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Achieving your revenue cycle goals | The future of healthcare intelligent automation

Achieving your revenue cycle goals

A practical and profitable approach to achieving bottom line goals, enhancing the customer experience, automating patient interactions, and improving access to care.

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Melissa L. Edwards

Managing Director

KPMG in the U.S.

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Revenue cycle leaders and CFOs continue to face the familiar challenge of augmenting their revenue cycle management (RCM) workforce in a way that reduces cost and increases productivity while maintaining quality. In many cases, they have turned to outsourcing or offshoring certain revenue cycle functions as a “turn-key” solution with promises of achieving all of the above benefits. However, most organizations tend to share the sentiment that the reduction in fixed labor costs, balanced with both the effort to manage the vendors as well as the outcomes of the work, rarely leads to the fulfillment of those promises and expected return on investment (ROI).

Recognizing ever present margin pressures that providers are facing, KPMG LLP (KPMG) and Blue Prism are collaboratively leading a discussion around a practical and profitable approach to achieving bottom line goals. Specifically, the two have worked together and implemented intelligent solutions, such as Blue Prism’s connected-robotic process automation (RPA) technology, that utilize automated, digital workers to replicate process work performed by humans, so employees can focus on strategic and customer-focused activities. This technology helps healthcare organizations manage large volumes of manual-processing work associated with RCM – so productivity is increased, cost-to-collect is reduced and the quality control gap is solved - in ways that offshoring never could.

The Business Case

In a recent article, the CAQH Index® found that healthcare providers could save as much as $14.64 per patient¹ encounter by using a fully automated workflow. These cost savings can be realized throughout the RCM continuum and provide significant savings over using traditional workforce solutions.

While inefficiencies in RCM processes can delay or prevent revenue realization, equal pressure exists in the sourcing and retention of talent to do the work. Finding qualified talent that can respond to constant procedural and technology changes can be a daunting task, especially when operating within budgetary constraints. The operational challenge of balancing available resources against highest value tasks leads to inevitable gaps that have traditionally been “solved” by outsourcing specialized functions.

Compounding these challenges, it is common for organizations to have unrealized financial and operational benefits from large electronic health record (EHR) investments. The combination of complexity, staffing challenges, and unrealized benefit lends itself to an industry disruptor. In this case, that disruptor is connected-RPA—a highly efficient, noninvasive solution to address the aforementioned issues.

KPMG has focused on developing and deploying a catalog of revenue cycle and connected-RPA technology, to improve processes and realize tangible benefits, including:

—  an audit-enabled automation of repeatable tasks,

—  reduced cost in both fixed labor and outsourcing spend,

—  improved productivity and morale within the workforce (higher/more complex tasks),

—  increased technical capabilities, promotion of innovation and capital investment.

An awareness of connected-RPA is quickly becoming a known quantity for most organizations given the importance and focus on efficiency. However, the biggest remaining challenge is how and where to operationalize these solutions. To that end, KPMG and Blue Prism have successfully collaborated with clients to:

  1. Define the plan to implement and activate the technical infrastructure necessary to support automation
  2. Identify and assist in the development and automation of the revenue cycle processes in a structured and value-based fashion
  3. Implement real intelligent automation solutions with providers, with a history of successful outcomes.

This approach is highlighted in the sections below, with the intention of encouraging and demonstrating how to practically undertake this critical transition and further support the enhancement of revenue cycle operations.

In the early stages of adoption, it’s important to think about the investment in connected-RPA from a strategic standpoint. Finding experienced partners and utilizing them to help navigate the design, build and implementation process is as important as finding the right business cases where the automation will be used. Without a clear vision around which revenue cycle processes are best suited for automation, particularly those with “Quick Hit” potential, organizations will not realize the intended ROI of the initiative.

In addition, this initiative will not succeed in an organizational vacuum. Setting a governance structure, engaging IT leaders as early as possible and roadmapping a path toward early returns by leaning on leading practices – should lead to partner engagement and focus.

Let’s do this: where and how have clients automated processes

A tested and effective approach to achieving successful automation programs with clients has been to collaboratively discuss, itemize, and quantify the financial impact of individual processes within the revenue cycle. Each process is then scored against a set of criteria that indicate the level of effort, interest (sponsorship), and benefit, leading to a prioritized list of automations.

Building these automations can take 4-8 weeks, depending on complexity, and can either be completed with internal resources, the assistance of KPMG, or other service providers. Below are two examples of automations in production at various clients:

1.    Credentialing – integrating ERP (HR) with various business units

Ninety-four percent of processes related to credentialing (licensing, enrollment and privileging) can be automated and integrated with various parts of the business.

2.    Referral Management – converting open requisitions to appointments (revenue)

The primary cause of patient no-shows is the inability to acknowledge and schedule the patients in a timely and satisfactory manner to the customer.

In addition to these examples, KPMG and Blue Prism have found numerous opportunities to utilize connected-RPA technology. Download the .pdf to learn more. 

Intelligent automation is here to stay.

The question facing RCM leaders ready to take on this challenge is when and how to adapt. Leveraging KPMG and Blue Prism’s experience in implementing real solutions is one path forward. Regardless, the least effective path forward is inaction.

Here’s why. As the patient population becomes more technically savvy, their expectations of accessing and managing their healthcare utilizing this technology will continue to increase. Whether through online appointment scheduling, or virtual payments, today’s consumers demand a higher technology solution, which providers must be able to accommodate.

Improving both customer-facing and internal capabilities are of equal importance in achieving an end-to-end, digitally enabled solution.

Intelligent automation is here to stay.

The question facing RCM leaders ready to take on this challenge is when and how to adapt. Leveraging KPMG and Blue Prism’s experience in implementing real solutions is one path forward. Regardless, the least effective path forward is inaction.

Here’s why. As the patient population becomes more technically savvy, their expectations of accessing and managing their healthcare utilizing this technology will continue to increase. Whether through online appointment scheduling, or virtual payments, today’s consumers demand a higher technology solution, which providers must be able to accommodate. Improving both customer-facing and internal capabilities are of equal importance in achieving an end-to-end, digitally enabled solution.

KPMG has worked with leading technology firms to enhance the customer experience, automate patient interactions, and improve access to care. The next generation of connected-RPA’s digital workforce will be more efficient, more connected and more capable of not only augmenting current capabilities but also giving critical insights and a competitive edge to anticipate and meet demand in ways not possible today.

If you are considering this type of solution, now is the perfect opportunity to take advantage of the benefits intelligent automation can bring to your organization.

Contacts

Elliott Skrinjar Principal, KPMG LLP

T: 412-916-4778

E: eskrinjar@kpmg.com

Melissa Edwards

Managing Director, KPMG LLP

T: 202-297-2734

E: melissaedwards@kpmg.com

Nick Petrus Director, KPMG LLP

T: 678-628-5475

E: npetrus@kpmg.com

Sam Whitten

Healthcare Practice Director, Blue Prism

T: 615-604-8091

E: sam.whitten@blueprism.com

Jason Salmani

Healthcare Sales Director, Blue Prism T: 240-743-7676

E: jason.salmani@blueprism.com

Some or all of the services described herein may not be permissible for KPMG audit clients and their affiliates or related entities. Any trademarks or service marks herein are the property of their respective owners.

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