Revolutionizing Traditional Risk Adjustment and Revenue Cycle

The RISE conference in Nashville brings together payers and providers around the topics of risk adjustment, quality improvement and compliance. This year, there emerged a new crop of technology-driven topics not typically seen. 

And, because these three areas are resource-intensive, it makes sense that we should highlight the “next generation” of technologies and our take on how these approaches can be beneficial to health plans and providers. 

Tech Highlights from Sessions:

The three sessions that focused on technology revealed that there is lots of interest in technologies like artificial intelligence, machine learning and natural language processing.  

However, it is very challenging for people to “see” the benefit in the real-world, right now. 

Here are the three sessions with our takeaways, as well as what we see as the most practical, risk-averse and easy-to-implement entrée into these “Next Gen” technologies – Robotic Process Automation (RPA).

Planning an omnichannel strategy that centers mainly around technology

Session 1:

Building a Compliant Risk Adjustment Program with Artificial Intelligence (AI) 

  • AI is being used the most in the financial services industry, especially investments management and banking, because of the enormous amounts of daily transactions that need to be screened for money laundering, market manipulation, insider trading, third-party risk, etc. 
  • As AI becomes more advanced and qualitative in its results, it could be exported to virtually any industry that must contend with compliance requirements involving large amounts of data, particularly in the healthcare industry. 
Creating customer experiences from a very narrow view

Session 2:

Don’t Fear the Audit: Using NLP-Enabled Technology to Increase Coding Accuracy, Validate Claims Submissions, and Ensure Risk Adjustment Compliance 

  • Artificial intelligence is used to extract pertinent data and terms from a text-based document and convert them into a set of medical codes  
  • Complex algorithms to recognize dictation, speech, and language patterns, generate codes, and enable querying electronic text 
  • By leveraging speech and natural language processing (NLP), payers are able to reduce the audit cycles, creating shorter lead times for better decision-making and measured actions for detected compliance problems. 
Forcing customers to fit into your omnichannel strategy rather than fit their preferences

Session 3:

Demystifying Machine Learning – A Tool to Simplify Complex Member Data and Launch Effective Risk Adjustment Campaign

  • Technology is the foundation of every product and service. Not only do payers focus on the user experience, they are driven to deliver the perfect client experience 
  • The ability to extract meaning from large volumes of free text is also critical for clinical decision support and predictive analytics – another area where machine learning is starting to shine 
  • Identifying and addressing risks quickly can significantly improve outcomes for patients and/or members with any number of serious conditions, both clinical and behavioral  

Unless yours is a large, national payer willing to take the plunge into cutting edge technologies, you’re probably more interested in pragmatic technologies that deliver results to your current problems – inefficient or inaccurate outcomes, labor-intensive tasks and manual processes.  We believe that the “Next Generation” technology that brings the most value now, with the least time and risk is Robotic Process Automation (RPA) and here’s why:

  • According to Gartner, by 2020 85% of IT Leaders will be piloting AI initiatives through a combination of Buy, Build and Outsourcing efforts. 
  • Robotic Process Automation is one of the key technologies providing a pragmatic learning pathway to develop AI & machine learning capabilities while acting as an accelerator to digital innovation. 
  • Unlike traditional IT automation, RPA has the ability to be aware and adapt to changing circumstances, often blending a combination of the following techniques: AI, Process Automation, Cognitive Automation, Digital Workforce, Analytics, and Crowdsourcing 
  • Rapid Solution Development that will show a minimum of a 2:1 ROI within a 4- 6-week timeframe 

To learn more about SDLC’s RPA Kickstarter Solution, or to schedule a complimentary whiteboard session, contact us.

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