Digital Health

Our Power to Be the Change at HIMSS21: Ideas from VisiQuate


By Brian Robertson, CEO of VisiQuate

According to a recent survey by HFMA, administrative waste drains more than $262 billion from America’s healthcare providers in the revenue cycle process alone. That’s not a typo. Unfortunately, it could even be an underestimate. At every stage of the revenue cycle, it’s estimated that an astonishing 30 percent of the total administrative cost is wasted. Those dollars that were wasted in chasing other dollars could have been used for the good of each provider’s community. It’s money that could let them add a new MRI, sponsor a farmers’ market in a local food desert or provide scholarships for the next generation of nurse practitioners.

What causes this waste? From pre-bill to final payment, there are countless tiny inefficiencies, broken processes and huge errors that shortchange providers of their duly earned revenue needed to operate.

Here are just a few examples that start with preauthorization and cascade through the entire revenue cycle:

  • Lack of accurate information: It’s 2021, but some payers still don’t have an online way to verify details about covered benefits, benefit variations by plan and what types of care require prior authorization.
  • Staggering complexity: We have seen one client who contracts with 340+ payers with more than 10,500 health plans, each with its own set of rules and idiosyncrasies. There is no way any one human — or cube farm filled with them — could remember all those details and efficiently resolve claims and related administrative processing.
  • Endless on-hold times on complex claim resolutions: All too often, getting a specific answer to a specific question involves making a phone call to payers and having often lengthy calls. One provider says they have seen patient access staff wait on hold for three hours with some payers.
  • Compliance issues: Today, an average size hospital employs 59 FTEs to manage regulatory compliance, and 25 percent of those FTEs are physicians and doctors who are working with keyboards instead of patients.

We could go on and on, but we’d rather get to the laser surgery we perform on all this unhealthy fat:

At VisiQuate, we’re intimately familiar with the root causes of poor business health, and we know how to treat it. We focus on a combination of Advanced Analytics, Intelligent Action and Automation, together Intelligent Process Automation (IPA) to help our clients evolve towards what we call Peak Business Health.

AI is a key component of our success. We are a leader in using AI to optimize healthcare financial management for practices, hospitals and health systems. Five years ago, we started with a chatbot named Ana, who we created to help users find data and customize reports. But in no time, Ana began to anticipate what users wanted and started recommending even more valuable things for them to ask for. From there, with her machine learning, Ana has evolved to become a recommendation engine, a cognitive decision engine, an aggregator of crowdsourced wisdom and the technology that supports Intelligent Process Automation.

Intelligent Process Automation (IPA): Finally, with our deep domain expertise, we understand there is little value in using automation to merely replicate human activity. Instead, we are advancing the capabilities of Intelligent Process Automation by analyzing and optimizing each client’s unique processes to take full advantage of the power of the human and machine combination. VisiQuate’s artificial intelligence (AI) and machine learning (ML) make it possible for the entire system to continuously self-monitor and correct for anomalies that erode hospital margins. Today’s technology and VisiQuate’s advanced methods gives us the ability to dramatically reduce billions in waste and simultaneously increase yield, with an even shorter time to revenue. It’s a service we’re honored to deliver.

Find VisiQuate in Booth C-152 at HIMSS21.

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