Open Enrollment Strains the Healthcare Industry; Automation Heals It

As the 2022 Open Enrollment Period begins, healthcare providers brace for the inevitable increase in new patients. An industry teetering on the edge, practitioners and staff alike are stressed for resources – so much that the World Health Organization is issuing warnings about the consequences of an overwhelmed healthcare system.

After the 2021 Special Open Enrollment Period ended in August, a record-high 12.2 million Americans were enrolled in marketplace coverage. Even prior to the pandemic, the United States was projected to face a physician shortage by 2034. Due to the effects of COVID-19 on the healthcare workforce, that deadline may come sooner than initially expected.

With the impending increase in new patients juxtaposed with a shrinking population of healthcare workers, it’s time to think critically about the healthcare industry’s severe state.

Americans need health insurance now more than any time in recent memory. Unfortunately, the healthcare system simply isn’t positioned to sustain its current workload. Having health insurance isn’t impactful when the doctor’s office doesn’t have the capacity to take on new patients.

More opportunity with automation

Every day, there are new headlines about advancements in medicine, like AI that can diagnose genetic disorders and robots that perform brain surgery. As impressive as these new inventions are, they aren’t available to the average healthcare provider, and as a result, they don’t impact the everyday American. 

Instead, the healthcare industry should look to a more attainable, sustainable solution: cognitive process automation.

Cognitive process automation (CPA) is an accessible resource for healthcare providers’ back offices. Creating staff schedules, onboarding patients, verifying healthcare coverage, and revenue recovery are repetitive, monotonous tasks that detract valuable back-office support away from frontline medical providers, like nurses and doctors. 

The medical community should never stop innovating for the future of medicine, but the average clinic – and patient – stands to benefit from cognitive process automation today. 

Use cases for cognitive process automation in healthcare

A distant relative of RPA, cognitive process automation uses more advanced technology, like machine learning, artificial intelligence, and specialized optical character recognition. The result is a team of bots that understand the industry, continuously learn, and evolve their processes alongside the human staff.

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Bots are not a replacement for back-office staff. During times of increased demand, however, bots can alleviate the workload, and in turn, healthcare worker burnout.

For example, verifying patient insurance information is a time-consuming but necessary evil. If the patient data is inaccurate, the insurance company could wrongfully deny a claim. If the healthcare provider doesn’t take steps to reverify information on a monthly basis, the provider could lose revenue.

Rather than spending time on the phone with an insurance company, back-office can support healthcare providers with their increased patient workload. Meanwhile, bots use CPA to extract and verify data from patient insurance ID cards. Specialized OCR reads text from the ID card, and the bot can verify the validity of the insurance in a matter of minutes. Errors are immediately noticed and rectified while the patient is still in the office. And each month, the bot continues to verify the patient’s insurance information online without being prompted by the staff.

It seems like a simple solution, but the issue of inefficiency in the back-office results in major losses on a yearly basis – for the healthcare provider, the insurance company, and the affected patient. A 2019 study found that the U.S. economy loses an estimated $265 billion annually due to ‘administrative complexity.’

Patient insurance verification is only one use case for healthcare automation. Even so, it’s indicative of the incredible impact that cognitive process automation can have on a struggling industry that’s facing employee burnout on a massive scale.

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The path forward

The 2022 Open Enrollment Period highlights the need for digital transformation within the healthcare space. Rather than waiting on futuristic advancements in medicine, healthcare providers need reasonable, accessible solutions to the problems they face today.

As medical workers brace for the increase in patients that typically follows an open enrollment period, cognitive process automation is a realistic resource for a sustainable healthcare model. It improves both the patient and the employee experience, returns revenue back to the provider, and decreases inefficiencies in the insurance b****** system. 

The COVID-19 pandemic has proven how valuable healthcare workers are to American society. Providing the industry with resources for a better quality workplace is now more important than ever.

[To share your insights with us, please write to sghosh@martechseries.com]