How Human Automation Fails Healthcare

The Real Cost of “Human Automation” in Healthcare

Too many digital health companies still rely on outdated processes to manage their provider data—but that’s set to change.

Over the past few years, scores of new digital health companies have emerged. In 2021 alone, total funding for digital health systems based in the United States amounted to over $29 billion, almost doubling 2020’s record $14.9 in investments. For analysts, this trend signals that digital transformation is now top of mind for payers, provider groups, and other healthcare organizations.

Yet when it comes to provider data and network management, many of these companies still have outdated “human automation” solutions—like outsourcing to large offshore teams and/or using manual methods like screenshots and PDFs to digitize primary-source files—at the center of their administrative processes.

Why? The legacy systems that handle provider credentialing, licensing, and enrollment were built primarily with security and compliance in mind and without access to newer tools like integrations, APIs, and workflow automation.

That said, relying on antiquated provider management strategies can negatively impact an organization’s efficiency, accuracy, and growth, not to mention its ability to deliver quality care. In this post, we detail the adverse effects that human automation has on the healthcare industry—and how tech-forward platforms offer a better way forward.

The Shortcomings of Human Automation

Generally, automation refers to the use of technological and/or mechanical processes that enhance the speed and accuracy of administrative tasks while also reducing human workloads. Ironically, human automation does not take advantage of such mechanized processes, instead offloading manual tasks from one group of people to another group less directly involved in the organization.

Unsurprisingly, in healthcare administration, this standard operating procedure can carry significant risks. Specifically, the impact of insufficient automation is twofold:

1. Inefficiency: On average, it can take up to 180 days to credential a provider and around 120 days to get a provider enrolled in-network, delaying their ability to see new patients and be reimbursed for services rendered.
2. Inaccuracy: Human errors and omissions on key forms and applications can lead to even longer rework cycles for licensing, enrollment, and credentialing, and stale network data can cause organizations to fall out of compliance.

What Do New Tools Do Differently?

Thankfully, recent advances have paved the way for a host of new solutions that offer critical improvements to the healthcare sector.

For the first time in the industry’s history, tech-forward tools, along with regulatory shifts, have made it possible for end-to-end automation to optimize essential tasks and reduce the administrative burden on both healthcare organizations and providers.

Some of today’s solutions include:

• Optical Character Recognition (OCR): OCR technology has the ability to extract text from primary-source documents and use it to auto-fill application forms, limiting the chance of human error and increasing the speed and number of applications submitted.
• Data scraping: Data scraping can automate data capture from hundreds of different sources at once, streamlining processes like credentialing.
• Data pipelining: Data pipelining helps health organizations stream accurate provider data from trusted primary sources and channels—rather than requesting information from providers themselves—enabling providers to shift to 100% clinical work and 0% admin. 

Identifying a Fully Automated Provider Data Solution

With so many provider data management solutions on the market, it’s easy to get distracted by buzzwords like “modern” or “innovative” that mask the manual processes happening behind the scenes.

When evaluating provider network management partners, you want to ensure their technology is up to speed and that it can deliver on efficiency for your organization. Here are some questions you can ask to get to the bottom of their automation strategy:

• What’s your credentialing turnaround time?
  If it’s more than a day or two, a vendor is likely using human automation
• How do you correspond with providers?
  If they’re chasing down credentials and data points via email or over the phone, that’s human automation.
• What is your files-to-processors ratio—or, how many files is each person processing per day?
  This is something of a trick question, as a truly automated platform will offer API-powered verifications and ongoing, built-in network monitoring, limiting the underlying human effort.
• What level of accuracy do you guarantee for your files?
  Automated solutions draw data straight from the primary source, so this number should be close to (or at) 100%. Moreover, any company that falls below 95% should offer you a rebate or similar reimbursement.

Understanding what’s going on at the back end of a provider network management solution can help you identify which vendors are leveraging all the benefits of workflow automation.

The Benefits of Provider Intelligence

In today’s digital landscape, what standard of automation should you expect and demand from your data partners?

Put simply, you deserve a solution that leverages the latest technology to reduce workloads, unlock deeper insights, and drive results for your team, your network, and your organization.

Certify makes this vision a reality by putting real-time, frictionless credentialing, licensing, enrollment, and network monitoring solutions at your fingertips. Our provider intelligence platform makes it easy to instantly access thousands of verified data points tailored to your precise business needs. The results, among many, include:

• One-click PSV carried out in a matter of seconds
• Over 50% increased application volume
• Up to 90% reduced credentialing costs
• Up to 40% less time spent on repetitive administrative tasks

Learn What Certify Can Do for You

Reach out to sales@certifyos.com to chat with a member of our team—or book a free demo to see our solutions at work.