October 2024 Newsletter

Fall, with its shorter days and cooler temperatures, invites us to reflect on the past year and prepare for the winter ahead.

This season of transformation is not limited to nature alone. We are also witnessing a significant shift in the technological landscape with the advent of artificial intelligence (AI) and automation. Much like the changing leaves, AI is reshaping our world in profound ways. It promises to enhance productivity, streamline processes, and open new avenues for innovation. However, it also brings challenges that we must navigate thoughtfully.

AI and automation are transforming industries by taking over repetitive tasks, allowing humans to focus on more creative and strategic endeavors.

We look forward to automating with you!

Revenue Cycle Prior Authorization Case Study

Industries: Healthcare, RCM
Provider Systems: Epic
Payer Portals: eviCore, United Healthcare, Magellan

Challenge

A large healthcare provider needed to ramp up their automation strategy to offset labor instability and attrition. Currently the staff manually have to go out to payer portals, submit requests and check statuses of Prior Authorizations, sometimes multiple times. Through Task Mining AI (Artificial Intelligence) analysis, it was determined that staff were spending about 30 – 40% of their time submitting requests and checking the status for 19,000 prior authorizations per month.

Prior Authorization Requests: 3 bots processing prior authorization requests in 3 separate portals (EviCore, Magellan and UHC).

EviCore: 923 transactions per month
Magellan: 595 transactions per month
UHC: 7,063 transactions per month

Prior Authorization Statusing: 3 bots processing prior authorization statuses in 3 separate portals (EviCore, Magellan and UHC).

EviCore: 5,536 transactions per month
Magellan: 3,572 transactions per month
UHC: 986 transactions per month

Solution

RPA bots are a much more accurate and effective solution to verify the status of patient health authorizations, RPA bots can repeatedly check requests under review for status changes and updates.

CampTek Software was engaged because of its healthcare and Epic experience. Through task mining, AI models were created, and results were reported back to the customer with enormous success. The next phase of design and build all occurred in a brief time. The bot now in production includes business rules, exception handling and daily reporting functionality. It is also supported by CampTek as an ongoing managed service solution for the provider.

The Bot is now saving 2,696 FTE (full-time employees) hours per month or 32,352 hours (about 3 and a half years) per year. The FTE capacity gain is 17 FTEs (full-time employees), and the ROI (Return on Investment) is $1,085,000 per year.

Sample Recording: Prior Authorization Request in EviCore

AI Journey 2024: Where are we?

As we get into the last quarter of 2024, it has gotten to a point where there is so much noise about AI that it’s difficult to discern what is actually worth paying attention to. Every major enterprise software vendor has “AI” embedded into their product. While GPT has been an incredible leap forward, its actual ROI hasn’t been widely realized. There are several reasons for this, which I will get into later. We, however, are already seeing some fallout from executives who made reactionary spending choices in late 2022 and 2023, where they wanted to bring AI into their organization but didn’t have clear ROI, were overpromised functionality, and the expectations didn’t meet reality. This is very common with hype cycles in tech; there will always be early adopters who want to be the “first to do it” and add it to their resume. This can be dangerous thinking based on the high costs of AI to get it to work properly. 

So where are we?

It’s a good question. I continue to contend, as do many others, that we are in the equivalent of the early-stage proliferation of the Internet as a GUI and interactive application. Think Mosaic browser and Yahoo Search engine, circa 1993-1995. Many of those reading this most likely will not have been born yet or even know what I am referring to. Let’s just say this was a period when e-commerce was still a few years away.

To compare the eras is doing the capability and promise of AI a bit of a disservice. AI has made the creation of AI more efficient, so in the case of the Internet era, it would take years for improvements to be made, i.e., browser changes, website functionality, HTML version changes, etc., which has helped advance the Internet from simple block text to today’s applications which are highly interactive and at greater scale. What we are seeing are major advances in the usefulness of AI and at breakneck speeds. GPT is everyone’s favorite to look at, but advancements in Multimodal AI, which can process various types of data simultaneously (text, images, unstructured data, etc.), open up a whole new way in which we as humans can use this tool to assist us with our day to day lives in our personal and business lives.

This is all very exciting, but I would encourage all of us to take a half step back and assess where we came from and where we want to go. At the end of the day AI is a data problem. The more QUALITY data you feed it the smarter it can become. That statement alone eliminates most workflows as the data can’t be had or there isn’t enough to train a model.  As a company, we are in the process of building very sophisticated AI models that solve a problem, while it may be large and high in ROI if it is solved. The approach is that it can focus on enough historical data that produces an outcome that can be analyzed. More to come there! In closing, the future is going to be great with more AI in our lives. I advocate you to read through the lines and choose wisely as you proceed on your journey. 

Written by: Peter Camp. CTO & Founder

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Additional Resources

Revenue Cycle Prior Authorization Case Study

Challenge

Solution

Sample Recording: Prior Authorization Request in EviCore

AI Journey 2024: Where are we?

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