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RPA & AI in Healthcare

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Robotics process automation (RPA) with self-learning capabilities is disrupting Healthcare technology arena, driving process efficiency and digital transformation.

Augmenting human capability with smart automation is proven to deliver results that drive process agility along with customer delight.

In this webinar, our RPA thought leaders delve deep into various use cases, adoption trends, and high opportunity space for healthcare players. Listen to our experts to discover never-discussed strategies employed by some of the fast transforming Healthcare Payers and Providers.
Click here to get your webinar recording https://www.imaginea.com/webinar/the-rise-of-rpa-and-ai-in-healthcare/

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RPA & AI in Healthcare

  1. 1. #ProductThinking Private and confidential. Copyright (C) 2019, Imaginea Technologies Inc. All rights reserve. 1 Build. Scale. Innovate. THE RISE OF RPA AND AI IN HEALTHCARE #ProductThinking
  2. 2. #ProductThinking Private and confidential. Copyright (C) 2019, Imaginea Technologies Inc. All rights reserve. 2 SPEAKERS Srikanth Vijay Director, Product Management Imaginea Suresh Babu Chief Revenue Officer Imaginea Srikanth leads the Business Analysis team at Imaginea. He has spearheaded several strategic automation initiatives for our insurance customers. Srikanth also has an extensive understanding of the automation landscape with a focus on emerging areas like Robotic Process Automation and Artificial Intelligence. Suresh drives Imaginea’s business growth through robust sales, marketing, and business strategies. He is a proven leader with a successful track record spanning 20 years, and is known for his ability to build high-performance teams and drive profitability and growth.
  3. 3. Healthcare inefficiency spiralling out of control Private and confidential. Copyright (C) 2019, Imaginea Technologies Inc. All rights reserve. 3 Source: CAQH Index $900 bn wasteful healthcare spend, largely created by … Inefficient processes Complex payment Friction between Providers and Payers $210 bn TOTAL ANNUAL WASTE $170 bn IS SPENT ANNUALLY ON MANAGING INACCURATE PAYMENTS $9.4 bn ANNUAL POTENTIAL SAVINGS WITH ELECTRONIC TRANSACTION
  4. 4. Manual vs. electronic claims processing: cost per transaction Private and confidential. Copyright (C) 2019, Imaginea Technologies Inc. All rights reserve. 4 Claim submission / receipt Eligibility / benefit verification Prior authorization Claim status inquiry Claim payment Claim remittance advice Claim attachment MANUAL ELECTRONIC $2.64 $8.39 $11.18 $9.79 $3.46 $6.19 $6.99 $0.68 $0.49 $1.93 $1.85 $0.78 $1.00 $1.27 Source: CAQH Index
  5. 5. Gartner estimate by 2022, 85% of large and very large organizations would have deployed some form of RPA solutions to automate their business. Private and confidential. Copyright (C) 2019, Imaginea Technologies Inc. All rights reserve. 5 McKinsey research suggests that, there is already a potential to automate 50-70% of current tasks that constitute 60% of today’s job. More than 51% and less than 60% of hospitals could see negative margins by 2025 if they are unable to achieve productivity growth. Source: Deloitte According to American Medical Association, 30% of providers reported having to wait at least three business days for responses from insurance companies, and 92% of providers reported that these delays caused patients to wait longer for care.
  6. 6. #ProductThinking Private and confidential. Copyright (C) 2019, Imaginea Technologies Inc. All rights reserve. 6 Maximize the benefits from RPA and AI in your automation initiatives
  7. 7. RPA vs. AI Private and confidential. Copyright (C) 2019, Imaginea Technologies Inc. All rights reserve. 7 RPA Systems based on rules. AI Systems that learn. Automate easy tasks, hands over data to AI AI learns to mimic and improve processes based on data handed over from RPA ▪ Access legacy system data ▪ Filling in web forms ▪ Copy data from one system to another ▪ Learn from human decisions ▪ Make fast judgments ▪ Interact with humans HEALTHCARE AUTOMATION
  8. 8. #ProductThinking Private and confidential. Copyright (C) 2019, Imaginea Technologies Inc. All rights reserve. 8 KEY TAKEAWAYS Role of RPA and AI in automation Planning and implementing automation initiatives that deliver high ROI Automation examples 1 2 3 How can you maximize the benefits from RPA and AI in your automation initiatives?
  9. 9. The role of RPA and AI in automation (1/2) Private and confidential. Copyright (C) 2019, Imaginea Technologies Inc. All rights reserve. 9 Expand automation to areas not addressed effectively by traditional approaches (BPM, Workflows, Business Rules Engines, etc.) RPA AI Automate repeatable manual tasks Data entry from structured forms into systems Access information from systems where integrations are expensive or not feasible Create reports or consolidated view from information residing in multiple legacy and modern systems Pre-defined features that enable rapid automation Extraction of members information from Excel to update payer systems, Automation in Citrix environment Scale based on need by adding bots Onboarding employees to medical plans, M&A
  10. 10. Private and confidential. Copyright (C) 2019, Imaginea Technologies Inc. All rights reserve. 10 RPA AI Processes that require human-like behavior Handling customer enquiries Derive information from unstructured data Medical coding, data extraction Automate tasks that require complex decision making Claim adjudication, clinical decision making Processes that need to adapt to changing input patterns Fraud detection of claims The role of RPA and AI in automation (2/2) Expand automation to areas not addressed effectively by traditional approaches (BPM, Workflows, Business Rules Engines, etc.)
  11. 11. #ProductThinking Private and confidential. Copyright (C) 2019, Imaginea Technologies Inc. All rights reserve. 11 Planning and implementing automation initiatives that deliver high ROI
  12. 12. Define the ‘Why’ → Goals Private and confidential. Copyright (C) 2019, Imaginea Technologies Inc. All rights reserve. 12 AUTOMATION OPPORTUNITY ASSESSMENT IDENTIFY GOALS DEFINE THE GOALS Organization Division Team Process Revenue Efficiency & cost Quality Scalability Compliance Customer Satisfaction
  13. 13. Assess the ‘What’ → Opportunities Private and confidential. Copyright (C) 2019, Imaginea Technologies Inc. All rights reserve. 13 AUTOMATION OPPORTUNITY ASSESSMENT IDENTIFY AUTOMATION OPPORTUNITIES QUANTIFY BENEFITS AND RANK OPPORTUNITIES Granularity can depend on the level (organization/ division/ team/process) at which the opportunities are being assessed Manual effort Multiple applications Processing time Turn around time Quality Customer satisfaction Volume Business priority
  14. 14. Private and confidential. Copyright (C) 2019, Imaginea Technologies Inc. All rights reserve. 14 Unstructured data / complex decision making Decision based on ▪ Process maturity ▪ Frequency of change ▪ Readily available APIs ▪ Frequency of change to UI Structured data Process flow Integrations Map approaches to opportunities RPA or Traditional AutomationAI Unstructured Data Structured Low Transaction Volume High Low Number of Applications High High Exceptions Low Low Task Repetitiveness High High Frequency of process change Low High Turn around time Low Low Error rate High Input Attributes Task Complexity Process Maturity Quality Low Prioritization High Prioritize opportunities Define the ‘How’ → Automation roadmap (1/2)AUTOMATION OPPORTUNITY ASSESSMENT
  15. 15. Private and confidential. Copyright (C) 2019, Imaginea Technologies Inc. All rights reserve. 15 Define the ‘How’ → Automation roadmap (2/2)AUTOMATION OPPORTUNITY ASSESSMENT Input from emails Classification ▪ Type of information to be extracted ✓ Standard email fields ✓ Attachments ▪ Type of documents ✓ Unstructured ✓ Not templated ▪ Change in document categories ✓ Not frequent ▪ RPA (chosen) ✓ Out-of-the-box feature ▪ Integration with mail application ▪ AI (Chosen) ✓ Large training and test data available ▪ RPA for frequently occurring document categories Evaluation Criteria Solution Approaches
  16. 16. Always know the ‘Status’ (1/2) Private and confidential. Copyright (C) 2019, Imaginea Technologies Inc. All rights reserve. 16 AUTOMATION OPPORTUNITY ASSESSMENT ▪ Process monitoring ▪ Exception handling ▪ Task management ▪ Regulatory compliance ▪ Monitoring ▪ Configuration ▪ Deployment ▪ Exception handling PROCESS MANAGEMENT ROBOT MANAGEMENT AI MONITORING ▪ Monitoring accuracy ▪ Managing outliers ▪ Error handling GOVERNANCE Include process, robot and AI governance in the automation roadmap
  17. 17. Always know the ‘Status’ (2/2) Private and confidential. Copyright (C) 2019, Imaginea Technologies Inc. All rights reserve. 17 AUTOMATION OPPORTUNITY ASSESSMENT Include process, robot and AI governance in the automation roadmap PROCESS GOVERNANCE ROBOT MANAGEMENT AI MONITORING AI Accuracy Report for Document Identification Total Documents AI Identified Percentage Accuracy 1000 950 95% # File name Actual Doc Type AI Identified Type 1 File1.pdf Policy Policy 2 File2.pdf Policy Policy 3 File3.pdf Correspondence Correspondence 4 File4.pdf Endorsement Policy
  18. 18. #ProductThinking Private and confidential. Copyright (C) 2019, Imaginea Technologies Inc. All rights reserve. 18 How can this process be accelerated?
  19. 19. Our recommendation Private and confidential. Copyright (C) 2019, Imaginea Technologies Inc. All rights reserve. 19 AUTOMATION OPPORTUNITY ASSESSMENT BUSINESS/ FINANCE/ TECHNOLOGY REVIEW FOR OVERALL AUTOMATION PROGRAME AUTOMATION PROGRAM PILOT PROCESS AUTOMATION ▪ Done at the organization or division level to identify roadmap for the overall automation potential ▪ Identify 1 process which is highly manual but of medium complexity (repeatable and low-medium input/output variance) ▪ Scope a 8-10 week pilot RPA project with outcomes that result in measurable ROI ▪ Automation Roadmap, Cost, ROI ▪ Proof of technology solution
  20. 20. #ProductThinking Private and confidential. Copyright (C) 2019, Imaginea Technologies Inc. All rights reserve. 20 Automation examples
  21. 21. Private and confidential. Copyright (C) 2019, Imaginea Technologies Inc. All rights reserve. 21 DOCUMENT PROCESSINGPayer/ Provider SCENARIO • Automate document processing • Examples: • Data Entry from Claim Form (CMS 1500, CMS 1450 etc.) • Invoice Processing • Enrollment • Claim summary from supporting documents • Data entry into legacy/ web-based/ stand-alone systems BENEFITS ▪ Automate 30-100% of the process ▪ Improve data accuracy Documents received (Claims, Invoices, Applications etc. ) Trigger AI Pipeline Update details extracted in downstream system 1 2 4 6 8 Workflow System CRM/ Claim/ Policy Admin/ Finance System Poll for emails/ tasks OCR Document classification (AI) Extraction (AI) Input Sources Update details for document Create task for document 3 5 Manual verification and update (process management application) Document Library 7 Save document in DMS with metadata
  22. 22. Private and confidential. Copyright (C) 2019, Imaginea Technologies Inc. All rights reserve. 22 MEMBER ENROLLMENTPayer SCENARIO • Extract details from enrollment form, validate and update in member database • Convert data to and from EDI formats and trigger workflows in downstream systems BENEFITS ▪ Ensure data accuracy through automated validation ▪ Reduce TAT Submit enrollment form Members 2 37 Member Database Get details from the enrollment form Transform to EDI format (834) Mailbox FTP enrollment file batch for verification and update 5 4 Receive enrollment file 8Welcome email • Perform validations/ data transformation • Enter/ Update member details in member database CMS (Centre for Medicare & Medicaid services) Receive updated files 6 Broker Portal1
  23. 23. Private and confidential. Copyright (C) 2019, Imaginea Technologies Inc. All rights reserve. 23 PROVIDER CREDENTIALINGPayer SCENARIO • Validate the provider information with multiple external sources • Set up UI-based automation (without integrating with external portals) BENEFITS ▪ Improve process efficiency by 40-60% ▪ Fast track provider onboarding to network Submit application with supporting documents Providers 2 3 8 Provider Database Get details Mailbox Verify details (License, Education, Insurance etc.) Create task with application detailsCreate or update provider details External Portals/ Databases 5 Portal1 Document Library Workflow System 4 Save Documents Update verification details Review and approve providerReviewer 7 6 e.g. fsmb.org
  24. 24. Private and confidential. Copyright (C) 2019, Imaginea Technologies Inc. All rights reserve. 24 PROCESS MEMBER / PROVIDER ENQUIRIESPayer Enquiry through email Trigger AI Pipeline Get information based on type of enquiry Members/ Providers 1 2 3 7 5 Workflow System Claims System Poll mailbox for new emails Classification to identify type of enquiry(AI) Extract claimant information (AI) Mailbox Create task for enquiry with recommended response and assign to processor or auto- respond based on type of enquiry 6 Save document in DMS with metadata Review and update response 4 Receive extracted information 8Response sent through email SCENARIO • Automate the processing of enquiries received from members or providers • Integrate with legacy systems for fetching/ processing information • Extend to chatbots for better customer engagement BENEFITS ▪ Reduction of manual effort by 40-70% ▪ Faster response time ▪ Increased customer satisfaction
  25. 25. Private and confidential. Copyright (C) 2019, Imaginea Technologies Inc. All rights reserve. 25 PRIOR AUTHORIZATIONProvider SCENARIO • Automate submission and checking status of prior authorization requests in payer portals • Application of front-end bots to expedite manual data entry BENEFITS ▪ Reduce operational costs for the process by 30 - 60% ▪ Faster processing of the pre-authorization requests to enable expedite delivery of service Verify if patient needs authorization Get patient data from the disparate sources Payer Portal(s) 2 Provider Systems with Patient Data Reviewer Is Authorization required? Requires Clinical Input? Front- end Bot Patient Databases No Update Create authorization request Bot pre-fills authorization request, reviewer completes it and submits Check status Update status Yes No Yes 1 34 5 6 7 8 9 10
  26. 26. #ProductThinking Private and confidential. Copyright (C) 2019, Imaginea Technologies Inc. All rights reserve. 26 SUMMARY RPA and AI are great enablers of automation; provided initiatives are planned and executed carefully Fast track implementations by combining a full scope pilot with the automation opportunity assessment Multiple Payer and Provider processes can be automated using RPA & AI with high ROI
  27. 27. Pramati’s M&A’s of leading products Serving from 5 global locations Innovation enablement Over 200 product & Enterprise customers Unique products & services Agile methodology Design exploration incubation lab 13 home grown products ▪ Doing business since 2009. Founded by the co-founders of Pramati Technologies (since 1998) ▪ A services company that started life as a product company & innovation in Enterprise ▪ “Product DNA” : Started several independent product companies ourselves ▪ Imaginea : Unique and unmatched product culture ▪ A strong team of 1500+ Engineers ▪ 5 Global locations : Mountain View CA (US HQ), London (UK Operations), Hyderabad (India HQ), Bangalore (ODC I), Chennai (ODC II) ▪ Over 200 Product Engineering & Enterprise Customers till date Imaginea: We bring a unique ‘Product Thinking’ culture 1500+ Engineers Private and confidential. Copyright (C) 2019, Imaginea Technologies Inc. All rights reserve. 27
  28. 28. #ProductThinking Private and confidential. Copyright (C) 2019, Imaginea Technologies Inc. All rights reserve. 28 GET IN TOUCH Srikanth Vijay Director, Product Management Imaginea Suresh Babu Chief Revenue Officer Imaginea suresh.babu@imaginea.com srikanth.v@imaginea.com
  29. 29. Credits Disclaimer This document may contain forward-looking statements concerning products and strategies. These statements are based on management's current expectations and actual results may differ materially from those projected, as a result of certain risks, uncertainties and assumptions, including but not limited to: the growth of the markets addressed by our products and our customers' products, the demand for and market acceptance of our products; our ability to successfully compete in the markets in which we do business; our ability to successfully address the cost structure of our offerings; the ability to develop and implement new technologies and to obtain protection for the related intellectual property; and our ability to realize financial and strategic benefits of past and future transactions. These forward-looking statements are made only as of the date indicated, and the company disclaims any obligation to update or revise the information contained in any forward-looking statements, whether as a result of new information, future events or otherwise. All Trademarks and other registered marks belong to their respective owners. Copyright © 2019, Imaginea Technologies, Inc. and/or its affiliates. All rights reserved. Images under Creative Commons Zero license. Private and confidential. Copyright (C) 2019, Imaginea Technologies Inc. All rights reserve. 29

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