Tag Archives: ia

Keys to ‘Intelligent Automation’

With new technologies and evolving customer expectations driving rapid change in the insurance sector, research suggests that more than 65% of insurance carriers will adopt at least limited automation by 2024. But, today, the insurance sector largely relies on multiple layers of manual processes that make customers wait while employees try to make sense of complex documents.

Intelligent automation (IA) offers insurance businesses an opportunity to revolutionize the way they operate to meet increasing demands from customers and pressures from the market and to plan for future, unanticipated interruptions. Through the combination of robotic process automation (RPA) and machine learning (ML), IA solves complex enterprise issues through the end-to-end automation of a business process.

The Insurance Ecosystem Involves Many Parties and a Deluge of Data

Many third parties are involved in the end-to-end insurance lifecycle. That’s the case whether you are in commercial, employee benefits, retail or any other type of insurance. A lot of information gets passed around. 

Brokers and insurers share data and documents. Advisers working with clients provide information, as do others, such as loss adjusters and lawyers. And the data arrives in the format preferred by the person who shares it.

That Data Comes in a Variety of Formats 

Data used for insurance purposes comes in many formats — structured, unstructured and semi-structured — and must be ingested, understood and digitized with accuracy before any automated processing takes place. This involves making sense of data such as cursive handwriting, which is commonly found in life insurance change-of-address and name-change forms, as well as in beneficiary documents. Insurance entities must extract data from highly unstructured employee benefits documents, such as dental, income protection, long- and short-term disability and medical documents. 

Brokers and insurers also need to compare and extract data from binders/slips, which can be up to 400 pages long and may use different words to describe the same thing. Insurers looking to ingest unstructured data (like email attachments, handwritten documents, PDFs and unlabeled data) — which is estimated to compose 80% of any enterprise’s data — can find their answer with cognitive machine reading (CMR).

While the industry’s standard data ingestion tool — optical character recognition (OCR) — can digitize structured data, it falls down when it comes to reading and extracting unstructured data such as tables, checkboxes and many other forms. In addition, OCR can’t read and digitize handwriting and signatures. 

A CMR-enabled intelligent automation platform (IAP) can analyze and process large amounts of unstructured data and complex business contracts in a fraction of the time it takes with traditional, manual processes. An IAP enables insurance companies to address the error-, labor- and time-intensive challenges involved with human-driven processes. 

For example, a global broking client wanted to extract 17 data points from commercial policies and endorsements. The documents came in from many different insurance carriers and in varying formats. All the data points required rules or reference tables to make the output usable, and most of the data didn’t have labels. In just a three-week period, with the samples of only 220 documents, with 40 different formats, multiple insurers and 10 coverage types, an IAP learned to extract 98.7% of the data, with 96.8% accuracy. Following this proof of concept, the client decided to implement this solution in multiple geographies.

See also: Automation Lets Compassion Scale   

CMR Allows Insurance Entities to Do More

John Hancock illustrates the many benefits businesses can derive from a CMR-enabled IAP. The company originally used manual processes to handle the large volume of policy management documents it received. Many of those documents held vast amounts of unstructured data — especially handwritten text in bold and cursive. 

Since adopting AntWorks’ CMR-enabled IAP solution, John Hancock has enjoyed higher business productivity, lower turnaround times and a more than 65% increase in accuracy for handwritten cursive recognition. Because the AntWorks IAP uses assistive and adaptive machine learning to learn from exceptions, the system’s accuracy gets better over time.

Insurance entities also can greatly increase their case volumes with the help of CMR. Using manual processes would require armies of people to do validation checks and take a lot more time, while producing higher error rates.

One of the world’s largest human resources consulting firms implemented AntWorks technology to manage large volumes of data and provide optimized quotations to customers for new policies and renewals. This company eliminated manual keying and automated healthcare claims-related processes by extracting data from paper documents and validating for accuracy. That enabled 70% faster processing and a 40% increase in accuracy.

A Fortune 500 insurance company that provides title insurance protection and professional settlement services found that the manual process of validating title documents was leading to error-prone and inconsistent output. CMR technology enabled this company to increase field accuracy across orders by more than 75% and increase productivity by 200%. (Field accuracy is one of the key performance indicators that insurance companies, their technology suppliers and analyst firms like NelsonHall use to evaluate automation solutions. For example, NelsonHall in its SmartLabTest evaluation of document cognition platforms looks at the proportion of fields correctly recognized, accuracy of extraction of recognized fields and proportion of fields overall that are 100% accurate and require no manual intervention.)

IAP Equates to Faster Time to Revenue and Richer User and Employee Experiences

When insurers adopt automation, they dramatically improve the experience for all parties — the broker, the customer and the insurer. They relieve employees from doing what is considered value-added but repetitive work like manual data entry. Automation also eliminates the need for error-prone, stare-and-compare work that’s common in the insurance industry.

That elevates the customer experience because IA allows insurance companies to process requests and respond much more quickly. Digitizing processes also delivers a better experience because customers don’t have to contend with the cumbersome process of filling out and handling paper forms. Meanwhile, IA enables insurance businesses to enrich their data with both structured and unstructured data from other sources and use data analytics and predictive analytics to make their propositions better and more personalized. 

IA also can enable businesses in the insurance ecosystem to move faster. That can help them to be more profitable.

Imagine a person is underwriting a life insurance case. If the data that person submits for the case is referred, an insurer would then have to go out to a doctor to get a medical report value. The underwriter would need to assess that report to understand whether it’s an acceptable case and communicate with the customer.

Getting and processing all the data can take weeks, delaying the policy kick-off. But if you can use intelligent automation to understand the data within medical reports, use rules to decide whether to accept or decline and automate the outcome, things happen much faster. 

The title insurance protection and professional settlement services insurance company mentioned earlier reduced its processing time by 70% after adopting a CMR-based IAP solution. Meanwhile, the human resources consulting firm noted above increased its operational efficiency by speeding turn-around time, leading to higher customer renewals, an uptick in new customers and increased revenues. 

Process Discovery Helps Companies Better Understand the Work They Do

Often, a lack of knowledge and understanding of process flows leads to automation failure. If you’re not quite sure which processes are the most optimal to automate or you’re not clear on all the steps involved in your process (and you don’t have time to do workshops with lots of analysts and business subject matter experts to figure things out), then process discovery is an excellent way of understanding exactly how the process is conducted. 

Process discovery enables organizations to identify high-value processes for automation by recording actions that users undertake. If an organization can look at, say, 10 different people doing the same process, it can better understand not only how the process really works but also all the variations in the process, including things like the different process times and different applications accessed. The discovery enables the organization to see the steps involved and create automated processes that use the optimal approaches to those processes. The organizations can then apply what they learned to claims data extraction, fraud detection, mortgage verification and processing, account set-up, policy administration, quotation validation, title verification and a wide variety of other insurance use cases.

In addition to helping companies better understand their processes, process discovery can help in identifying opportunities for automation, expedite digital transformation and unveil previously unknown processes for in-depth process mapping.

See also: Evolving Trends in a Post-Covid-19 World  

Intelligent Automation Makes Companies More Resilient

Our new normal puts increased focus on the importance of business resiliency. Manual processes work against that because they often mean that workers need to go to physical business locations to handle paperwork. That creates risk in today’s environment. Intelligent automation frees people and organizations from on-site, paper-based manual processes and instead relies on processes that are better suited to today’s digital, distributed, remote work world. IA also scales, as needed, to adjust to changing circumstances.

The time has come for insurance companies to look at ways to improve their operational processes through technology innovation. IA has the capabilities to help insurance practitioners to do business much faster, more efficiently and with greater security.

Not Your Mama’s Recipe for Healthcare

This article is about opening minds, eyes, hearts and futures. I’m going to take you on a journey into a world where I shine my flashlight into dark corners, challenging norms, introducing ideas and connecting different areas of current players and practice.  

Thanks in advance for sharing, caring and daring to think in ways that transform.

– Steve

***********************************************************************

Imagine if we could just wave a magic wand and all enjoy mutually delicious sips from the same icy cocktail of healthcare reform. The solutions appear to be so clear and obvious — to everyone except the major players that engage in healthcare.

Why would health systems, medical facilities and specialists willingly leave the B2B payer system and depend on consumer payments?  Why would hospitals, big pharma and providers want to compete on price when they can use their political influence and retain greater certainty in a regulated pricing model?

If large self-insured companies contract with health systems directly, could we count on these companies to pass savings directly to their employees, rather than pocket them as profit? Moreover, what would be the fallout on payer pricing to the individual and the fully insured markets? If payer competition was lessened through direct contacting, could health systems ultimately wield pricing leverage in these relationships?

Check out the latest reports on wellness plans and seniors’ use of digital health tools. Why would patients who feel good or are not remunerated financially want to make these consistent, long-term behavior changes?

In a country with a proven history of high obesity and chronic disease rates, why would patients choose to change their lifestyles en masse? What is the motivation for long-term adherence and results?

Okay, then, how do we disassemble a massively interconnected, for-profit health model that is complete with individual and institutional shareholders and bondholders? What about the leftover millions of employees from payers, brokers and insurance agents who are not able to be repurposed into other jobs?

What happens to the rest of the economy when consumer spending from all this unemployment and loss of investment money drops our GDP into the toilet? How would this affect future tax rates for individuals and companies?

We need payers, drug companies, providers and hospitals to lower healthcare costs. But, if they do lower costs, what then?

Instead of being motivated by satisfying shareholders and taking in more profit, will these companies choose to willingly pass on new savings as a result of lower pricing to healthcare consumers? If that’s the case, why haven’t we seen any major industry players going on record to say this?

Enter Will McAvoy from the HBO show “The Newsroom.”  The fake TV anchor from ACN said it best with his famous utterance: “The first step in solving any problem is realizing there is one.”

See also: Consumer-Friendly Healthcare Model  

Increased healthcare costs, lower quality, worsening outcomes, fraud, waste, abuse, mass unaffordability, stagnant wages, overutilization, defensive medicine, uber-administration and physician burnout are all too obvious, painful and expensive realities. Yet these are largely the emerging effects of a largely missed core problem:

The chief reason for our healthcare crisis has been political leaders’ lacking the guts to make the tough decisions for our future.

If our current weak, spineless, clueless, ego-driven, special interest capitulating, partisan robots led America during WWII, I fear we’d today be speaking Japanese or German. But the leaders in the 1940s recognized and decisively drew upon the need for all Americans to pull together for the greater good. Our citizens and businesses believed in the vision and greatness of perpetuating a better America for the next generation.

As much as I never thought I’d say it, we actually need greater government oversight in several key areas. It is obvious that large healthcare industries and public players are not simply going to go away or let their built-up leverage shrivel up. Consumers and employers need to stand on more equal footing, which cannot be accomplished solely by the Triple Aim (simultaneously improving the experience of care, bettering the health of the population and reducing per-capita costs).

When I think of great decisions that shaped our country, I think of John F. Kennedy’s decision to land a man on the moon. I think of Lyndon B. Johnson getting the Civil Rights Act passed. I think of Abraham Lincoln’s Emancipation Proclamation. I think of Congress passing the 19th Amendment. I think of Franklin Delano Roosevelt’s New Deal with 100 days of full bipartisan support. And I think of the way America rallied together, had conservation drives and raised war bonds during WWII.

We need those same leadership qualities to better position and deliver affordable, quality healthcare for the next generation. Consumer initiatives and bold plans are good — until special interests hit politicians.

Apart from aspirations of greater political leadership, we need to have a viable model for bringing fairness, accountability and affordability to the current status quo of health care.

ENTER: THE ‘HIT-IQ’ PLAN

HIT-IQ = Health reform by Intelligent augmentation, Transparency, Incentive and Quantity.

HEALTH REFORM: To speed up the ability for all players in the U.S. health system to benefit from reform, the HIT-IQ plan fills the cracks in healthcare reform. It is composed of the following:

INTELLIGENT AUGMENTATION (IA): Also known as intelligence amplification. Think of IA as a computer system or technology that supports and enhances human thinking, analysis, planning and decisions. Yet it allows the control and oversight to remain with humans. An example is Google’s search algorithm that allows us to find what we want online, in just a matter of seconds.

Contrast this with artificial intelligence (AI), where machines are meant to fully reproduce human cognition within a system that functions and learns autonomously in its own domain. True human-free AI is not fully here yet, though portions of AI are coming forward in new technology and solutions.

We now live in a world where much of our data has moved from paper to digital. Big data offers great benefit, yet it still has to be organized, analyzed, prioritized and optimized for a specific purpose. IA is the generator, and when coupled with massive computing power and speed, it allows humans to become far more accurate and efficient in their business and life activities.

See also: The Search For True Healthcare Transparency  

In a previous article on AI, I wrote about different companies, each with emerging technologies meant to improve accuracy and efficiency in different facets of healthcare. This includes medical imaging, mental health, risk management, drug discovery, genomics, hospital monitoring and lifestyle management. IBM’s Watson is a great example of IA in healthcare, where doctors can better diagnose and employ the latest personalized evidence-based care.

Help in efficiency can come none too soon. Recent reports show the last three quarters of U.S. worker productivity are at the lowest levels since the pre-stagflation period in the 1970s. According to popular economists, something very interesting is happening. The last six years of great technology has not helped overall productivity — in fact, it has gone backward in a hurry.

This becomes extremely important for healthcare, which, at the end of 2016, will have the highest employment pool of any U.S. sector. Moreover, the pricing of healthcare and health coverage has become unsustainable for many individuals and small to mid-size employers.

A big game of “financial musical chairs” now exists between employer profits, consumers who want to afford healthcare and retain their current standard of living and health companies that want to satisfy shareholders with ever-surging profits.

The big fear of robotic automation and AI is that computers will replace human workers. But I believe IA efficiency makes job elimination en masse an absolute necessity in bringing down the cost of healthcare. Any company’s purpose is to make profit, attain customers and stay competitive — and that does not include keeping people employed. That is, unless the replaced quality, accuracy and value becomes less than when current high levels of human capital were involved.

With what I continue to see coming in IA solutions, I believe it will not be long until we see deep learning and pattern recognition being applied to hiring, work flows, management and core operations — as well as patient intake, diagnosis, m-health data, patient marketing, population health and chronic and acute remote and in-house care management.

The fact that interest rates remain low also bodes well for healthcare companies to make investments in greater levels of integrated technologies that will replace bunches of humans with greater accuracy, efficiency, fewer errors and greater predictability. Let’s not forget this technology operates 24/7/365 with fewer salaries, benefits, sick days, arguments — or the ability to file lawsuits.

But wait…there’s more!

Look for malpractice rates and defensive medicine practices to come down significantly, as expertly designed, optimized, scalable and proven algorithms come into play. As medical malpractice rates drop, health systems and providers will capture that cost difference — and not add them over current net salaries. Et voila! Still lower costs!

It’s not magic, folks; we’re trading off large inefficiencies and human-based error inherent with a large employment pool. There’s a reason medical error is the third-largest killer in America, and big data analysis, predictability, accuracy, greater monitoring and efficiency are precisely what is needed for lower costs, higher quality, greater safety and better outcomes.

Best of all, the system will still be run by humans.

TRANSPARENCY: This is one area where the government must make a mandate across all states. We have seen that without mandated public and easy-to-access transparency, health consumers and employers have absolutely no chance of greater affordability.

Healthcare companies have no interest in making healthcare more affordable to consumers. And, please, don’t be lulled into thinking that just because payers, plans, medical device companies and big pharma/PBMs are working to lower healthcare costs and increase care quality that the savings will be passed on to the consumer in the form of lower, more affordable pricing.

Look at this: United Healthcare’s PATH program is a joint effort for better care outcomes. In 2015, 1,900 providers hit their program marks and were paid a bonus of $148 million, near $78,000 per provider. Sick and diseased consumers are going into bankruptcy and medical debt or are holding holding off seeing doctors because financial constraint — and United is paying doctors bonuses to lower costs that should have never been that high to begin with?

Is this a joke? Providers are being rewarded for doing what is expected anyway, and the consumers (errrr, paying customers) get regularly increased premiums? Take a look at the PATH consumer website; with all the accolades on improving health, help me find where it says United will reward customers by delivering lower prices for their plan’s premium pricing.

Here are needed areas of transparency:

1. An all-claims reporting mandate, from every payer, hospital, facility, doctor, self-insured company and government agency. While the recent ERISA ruling by the Supreme Court caused some setback, the Department of Labor could — and should — push through self-insured entities to report payments through state-mandated requirements.

2. Every hospital, facility, health system and provider should have their full fees, within 90 days for every product or service, be freely and easily available to the public. Any website or app could tie into the API or data to create patient or employer comparison shopping tools.

3. Every individual and company must be able to see what underwriting factors and specific influences went into a payer deciding upon their fully insured plan premium. Line-by-line calculations, each fully explainable.

4. All pharmacy benefits managers (PBMs) should be required to be fully transparent on all fees, kickbacks and bonuses.

5. There must be increased safety when it comes to providers and facilities. There is no reason that circumstances involving doctors, hospitals or medical facilities that have been found guilty of state law violations or have lost or settled in malpractice suits shouldn’t be made clear to consumers.

6. People should be made aware of drug companies’ R&D costs. We’re all sick and tired of the moaning relating to big pharma’s R&D and how our demands for price cuts will kill future new cures and drug development. Okay, then, let’s open those books so we can share in your pain. Hey, greater public appreciation and demand for IA in drug delivery will keep profit margins while bringing down prices.

INCENTIVES:  I’d like to meet the geniuses who believe that a healthcare population that is 40% obese, full of chronic disease and is constantly tempted by fast food and sedentary online entertainment is going to make (wait for it) long-term consistent changes by using wellness programs.

Will they do so because doctors (who are compensated by financial incentives or are punished by financial withholding penalties) tell them to do so?

Here’s a toughie: What if we asked doctors and practices to lower their cost to provide care, make less in profits and lower their salaries. Then, we told them they would willingly pass on these newfound monies to reduce pricing for patients because it would be financially healthier for the country’s future.

How do you think our white coat paladins, hospital administrators and health system executives would respond?

This is not rocket science — it is common sense. Studies are very clear that loss aversion related to money is a far better motivator, even than giving them money. Moreover, only 25% of employees find their wellness programs at work to be effective.

In a recent study of 7,600 businesses by Payscale, 73% of employers believe they pay fairly, while only 36% of employees feel the same. And just 21% of the workers believe the company is transparent about pay.

Catching my drift, employers? You can kill three birds with one stone: gaining healthier employees, potentially lowering healthcare costs and improving engagement through greater levels of trust and feeling appreciated financially.

Reward healthcare consumers by tying wellness goals to financial rewards or punishments. (We are talking cash here, folks — not trips, massages or points). Health plans? Same thing. If you want to balance out the risk of sicker members, per enrollment with the ACA mandates, hit up your chronic, pre-chronic and younger members. See how financial incentives and disincentives work there.

If they use wearables and contribute data to you or their provider, they are rewarded financially. If they hit goals on medication adherence, weight loss, lowering cholesterol or blood sugar, give them a paid check rebate. If they have a yearly physical, reward them.

Better yet, show them that future check with all applicable bonuses added together for their rewards. It is a nice, juicy number. Now, deduct 2% of that cash every week they don’t execute — like a melting ice cube. Keep showing them as often as possible what they are going to be missing. Catching my drift?

QUANTITY: Care delivery professionals, facilities and systems will soon have outcomes, patient satisfaction and cost numbers pitted against their service reimbursement levels — and, eventually, against each other.  Consumerism is growing and, whether healthcare stays largely regulated in its pricing or not, reimbursement levels at all aspects of the care supply and delivery chain (including on many prescription drugs) will likely decrease.

Moreover, reimbursement via bundled, value-based payments will come to replace the old, perverse, fee-for-service model. Hence, lower payments for the same work means the number of people engaging in healthcare products and services must grow if revenues are to grow.

Healthcare businesses will have to optimize every possible aspect of their business for new and repeat customer engagement and to retain their customer base. Especially important here will be those successful companies who focus on their intangible assets. These include advertising, marketing, sales, goodwill, customer relationships and various expertise that hospitals, providers, payers, drug companies and facilities have, which they can, and should, capitalize upon to their economic advantage.

The companies that get this will shape their precise outcomes through mastering the art of optimization. Learning how to maximize their intangible assets to drive more engagement of current and prospective consumer clients, thus increasing quantity of services and products. They will look at every consumer and business relationship, every past and present contact, every opportunity in current consumer interactions, every supply and distribution channel, every employee and every piece of capital or human capital they have.

See also: Is Transparency the Answer in Healthcare?

Many healthcare companies suffer from tunnel — instead of “funnel” — vision. They believe they provide products or care and are paid for such — and that’s it. But the organizations that recognize they can not only offer more but be more than their basic business offerings will derive greater revenue and profit.

Population health is a great example. It is about more than capturing data from wearables; it is about recognizing the interplay between chronic disease and genetics and the need for screening those who don’t currently engage in healthcare services. It is about tying in mental health for those who are caregivers and don’t take care of themselves. It is about recognizing that, if you work out a medical debt with more than a negotiation but perhaps a thank you card sent after, your name will be more gold than mud.

For direct primary care doctors, it is about offering a rebate to customers who bring new members to your practice. For a health system, it might be coordinating a telehealth counseling visit to a family member grieving because of a loved one’s illness. What about making that extra call to check up on how a patient is doing at home the day after they get home from the hospital?

Perhaps it’s giving a free service. Often, the most self-serving thing a company can do is actually to be selfless. Maybe it is a doctor’s office sending flowers after a successful surgery outcome or even upon a loved one dying. Maybe it is a call from a drug company outbound customer coordinator, just to see how the new medication is working.

Health companies of all types and sizes that replace current limiting beliefs with empowering ones will find themselves on a track toward capturing greater community value, engagement and increasing their market identity. In short, companies that get people to want to engage and help others engage with those same companies will thrive.

Players in healthcare must not forget that consumerism is not a dirty word; it is people putting up their hands saying, “I want to be cared for and find value in that care so that I can feel good about my time and money spent.”

If they have to be cared for because of sickness or an emergency, then that is all the more reason to make patients feel good about you.

It is no longer a healthcare world where providing the service, billing and receiving payment suffices. People and employers are smartening up and recognizing that lower reimbursement, more competition and new options for care and coverage are developing.

Those healthcare companies that can integrate the intangibles in a meaningful, ethical and value-added manner for their current and prospective healthcare consumers will thrive. Increasing quantity of consumers and identifying and rendering necessary services is key (especially in a healthcare business environment that has properly integrated lower costs, greater efficiency through technology and better outcomes).

It will make — and keep — current and future healthcare consumers far happier in the long run. Now that’s some of the best risk management I know about.