Intelligent Optimization Platform Vision, June 2021
The delivery of healthcare and healthcare services are undergoing major transformation. Digital technologies are gaining momentum in improving patient experience and convenience while offering physician assistance, cutting down costs and creating the platform to remain competitive.
The future of work in the industry reflects massive shifts in how people work and how business gets done. There has never been a greater driver for reimaging the future of work. Intelligent Optimization brings a fusion of digital and physical, implementing impactful digital solutions as foundational to continuous market differentiation. It has the potential to improve efficiency, to improve speed-to-value on new services, and to shift work to be more value-added. Intelligent Optimization is the practice of making better use of the available resources to optimize the business processes for efficiency with additional capabilities such as artificial intelligence (AI), process and data mining, business intelligence, robotic process automation, cloud, mobile etc. to help organizations dynamically optimize more types of start-to-finish experiences. At the core, Intelligent Optimization enables healthcare organizations to optimize clinical processes and adapt the changing models from future-of-work constructs.
- The key technology enablers for IO include Automation, Augmented intelligence, smart workflows that connect healthcare systems, clinical experts, and Machine intelligent digital agents seamlessly, enabling work to be delivered anytime, anywhere virtually.
- Particularly note-worthy are technologies like Robotic Process Automation that can drive Automated data entry of notes, orders, referrals etc. across disparate systems, Automated work in preauthorization, charge capture and payment information processing, and reporting and audits.
- Given the complexity and rise of data in healthcare, we are increasingly seeing the value in the application of AI. AI has the potential to transform many aspects of patient care and help clinicians, researchers, and administrators be more effective and efficient at their work.
- AI can help assess patient risk, diagnose, provide treatment recommendations, personalized care and predict treatment results.
- AI has huge potential in analysis of medical imaging leading to earlier and more accurate diagnosis, and ultimately better treatment and outcomes for patients.
- The digitization of critical information such as patient files, reports, images. and the automation of administrative tasks also reduces the risk of human error, a factor that can negatively impact healthcare costs and thus of heightened importance for IO.
The intelligent optimization market is evolving in more ways than one, with many organizations taking the step of implementing intelligent optimization, optimizing the process ahead of the automation implementation as essential to unlock maximum potential for an enterprise. Market surveys report that approximately $4.6B in costs are related to physician turnover and reduced clinical hours. In response, 34% of healthcare organizations are finding digital technologies to streamline and automate their processes. Northwell built a virtual assistant to answer questions in real time… New York Presbyterian Hospital are using RPA and ML to improve clinical coding, invoice processing and saving front line staff’s effort significantly. Health Fidelity is using RPA and NLP for medical record extraction and risk adjustments for millions of clinical documents.
Digital offers significant value opportunities in the healthcare industry. In addition to improving organizations’ cost bases, intelligent optimization also has the potential to improve data quality and standardize towards highly repeatable workflows that better ensure quality of care. It can also enable organizations to have more real-time situational awareness from “telemetric monitoring”. Furthermore, such a foundation is essential to enable more advanced capabilities such as augmented intelligence and predictive analytics.
A successful Intelligent optimization offers the opportunity to transform many critical functions in the health care industry. It acts as a wiring mechanism to improve health consumer experience, enhance the achievement of caregivers working in the healthcare sector, and help healthcare providers not only reduce costs, improve revenue flow, streamline operations, increase agility and reduce compliance risks, while improving the quality of patient care.
This new technology has the potential to optimize the operation of current business processes, improve the interoperability between disparate systems to close gaps in care and boost revenue cycle management. It could eliminate the drain on the budget and human resources, infusing speed, intelligence, efficiency and quality into healthcare processes. Most importantly, it extends the opportunity to augment our current human workforce into intelligent human/digital workforce. By optimizing time-consuming and repetitive processes, our caregivers and employees will have more time to provide value-based care for their patients and focus on more innovative and higher-value work, understand more on the consumer needs and expectations, which in turn leads to market innovations that help provide high quality, cost effective cancer care. In addition, the optimization normally is implemented in a short life cycle and gets a quick return on investment, which helps the organization gain significant cost savings. All these benefits would add up to the success of the digital transformation of the health care organization.
The key tenets of Intelligent Optimization and its value impact are:
- Autonomous process and data discovery
- Automated discovery of claims process and analysis of bottlenecks
- Predictive analytics in claim rejections
- Quality and Safety forensics
- Biospecimen tracking
- Pathology Results routing
- Administrative operations optimization
- Rework elimination such as refaxing failed faxes
- Handling work spikes in patient creation, visit scheduling and employee Testing for complying with COVID regulations
- Systems interoperability
- Revenue and billing cycle optimization
- Onboarding new patients and managing patient profile and insurance data
- Claim adjudication
- Release of patient medical records for HPA claim rejections
- Charge capture and billing process streamlining
- Patient engagement
- Texting appointment reminders for Radiology and Ambulatory visits
- Virtual assistant for Telemedicine visits
- Clinician experience
- Radiation oncology treatment planning and Radiotherapy workflow
- Radiology Image connectivity with external partners
- Employee experience
- Chat Bot to answer HR Benefits enquiries
- Unified, automated employee services with Alexa support
- Research support
- Clinical trial visit processes (Physical initially, then Clinical trials at home)
- Focus group studies for Patient Reported Outcomes (PRO)
Lalitha Kompella 