Tag: Firstsource

Automation Wins the Revenue Cycle Challenge

Venkatgiri Vandali

By Venkatgiri Vandali, president of healthcare and lifesciences, Firstsource.

Solving the challenge of containing costs while improving revenue cycle operations despite labor shortages has a direct impact on a health system’s financial health and ability to serve patients. The good news is that automation solutions exist to streamline revenue operations, enabling revenue professionals to work at the top of their skill sets and giving patients better financial experiences.

Here’s a quick look at where and why automation can strengthen cash flow and revenue streams while patients and revenue professionals experience greater satisfaction.

Why should providers be concerned about the financial experience they deliver to patients?

Patients are now responsible for more of their health costs than ever. That means providers collect a higher percentage of revenue from patients.  Other service providers—think credit cards, mortgage lenders, online retailers—have trained consumers (aka patients) to expect easy, seamless, digital payment processes. Healthcare payment processes are not easy or streamlined. That makes it difficult for providers to collect from patients, slowing revenues. Patients increasingly will choose healthcare organizations that make it easy for them to understand and pay their bills.

How can healthcare providers improve financial experiences with continuing staffing and cost containment pressure?

Many hospital revenue professionals spend most of their time on tasks that don’t require much skill, such as looking up data in a payer portal or calling payers to check on prior authorizations. Automation can take over those tasks, freeing time for revenue professionals to work directly with patients, offering financial counseling, helping them understand their insurance coverage and calculating their financial responsibility. Automation can also assist professionals in high value activities, such as by checking claims for accuracy before submission and flagging potential errors for review.

What’s the difference between robotic process automation and AI and machine learning?

Robotic process automation (RPA) is proven, cost-effective technology that automates time-sucking repetitive tasks.  Using software bots, RPA mimics the keystrokes of human operators—including those needed to switch between applications and systems–and makes simple if/then rule-based decisions. A software bot can usually be trained and deployed in a matter of weeks.

AI and machine learning based automation is more sophisticated and often built on top of the processes and data accuracy improved by RPA. AI/ML solutions manage complex tasks that involve following business rules and making decisions based on the models’ data analysis.  Such solutions often are more expensive and take longer to implement than RPA. They are best suited for providers that already have standardized processes and cleaner data from existing automation.

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New Wave of Health Insurers Driving Change for Members and Incumbent Plans

Venkatgiri Vandali

By Venkatgiri Vandali, president of healthcare, Firstsource.

A new generation of health insurers has appeared in recent years, gradually gaining momentum in key markets in part by claiming to offer a more modern, digital consumer experience.

The advent of these modern, tech-driven upstarts bodes well for members of plans new and old alike, who are looking for health insurers to finally begin to offer the levels of customer experience, personalization and convenience they have long experienced in other markets like finance and consumer goods.

Consumers clearly want and expect their health insurance provider to offer the same quality of experience they enjoy in other areas of their lives, and plans that can meet that expectation will enjoy a significant competitive advantage.

Companies like Oscar and Clover arguably pose a serious threat to the status quo.  Oscar Health, widely seen as a leader in this new wave of companies, recently topped one million members and has reported north of $6 Billion in revenues for 2021. Clover Health, another new wave exemplar, targeting the lucrative Medicare Advantage (MA) segment, reported a 25% increase in its MA enrollment for this year.

They are growing fast, expanding their coverage areas (Oscar has recently expanded to cover 22 states), and successfully creating the impression that they leverage modern technologies, process automation and business cultures in ways that traditional health insurers have not.

However, the reality is that their customer experience innovations have not been particularly sophisticated, and many of the advantages they claim today – such as adopting mobile first strategies for member engagement — can be replicated by incumbent plans.

In fact, large health plans have been moving quickly to adopt new, digital customer experience technologies and business process automation (BPA), and the small- to mid-sized plans are poised to follow suit. Cultural change will likely be the toughest area for traditional health plans to transform, but technology may have a role to play there as well.

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The Outsized Impact of Digital Engagement On Patient Experience

Noel Felipe

By Noel Felipe, revenue cycle practice leader, Firstsource.

The pandemic has created a sense of urgency around improving patient engagement. Consumers accustomed to Amazon-like retail experiences are now embracing digital across personal transactions, including healthcare. Telehealth and remote monitoring have gained rapid traction, especially for non-emergent conditions and follow-up. At the same time, outpatient visits are rapidly outpacing inpatient. Together, these two trends are resulting in patients spending very little time at hospitals receiving care and paying bills.

With more care delivered through outpatient and virtual settings, healthcare leaders are asking: how do we effectively engage patients to optimize the patient financial experience and enhance recovery?

The answer lies in understanding shifting consumer expectations and designing a patient engagement solution that best fits their evolving needs.

What do modern consumers expect?

As robo calls continue to rise, Americans are using their smartphones to screen calls, making it harder for providers to connect with patients after service. Studies show that the chance of collecting goes down by 58% once patients leave the facility, as they are less motivated to pay once the services have been rendered. This means providers must begin the patient engagement process early in the revenue cycle at the pre-service stage and maintain high levels of engagement during and after service to improve their net revenue.

The good news is consumers increasingly prefer digital channels of communication that offer the flexibility to engage with providers outside traditional business hours and in the privacy of their homes. They also want to get things done quickly and easily. Whether they are shopping for a provider or checking their health insurance coverage, they want to get the information they need, when they need it – and they are willing to use self-service to achieve this.

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