brokers can offer a broader range of options to their clients.
Hospitals are continuing to reimagine the claims process, with AI in mind. In fact, recent research indicates that 61% of hospital leaders are looking to implement AI/RPA within the next two years. Hospitals will continue leveraging AI solutions to streamline backend functions to reduce operational costs, alleviate administrative spending, and allow employees to focus on more important tasks.
Just what the doctor ordered
Also, when searching for the best surgeon, consumers may get a major assist from AI, a new study says. The report in the Journal of Medical Internet Research (JMIR) compared healthcare decision-making based on a range of choices: consumer ratings; quality stars; reputation rankings; volumes and outcomes; and precision machine learning-based rankings.
That last category looked at a type of AI that uses data to determine whether a hospital is a good fit for a potential patient. The study found that the machine-learning approach to picking a surgeon delivered better outcomes than choosing surgeons by other methods. The AI approach allows a more personalized choice—the algorithm matches the patient to the hospital that has the best outcomes for patients with similar profiles.
Benefits in administration
AI offers employers and brokers an opportunity to maximize the impact and efficiency of their offerings and human resource programs. In 2021, and in the wake of COVID-19, the role of AI will grow as companies continue to transition to long-term remote work, tackle COVID-19-related expenses, educate employees on their health benefits, and introduce benefits platforms to address individual needs better.
In 2021, we’ll likely see AI play a more significant role in helping employees avoid burnout through tools that encourage real-time engagement, provide individualized recommendations on how people can do their best work, and robot coaches. For HR teams, AI-powered solutions will quickly flag employee roadblocks and prioritize those most at risk. Greater use of remote teams also means more integration of HR and day-to-day collaboration tools.
HR data analytics’ power is in how it can proactively assist in more accurately predicting annual benefits costs—a tool that will become crucially important for families, employers, and health plan providers as they plan for this year. This emerging, critical decision-making data will play a key role for brokers, employers, and health plan providers as they navigate both expected and unexpected changes. With COVID-19-related fraud also on the rise, health plan providers and employers who use HR data analytic tools to spot and flag outliers could save themselves hundreds of thousands of dollars.
In 2021, health plan providers and employers expect employees to prioritize flexibility and personalization in their healthcare coverage to meet their unique needs and challenges. With budgets top of mind in 2021, employers and employees will continue to use these financial tools to save money and lower medical plan premiums. Brokers, health plan providers, and employers will continue to leverage AI to educate employees on their medical costs and personalize their benefits based on their current and projected future needs.
Insight-driven benefits administration relies on automated platforms to collect, aggregate, streamline, and analyze data from multiple systems to produce actionable steps to drive value. These platforms will only become more essential as companies continue to adapt to the changes seen in 2020.
As priorities continue to shift in 2021, the demand for employee data to evaluate workplace wellness programs, retention, and benefits will grow. But seamless interaction with personalized benefits program offerings will likely provide the most significant avenue for growth of modern benefits platforms. Modern benefits platforms will become an even more essential tool to health plan providers and brokers in the coming year as they allow them to reach the end consumer more effectively.
AI will continue to drive evolution in the benefits space. While many things changed in 2020, data is still the most dependable way to understand what is happening now and predict the future. As everyone adjusts to the changes on the horizon, we will continue to rely on the data and insights AI provides to support the healthy growth of the benefits ecosystem.
At a glance:
* Healthcare industry’s financial losses projected at more than $300 billion in 2020
* 61% of hospital leaders are looking to implement AI/RPA within the next two years
* AI automates repetitive tasks to reduce mistakes, enhance workflows
* AI is being used to minimize the hefty costs associated with insurance claim denials
* AI uses data to determine whether a hospital is a good fit for a potential patient
* HR data analytic tools can be used to save hundreds of thousands of dollars
* Benefits administration relies on automated platforms to collect and analyze data