Role of RPA in improving healthcare and insurance industries

Optimised RPA drives a faster, more impactful business outcome and RoI, believes Ram Mohan Natarajan, Senior Vice President – Business Transformation, HGS. In an interview, he speaks of its relevance for healthcare organisations

What is the rationale behind the concept of robotic process automation (RPA) in improving today’s healthcare payment process? Are there any relevant studies that prove this concept?

Ram Mohan Natarajan

If you look at the way healthcare companies — consisting of payers and providers — work and interact with their customers/ patients, one would say it’s complex and traditionally been inundated with back office processes that required human intervention to run them. The processes are varied and could range from patient scheduling, billing, claims processing, selling of insurance policies, underwriting and updating database of hospitals.

In the last couple of years, although healthcare companies have been automating many of their processes continuously on their own, there are still a huge volume of exceptions that require human intervention. These healthcare companies across the globe and their business process management (BPM) partners have been adopting automation technologies, especially robotic process automation (RPA) to help them streamline some of these manual processes. RPA, as a primary tool for automating processes, is used to automate these exceptional cases within a shorter time span without any huge investments. The objective is to increase efficiency and accuracy, faster turnarounds and enhanced customer relationships. Of course, companies and geographies are at different levels of maturity in terms of adoption.

With healthcare costs rising year-on-year and the changing demographics towards a huge ageing population, studies and HGS’ own experiences show that RPA can drive significant savings in costs, time and effort. For example, a report by Alsbridge says that a healthcare claim requiring human intervention costs approximately $4 to process while the cost-per-claim with RPA systems can be as little as $1.25. The turnaround time can be reduced by at least 50 per cent. The effort saved on administrative tasks can be instead focussed on front-end activities such as patient care and customer experience.

How does one go about choosing the right RPA approach?

Although RPA has proved to be beneficial for many healthcare organisations, I would say they are yet to be utilised as per its true potential.

Before you start using RPA as a tool to minimise your process-oriented work, you need to first identify and select the processes that need to be automated, understand the type of RPA operating model that will best suit your existing organisational processes, and plan your implementation and execution strategies. Don’t just look at layers. It is critical to assess individual process-centric candidates, score them according to their efficiency and level of complexity, and then prioritise them. Dig deeper and consider factors such as volumes, number of FTEs used to run the process, average processing time, etc. Evaluate the kind of data and inputs — is it structured or unstructured? Check if the processes are rule-based and heavily relying on human directions, and the number of exceptional cases managed.

Will RPA mean lesser human intervention?

The idea behind implementing RPA is to help organisations to automate their repetitive manual processes, reduce costs incurred, and enable faster and accurate processes. However, it does not mean that implementing RPA will negate the need for human workforce. While RPA is likely to replace certain tasks performed by people, humans will still be required to complete these processes, especially where decision-making is critical or interaction with customers is needed. It is more like a combination of robots and human brains working together, something we refer to as ‘Bots and Brains’ at HGS.

As industry experts, what we predict is redistribution of the jobs performed by humans that need more analytical skillsets, strategic decision making, and most importantly, maintaining customer and client relationships. Thereby, the nature of jobs will change.

Does RPA positively affect real-time business needs?

Although RPA is primarily considered to be a mid- to long-term solution, it can also be a powerful tool to positively affect your real-time business needs. With RPA, your business processes are automated to help you to get the work done more quickly at reduced cost and more accurately. In a contact centre, typically agents will have to refer multiple applications to answer a query where RPA can help make it easier for the agent and help resolve queries faster.

How can organisations design strategic human expertise with end-to-end process automation?

A 2017 Ernst & Young report revealed that between 30-50 per cent of RPA projects fail in its initial trials. This could be due to choosing the incorrect RPA candidate process, lack of proper governance or disconnect between the business processes. In order to ensure that strategic human expertise is made an integral part of the end-to-end process automation, you need to smartly bind the suggested automation steps with that of human-driven processes and the aligned decision-making. While there are steps that can be completely automated, there are also certain processes that are not rule based and require decision-making strategies to complete the process. In such scenarios, it is important for the organisation to understand the working equation of robots and human brains, and use them to have a bigger and higher impact on the business.

How does optimised RPA impact a healthcare organisation’s business outcome and RoI? Can you share some relevant case studies and examples?

RPA does offer immense business value. In fact, a McKinsey report on emerging and disruptive technologies has predicted that automation technologies such as RPA will have a potential economic impact of nearly $6.7 trillion by 2025. As a healthcare organisation — be it payer or provider, don’t just go with the hype and trend. Be sure to evaluate which of the processes are suitable for automation and how automating these will result in increased productivity of your existing workforce along with utilisation of their skillsets to resolve complex tasks and increase business value.

As for examples, healthcare providers need advanced automation solutions for assisting in tasks such as billing, claims processing etc to make them more efficient, eliminate paperwork and reduce time for completing the task. This has also resulted in increased levels of customer satisfaction.

This sector has witnessed a gradual transition from being a provider of services through human labour to one offering quality services through technological intervention.

How HGS’ RPA solutions are contributing to the healthcare insurance sector? How does this add value?

HGS’ back-office automation solutions are designed with an end-to-end intelligent automation approach that leverages design thinking. Our solutions include self-service and RPA along with cognitive learning and natural language processing, which drive significant process improvements, error reduction and speed. Our solutions are technology agnostic and leverage analytical insights to improve complex processes.

With healthcare being our biggest vertical, HGS has implemented these solutions for several existing US-based clients who are looking for cost transformation and enhanced customer experience. This goes beyond the much needed transaction-based engagement to more proactive, preventive healthcare assistance.

To give an example: we have partnered with a top five US healthcare payer to transform the way our engagement with them is operating, including finding ways to re-engineer existing processes by eliminating, simplifying and automating multiple processes through RPA. Result: More than $3 million in annualised cost saving, over 99 per cent accuracy in transaction quality and 40 per cent reduction in FTE requirement across queues. Another example is HGS helping the international arm of an insurer to improve member engagement and adopt an agile operational model through a combination of RPA and advanced analytics. We have also developed Centers of Excellence in both automation and analytics to create a bigger impact for the clients we serve.