Robotic process automation for healthcare

Autonomics and multi-agent systems will be applied in healthcare to definable, repeatable, and rule-based processes. Robotic process automation will be a competitive advantage, not replacing humans but enabling them.

Autonomics ultimately aims to develop computer systems capable of self-management and was started by IBM in 2001. These self-regulating autonomic components are driving the research of multi-agent systems (MAS). MAS are computerized systems composed of multiple interacting intelligent agents within an environment. Robotic process automation (RPA) is capable of automating activities (by creating software agents) that once required human judgment. This is the evolution of automation: the automation of automation.

Transactional to analytical

In 1990, traditional onshore labor was the norm. By 2000 offshore labor was ripping through every industry including healthcare. Huge cost savings were realized shifting from the traditional onshore model to an offshore model. The next revolution of digital labor is called “no shore.” This robotic process automation is autonomic, self-learning, and self-healing system.

The Institute for Robotic Process Automation (IRPA) published an excellent report highlighting the top ten benefits of robotic process automation that cross industries.

1. Decreased operational costs – no shore models (digital software agents)

2. Improved data analytics – task executed by robots allow for analysis

3. Increased regulatory compliance – steps are tracked, traceable, and documented

4. Increased efficiency – software robots never need time off

5. Higher employee productivity – software agents address repetitive activities, freeing workers to participate in more value-added activities

6. Improved accuracy – employees are human, and all humans make mistakes

7. Increased customer satisfaction – decreased errors build deeper customer relationships, improving retention and customer happiness

8. IT support and management – it’s easier to scale software than it is people

9. Logistical upside – minimize or eliminate complications with offshore labor

10. RPA and business processors – presentation-layer automation software, mimicking the steps of rules-based non-subjective processes

Automation process cycle

When do labor efficiencies become labor elimination? To better understand how RPA can enable your organization we first need to identify the five phases of the automation process cycle:

1. Manual execution – one off, no repeatable processes

2. Scripting – linear tasks, standard and repeatable

3. Orchestration – activities that are complex, standard, and multi-scripted

4. Autonomics – dynamic processes that are non-standard, contextual, and inference based

5. Cognitive – self-aware systems, that are predictive, self-learning, and self-healing

If we want our employees engaged in activities that involve personal interactions, problem-solving, and decision-making we need first to get them out of the tedious and repetitive activities.

What if you were told there will be a new team member joining your team. You’re not sure where they are geographically located, but you managed to get some intel from your colleague. You are told they never complain, didn’t want a desk, never need coaching, and love daily performance reviews. This is the resume of the modern robot, a leader in process automation. The competition just got stiffer.

Multi-agent systems

Robotic process automation begins with an understanding of agents. Typically, multi-agent systems refer to software agents, but these systems could equally be robots or hybrid robot and human teams.

There are three primary types of agents: passive agents (simple – agents without goals), active agents (advanced – agents with simple goals, and cognitive agendas (complex – with complex calculations and activities). Agent environments where these types of agents reside can be divided into three environments: virtual environment, discrete environment, and the continuous environment. Also, each agent environment has one or more associative properties:

1. Accessibility – when possible to gather complete information about the environment

2. Determinism – if an action performed in the environment causes a definite effect

3. Dynamics – how many entities influence the environment at the moment

4. Discreteness – whether the number of possible actions in the environment is finite

5. Episodicity – whether agent actions in certain time periods influence other periods

6. Dimensionality – whether spatial characteristics are important factors of the environment and the agent considers space in its decision-making

RPA applied to healthcare

Transparency Market Research, predicts that the global IT robotic automation market to be worth USD $4.98 billion by 2020. Robotic automation is a powerful alternative to offshore outsourcing. It is curious how these processes managed to escape automation. Regardless, there are many areas where RPA can be applied to healthcare including account management, claims processing, underwriter support, customer support, billing, collections, reconciliation, and reporting and analytics consolidation.

The HfS Blueprint Report helps us identify precisely where RPA can be applied within the healthcare ecosystem.

1. Claims administration – claims adjudication and processing, payment integrity complaints, and appeals

2. Member management – account setup, eligibility, and enrollment, billing, benefit management, and customer service

3. Provider management – provider credentialing, provider data management, contracting audits, and network management

4. Health & care management – population health and wellness, utilization management, care coordination and case management, and remote monitoring

5. Administration – finance, accounting, and training

Intelligent automation is entering the business world, and CFOs are happy because RPA is delivering the promised cost savings. However, cost-only value propositions are no longer attractive to top executives. They are looking for cost-plus value propositions (transactional plus judgement-intensive plus analytics). Global labor arbitrage, the disintegration of barriers to international trade or moving to where costs of doing business are low, is no longer sufficient. In this quest for greater cost-plus value propositions, technology plays a critical role.

Start by getting to understand where repetitive task hurt your organization. First, identify the opportunity, second validate the opportunity, third design the mode, and fourth deploy a pilot. Health plans and providers are discovering software agents as a cost-effective alternative to enhancing or replacing platforms.

The conversation has expanded beyond cost reduction to quality, engagement, and innovation. This new phase of sourcing will engage and manage resources to shift workers from the mundane task to activities with deeper customer interactions.

Health innovators are using robotics process automation to drive the next stage of transformation – at affordable costs. Robotic process automation isn’t coming soon; it’s here.

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Peter is a technology executive with over 20 years of experience, dedicated to driving innovation, digital transformation, leadership, and data in business. He helps organizations connect strategy to execution to maximize company performance. He has been recognized for Digital Innovation by CIO 100, MIT Sloan, Computerworld, and the Project Management Institute. As Managing Director at OROCA Innovations, Peter leads the CXO advisory services practice, driving digital strategies. Peter was honored as an MIT Sloan CIO Leadership Award Finalist in 2015 and is a regular contributor to CIO.com on innovation. Peter has led businesses through complex changes, including the adoption of data-first approaches for portfolio management, lean six sigma for operational excellence, departmental transformations, process improvements, maximizing team performance, designing new IT operating models, digitizing platforms, leading large-scale mission-critical technology deployments, product management, agile methodologies, and building high-performance teams. As Chief Information Officer, Peter was responsible for Connecticut’s Health Insurance Exchange’s (HIX) industry-leading digital platform transforming consumerism and retail-oriented services for the health insurance industry. Peter championed the Connecticut marketplace digital implementation with a transformational cloud-based SaaS platform and mobile application recognized as a 2014 PMI Project of the Year Award finalist, CIO 100, and awards for best digital services, API, and platform. He also received a lifetime achievement award for leadership and digital transformation, honored as a 2016 Computerworld Premier 100 IT Leader. Peter is the author of Learning Intelligence: Expand Thinking. Absorb Alternative. Unlock Possibilities (2017), which Marshall Goldsmith, author of the New York Times No. 1 bestseller Triggers, calls "a must-read for any leader wanting to compete in the innovation-powered landscape of today." Peter also authored The Power of Blockchain for Healthcare: How Blockchain Will Ignite The Future of Healthcare (2017), the first book to explore the vast opportunities for blockchain to transform the patient experience. Peter has a B.S. in C.I.S from Bentley University and an MBA from Quinnipiac University, where he graduated Summa Cum Laude. He earned his PMP® in 2001 and is a certified Six Sigma Master Black Belt, Masters in Business Relationship Management (MBRM) and Certified Scrum Master. As a Commercial Rated Aviation Pilot and Master Scuba Diver, Peter understands first hand, how to anticipate change and lead boldly.