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AI and RPA can help hospitals and health plans supercharge back-office staff and improve the customer experience

Health Care Current | April 2, 2019

This weekly series explores breaking news and developments in the US health care industry, examines key issues facing life sciences and health care companies, and provides updates and insights on policy, regulatory, and legislative changes.

My Take

AI and RPA can help hospitals and health plans supercharge back-office staff and improve the customer experience

By Steve Burrill, vice chairman, US health care leader, Deloitte LLP

Many people have a great relationship with their doctor…and they might even enjoy the occasional routine office visit. But no one looks forward to sitting in a waiting room surrounded by sneezes and last year’s magazines, or being on hold indefinitely with a health care call center, billing office, or a doctor’s front-office staff. Meanwhile, employees who answer phones, schedule appointments, and process claims might be just as frustrated as the patients they serve.

In the health universe, consumers are becoming the center of gravity and they are demanding better service, more convenience, and easier ways to navigate the health system. These are things they’ve come to expect from other customer-facing industries such as retail, banking, and travel. However, consumers agree health care is more difficult to navigate than other industries, according to our 2018 health care consumer survey findings.

My colleagues and I regularly talk about the positive impact future-of-work technologies—such as robotic process automation (RPA) and artificial intelligence (AI)—can have on clinical outcomes and cost of care. While use of these technologies on the clinical side might seem more interesting, health care organizations should look at the more mundane, back-office functions, too. Technology can improve the customer experience by streamlining some of the repetitive and cumbersome tasks that customer service and administrative staff perform every day. For health plans and health systems, I see this as low-hanging fruit in the move to the future of health and a customer-focused health economy.

The Deloitte Center for Health Solutions recently surveyed more than 100 chief operating officers (COOs) and chief administrative officers (CAOs) from health systems and health plans and conducted in-depth interviews with 16 others. We wanted to understand how health system and health plan executives are preparing their nonclinical, business, and administrative workforces for the future.

AI could soon drive most customer interactions

The future of work involves reimagining the way work gets done. It addresses generational changes, new technologies and talent models, and increasing consumer demands. Over the next 10 years, nearly half (47 percent) of US jobs could be automated, and in just five years, 95 percent of customer interactions are expected to be driven by AI.1 As work processes become more automated, some employees might worry that jobs are on the chopping block. However, more than 60 percent of 11,000 business leaders say they are actively redesigning jobs around AI, robotics, and new business models, according to our 2018 Global Human Capital Trends report. As many as 133 million new jobs could be created as organizations shift between human workers and machines (AI, robotics, and automation)—a net gain of 58 million jobs, according to a 2018 World Economic Forum report.

These numbers highlight a need for health care organizations to consider prioritizing future-of-work strategies to drive efficiency, improve employee engagement, and ensure a better customer experience. While 65 percent of the health plans and health systems we surveyed say they have a strategic plan and vision for the future of work, only 38 percent are focused on training and developing staff. Most of the health C-suite executives we interviewed understood that many mundane tasks and processes could be automated. However, many of them admitted they didn’t know how to launch broader organization-wide efforts. Here’s how we see the future of work playing out in several areas:

  • Open talent models: Allowing a virtual workforce could mean a deeper talent pool for positions that can be done remotely and regardless of geography. Some health plans are recruiting customer service staff from consumer-focused industries such as banking and retail who are accustomed to engaging with customers. Health systems are just beginning to explore this area, according to our research. The C-suite executives we interviewed recognized a need to build a diverse workforce to help spur new ideas and innovative problem-solving. Managing talent, especially younger employees, can be a challenge, according to Deloitte’s 2017 survey of US health system CEOs. In a separate survey, more than 90 percent of millennial physicians said it is important to strike a balance between work life and personal life, but only 65 percent said they had achieved that balance.2 Technology could help health plans and health systems address these work/life balance issues by enabling employees to work from anywhere.
  • Revenue cycle automation: Health systems tend to employ a lot of people in this area, and the work can be highly repetitive and manual. Many executives are beginning to realize that revenue-cycle processes—such as eligibility determinations, prior authorizations, and claims processing—can be automated. This could free up staff to spend more time on patient interactions. We learned about one hospital that cut its patient billing cycle from 30 days to just three. Long lags in billing can negatively affect the customer experience.
  • Customer service and claims processing: AI-powered chatbots and virtual assistants are intuitive and can be programmed to answer common customer service questions or respond to certain requests. This can give human employees more time to answer complex questions from consumers. To prevent members wasting time on hold, some health plans ask members to leave their question and a call-back number so a customer service rep can call back with an answer.
  • Human resources: Repetitive tasks are common in areas such as recruitment, payroll, and employee engagement. Instead of having employees manually sift through resumes and job applications, AI and RPA could scan applications and resumes, identify key words, and find top talent with expertise in customer service. Other labor-intensive processes, such as payroll, are industry-agnostic and employees could be recruited from other industries that have already adopted future-of-work initiatives.

As they head into a rapidly changing future, health systems and health plans that don’t adjust to the future of work could wind up with dissatisfied customers and an unhappy workforce. Competition for customers and top talent will become more challenging. The real opportunity presented by the future of work can be far greater than just cost savings. The future of work allows organizations to completely reimagine their work, workforce, and workplace as well as the possibilities of what can be created and accomplished. It can usher in innovations that not only improve returns for the company, but also create greater value for employees and consumers.

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1 Source: Finance Digest, “AI will power 95 percent of customer interactions by 2025,” March 10, 2017; Carl Benedikt Frey and Michael A. Osborne, The future of employment: How susceptible are jobs to computerisation?, Oxford Martin School, University of Oxford, September 17, 2013; Dan Kopf, “Almost all the US jobs created since 2005 are temporary,” Quartz, December 5, 2016; Morley Winograd and Dr. Michael Hais, How millennials could upend Wall Street and corporate America, The Brookings Institution, May 2014.
2 American Medical Association, Millennial physicians sound off on state of medicine today, March 27, 2017.


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In the News

Senate HELP Committee discusses interoperability, health data access

On March 26, the Senate Committee on Health, Education, Labor, and Pensions (HELP) held a hearing on the 21st Century Cures Act’s interoperability provisions. HELP Committee Chairman Lamar Alexander (R-Tenn.) discussed the February proposed rules from the US Centers for Medicare and Medicaid Services (CMS) and the US Department of Health and Human Services (HHS) Office of the National Coordinator for Health Information Technology (ONC), which seek to reduce information-blocking and promote electronic health record (EHR) interoperability (see the February 19, 2019 Health Care Current). If implemented, Alexander noted, these rules could give more than 125 million patients easier access to their own health records and reduce physician burden. He also said the rules should help ensure that “bad actors” can no longer “game the system and continue to information-block.”

Ranking Member Patty Murray (D-Wash.) affirmed her colleague’s statements and discussed existing barriers to free data exchange, such as user fees, restrictive contracts, and gag clauses for physicians. According to Murray, physicians should be able to speak out about issues related to EHR technology. According to Deloitte’s 2018 Physician Survey, 62 percent of physicians indicated that improving EHR interoperability would allow them to improve care delivery.

During the hearing, a former chief officer for ONC noted that information-blocking is bad for business and suggested that rules to prevent it should be applied to technology beyond certified EHRs. The head of medical informatics for a multi-state hospital system explained how a lack of interoperability among the organization’s EHRs adds to burden on physicians and other staff. He also urged caution regarding some initiatives, such as using smartphones and applications for data exchange, which could allow for unvetted third-party access to patient health information.

Enrollment in ACA exchanges dipped slightly for 2019

Enrollment in the Affordable Care Act (ACA) insurance exchanges dipped in 2019, according to a March 25 CMS report. Lower enrollment was expected after Congress zeroed out the individual mandate penalty in 2017, which went into effect on January 1, 2019 (see the January 29, 2019 My Take).

For 2019, approximately 11.4 million consumers nationally either enrolled or were automatically re-enrolled in an exchange plan, which was a slight decrease from 11.8 million consumers for 2018. CMS’s report also found that:

  • Enrollment in the 39 states using fell by about 3.8 percent, from 8.7 million people in 2018 to 8.4 million in 2019. 
  • In the 12 states that operate their own exchanges, enrollment rose by nearly 1 percent from 2018 to 2019. 
  • For the states that rely on, the average monthly premium for a policy for 2019 was $612 without a tax credit—about 1.5 percent lower than last year. 
  • The average premium for coverage sold through a state-based exchange was $543—about 2.4 percent higher than last year.

(Source: CMS, Health Insurance Exchanges 2019 Open Enrollment Report, March 25, 2019)

RELATED: On March 25, the US Department of Justice (DOJ) informed the Fifth Circuit Court of Appeals that it changed its opinion on the ACA to agree with the District Court judge’s December 14 decision that nullification of the individual-mandate penalty should render the entire ACA invalid (see the January 29, 2019 My Take).

On March 26, House Democrats unveiled draft legislation aimed at lowering premiums for health coverage sold through federal and state insurance exchanges. The bill would strengthen tax credits and raise the qualifying income threshold for families up to $96,000 per year. The bill would also direct funds to a reinsurance program to cover high-cost enrollees and assist individuals signing up for coverage on the exchanges.

CMMI model is helping states improve population health

A recent report from the Center for Medicare and Medicaid Innovation (CMMI) and a research organization found that CMMI’s State Innovation Model (SIM) Round 2 Test helped states make significant payment reform progress for behavioral health integration and population health infrastructure. Round 1 of the SIM initiative began in 2013, when CMMI awarded $250 million to six states to test how state governments develop policies and implement regulations to accelerate health care transformation. In 2015, CMMI awarded about $622 million to 11 new test states for SIM Round 2.

According to the report, New York implemented the most comprehensive changes in Round 2 by creating a patient-centered medical home model that meets both Medicaid and private-payer standards. Additionally, more than half of the states participating in Round 2 have launched population-health programs involving clinical and community-health integration.

(Source: RTI International, Evaluation of the State Innovation Models (SIM) Initiative Round Two: Model Test Year Three Annual Report, 2019)

State health news roundup

  • Kansas House approves Medicaid expansion: On March 21, the Kansas House of Representatives approved a modified version of Governor Laura Kelly’s (D) plan to expand Medicaid eligibility. Medicaid expansion has bipartisan support in the Kansas legislature. The bill requires the state’s health department to refer unemployed beneficiaries to job-training programs, but it does not include a request to implement work requirements.
  • Maryland votes to allow uninsured to apply for coverage: On March 22, Maryland lawmakers passed legislation allowing uninsured individuals to apply for health coverage using their tax returns. If Governor Larry Hogan (R) signs the bill, Maryland would be the first state to enact such legislation. The program, known as the Maryland Easy Enrollment Health Program, would let Marylanders check a box on their tax returns indicating if they want to enroll in health insurance. The state treasury would send this information—along with their tax information—to the Maryland Health Benefit Exchange. Those who qualify for Medicaid would be enrolled automatically, and the state’s insurance exchange would contact those who qualify for private insurance and help them pick a plan.
  • New Jersey will transition to a state-based exchange: On March 22, Governor Phil Murphy (D) announced that New Jersey would transition from the federally operated exchange platform to a state-based exchange by the 2021 plan year. According to Murphy, this move will give the state more control over its health insurance market. Last May, Murphy signed legislation requiring all New Jersey residents to have health insurance or pay a penalty (see the June 5, 2018 Health Care Current). Nevada and New Mexico, which now rely on the federal platform to operate their state-based exchanges, also expect to leave the federal platform. However, New Jersey would be the first state to switch from relying solely on to running its own exchange (see the October 2, 2018 Health Care Current).
  • Georgia lawmakers approve partial Medicaid expansion: On March 25, the Georgia Legislature approved Governor Brian Kemp’s (R) partial Medicaid expansion proposal and it is expected to be signed into law, according to the Governor (see the February 19, 2019 Health Care Current). The proposal would give authority to the Governor’s office to pursue flexible waiver programs that would allow individuals with incomes up to $12,000—100 percent of the federal poverty level (FPL)—to qualify for Medicaid coverage.
  • Judge strikes down Medicaid work requirements in Arkansas, Kentucky: On March 27, a US District Court judge blocked the new Medicaid work requirements for Arkansas, and struck down Kentucky’s work requirements for a second time (see the March 12, 2019 My Take).

Breaking Boundaries

Alternative pain-management tools take a step forward

Pain-focused mobile and electronic health apps have led to small improvements in pain intensity and depression among patients who have chronic pain, according to a systematic review and meta-analysis highlighted last month at the American Academy of Pain Medicine’s annual meeting. The improvements were slight, but statistically significant over short-term and intermediate-term follow-up periods.

Many patients who struggle with chronic pain see clinicians once or twice a month. Clinicians are interested in technologies that could help track those patients between visits and collect more detailed information, rather than just asking patients to remember details about their pain, sleep patterns, or physical activity over the last few weeks. However, for digital programs or apps to be effective, they need to be able to engage patients.

For this analysis, researchers searched four databases for randomized controlled trials of adults who had chronic, non-cancer pain, and electronic interventions that required no clinician contact, from the year 2000 to 2018. Researchers included 17 trials (more than 2,000 patients), and selected outcomes based on a validated set of criteria, classifying outcomes as short-term (three months or less), intermediate-term (4-6 months), and long-term (7 months or longer).

Overall, the findings show small but statistically significant advancements these interventions can make for patients with chronic pain, based on improvement in pain intensity, depression, and physical functionality. Researchers and clinicians at the meeting were optimistic that pain-focused apps are improving—providing patients with a wide range of options such as relaxation sound files, education, cognitive behavioral therapy, and skills such as problem-solving.

RELATED: Deloitte’s 2018 paper, Strategies for stemming the opioid epidemic, found that a recurring theme across various stakeholder groups was the need for more research on chronic pain and on effective non-opioid pain-management therapies. To date, there is limited evidence about the use of acupuncture, spinal manipulation, and yoga to treat different kinds of pain. However, stakeholders are interested in exploring these alternative methods because they do not involve potentially addictive medications. The study was based on interviews with 35 stakeholders from health plans, pharmacy benefit managers, clinicians, and technology professionals who are working to help prevent and treat opioid misuse and opioid-use disorder.

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