Widespread healthcare and home care staff shortages have created a huge void that exerts heavy pressure on the currently employed staff. And guess what? These shortages are expected to continue for a while now.

The home care staff have to perform various manual tasks every day, such as scheduling medication refills, taking vitals, conducting wellness checks, etc. Stress on the nursing staff has been piling up, which eventually makes them feel fatigued, burned out, and heading for the exits. A survey conducted on 1,327 workers from hospitals, nursing homes, outpatient clinics, and home healthcare providers revealed that 62% had felt stress related to COVID-19 (Sudo, 2021). Personal Support Workers (PSWs) have dealt with burnout throughout this pandemic. Many are overwhelmed and exhausted.

What is causing home care staff burnout?

If we consider the nature of the industry, the volume of patients or clients, and the shortage of resources, these burnouts are caused by unfair treatment, pressurizing workloads, unclear job duties or roles, little or no communication from the manager, and unreasonable time frames. These caregivers have to multitask and make decisions that take a heavy toll on their physical health.

Not to forget, overtime or extra shifts are also there to blame on. Moreover, while in the patient’s home, workers have to conform to their new or controlled environment, which is one of the reasons that lead to burnout. It is said that half of all the caregivers working in the home care domain tend to experience burnout at some point in time. In simple words, these burnouts occur as caregivers help and take care of their patients, and they simply forget about themselves.

These burnouts are characterized by multiple factors, such as

• Exertion
• A sense of detachment
• Frustration or anxiety
• Panic attacks
• Inability to face demand
• Headache and extreme fatigue
• Body ache
• Change or loss of appetite
• Sleeplessness

It doesn’t stop here, a study by the American Psychological Association indicates that employees with burnouts “are 2.6 times as likely to be actively seeking a different job, 63% more likely to take a sick day, and 23% more likely to visit the emergency room” (Moss, 2019). Which ultimately increases the caregivers’ attrition rate in the domain.

How can AI save Caregivers from these burnouts?

1. Automates manual and administrative tasks:

   Home care has an overwhelming amount of repetitive or manual administrative tasks that consume a heavy chunk of caregivers’ energy and time. These tasks include scheduling, billing, reporting, testing, coding, ordering, etc.

   These tasks simply disconnect the caregiver from the core duties and their interaction with patients. AI can automate these tasks using, Natural Language Processing, Speech Recognition, Intelligent Document Processing, and Machine Learning. For example, AI can smartly create electronic health records by transcribing your voice notes. It can generate billing codes from your diagnoses, suggest optimal schedules and appointments, and also provide automated reminders and alerts. This dramatically reduces the stress and workload on caregivers as AI takes care of these tasks with precision and accuracy.

2. Augments decisions:

   The complexity and uncertainty of clinical decisions requires a large amount of data to be processed with guidelines. Here, AI can create magic by augmenting your decisions using data analytics, predictive modeling, and predictive analytics. For example, AI dives deep into a patient’s data and medical history, compares it with similar cases in the past with outcomes, and identifies and suggests potential diagnoses and treatments. It also ranks them based on their probability and efficacy. This adds speed and accuracy to caregivers’ service by expediting the diagnosis and shortening the treatment cycle by guiding them with potential treatment.

Many people who work in healthcare or depend on prescription medicines have probably experienced how slow and frustrating it can be to deal with health insurance claims. This is because a lot of the work is done by people typing things into computers, and there are often mistakes and delays in the process.

As per the report, around 52% of individuals have insurance claims, both personal and at the workplace. To make things better, many healthcare organizations are turning to smart computer programs, like robotic process automation, to help with all the steps involved in handling insurance claims. This is because there are many problems in healthcare, such as doing the same tasks over and over again, using old computer systems that don’t work well, missing important deadlines, and making mistakes when processing claims.

In our earlier blog, we discussed medicare payment processing using Automation, and now we will explore how automation can simplify healthcare insurance claims.

Understanding Healthcare Insurance Claims Processing Challenges

Traditional healthcare insurance claims processing can be slow and error-prone. Here are some common challenges:

1. Manual Data Entry-

   Claims often involve entering large amounts of data manually, which can lead to errors and delays.

2. Complex Rules and Regulations-

   Healthcare insurance claims are subject to a myriad of rules and regulations. It can be easy to miss something, resulting in denied claims.

3. Communication Delays-

   The exchange of information between healthcare providers and insurance companies can be slow, leading to a long wait for claim approval.

4. High Administrative Costs-

   The manual processing of claims is costly and time-consuming, driving up administrative expenses.

Enter RPA to Simplify the Healthcare Insurance Claims Processing

Robotic Process Automation (RPA) offers a groundbreaking solution to tackle the challenges confronting health insurance companies. RPA software robots emulate human actions and automate tasks that are rule-based and repetitive, leading to more efficient processes and higher accuracy levels. Let’s explore some of the ways in which AI-driven automation is transforming the landscape of health insurance claims processing

Key Features of Service Orchestration Automation:

1. Simplified Claims Intake

   RPA plays a crucial role in automating the extraction of data from claim forms, eliminating the need for manual data entry. Using Optical Character Recognition (OCR) technology, AI bots swiftly capture relevant information from scanned documents. This not only reduces errors but also expedites the claims processing timeframe.

2. Improved Claims Adjudication

   RPA thoroughly evaluates claims by comparing them against predefined rules, policy terms, and historical data to assess coverage eligibility and determine payment amounts. By automating this process, RPA ensures consistent and precise decisions, thus mitigating the risk of human errors and providing swift resolutions to policyholders and healthcare providers.

Healthcare providers are under significant pressure due to chronic diseases becoming more prevalent among aging populations and a growing general population. As patient needs evolve and technology trends and tools become more accessible, healthcare providers are adopting them to improve patient care.

If reports are to be believed, the telehealth market is projected to expand at a compound annual growth rate (CAGR) of 24.0% from 2023 to 2030. With this substantial increase, technology-driven solutions have become increasingly important in the healthcare industry, especially in the context of home care.

But what are the opportunities in home care processes, and how can automation become a part of them? Let’s explore more about the home care processes and how automation can accelerate patient care experience.

How can AI and Automation Reduce the Administrative Burden From Homecare?

As per the report, Home Healthcare Market is expected to grow at a CAGR of 7.96% from 2023 to 2030.

With higher adoption of Home healthcare services, home healthcare teams currently grapple with unnecessary inefficiencies. Hindered by outdated technology and disjointed systems that have persisted for decades, it’s imperative to reconsider how these teams handle the overwhelming administrative workload.

Excessive and laborious hours devoted to monotonous tasks are not only leading to staff burnout but also resulting in subpar patient outcomes, diminished revenue recognition, and notable operational drawbacks. But here, AI and Automation can be saviors to home healthcare teams and help them automate administrative tasks and offer on-time patient care.

Let’s have a look at some of the home care processes to automate using AI and Automation.

1. Electronic Visit Verification Process

   An electronic visit verification system requires tracking a variety of information, including the type of service performed, the location of the service, the medical notes generated, the location and date of the service, who provided the service, who received it, and when the service began and ended. Caregivers often miss to clock in/clock out and enter the service provided to patients, and with missing information, it gets challenging for home care providers to create billing and initiate payments.

   Here, instead of the administrative team following up with caregivers and patients, the AI bot can connect with them via SMS/Call to record input and update the system. This helps homecare agencies improve compliance, get paid and improve the cash flow cycle.

2. Patient Referral

   Don’t let an incident make a greater impact than your response. In the case of emergency patient referral, home care providers must be on their toes to reduce the time spent on administrative tasks and offer faster patient care. Right from patient data extraction and entry, referral form processing, and appointment scheduling, there is a lot of work the homecare team has to handle manually.

   Here RPA and AI chatbots can be used to extract the patient data record and help home care providers to further execute the patient referral form. Also, once all the verification is done using the EHR system, home care providers can share all the patient details to caregivers and offer on-time patient care.

3. Revenue Cycle Management

   At homecare, revenue cycle management is a complex and multifaceted process that involves numerous challenges like medical billing errors, claims rejection, slow reimbursement cycles, inefficient manual processes and a lot more. Performing all these processes manually is time-consuming, and high-volume records make it more challenging.

   By employing AI and automation tools, home care providers can offer patients more efficient and trouble-free care, which in turn can lead to quicker revenue generation for the agency. These tools streamline various processes such as pre-claim assessment, pre-visit preparations, insurance verification, and patient record keeping. With medical coding and error-free submission of insurance claims, homecare providers can process incoming payments and manage claim denials on time. Also, this AI bot analyzes rejections and provides valuable insights through dashboards.

4. Patient Intake

   It is another time-consuming process that requires high manual efforts and time from home care teams to proceed with patient intake. From collecting the electronic health record to verifying the insurance details before patient intake, the homecare team has to manage faster to make sure on-time patient care is given. A minor error or delayed patient care can lead to a lower patient care experience.

   Here, automation and AI technologies can alleviate the patient care experience by utilizing ready workflow to collect, manage, and process patient information. This entails pre-registration, sending appointment reminders, obtaining consent forms, verifying identity and insurance details, syncing patient data with the Electronic Health Record (EHR) system, gathering medical histories, processing payments, and seamlessly connecting with other systems to facilitate information exchange. The faster the information process, the easier the patient intake.

5. Medical Record Management

   Managing patient medical records can be a complex task, especially when these records exist in various systems and formats. Also, integrating with your existing IT infrastructure eliminates the need for a costly overhaul.

   Here, automation and AI can offer medical coding in Electronic Health Records (EHR), ensuring precise OASIS (Outcome and Assessment Information Set) submissions to iQIES (Integrated Quality Improvement and Evaluation System), facilitating timely physician and staff notifications, efficient order processing with built-in quality checks, sending orders for digital signatures, and conducting thorough pre-claim reviews.

   By utilizing the automation approach to medical records management, healthcare organizations can enhance their operational efficiency while maintaining data accuracy and compliance. Our solution helps bridge the gap between multiple systems and formats, facilitating smoother healthcare workflows and ultimately improving patient care.

6. Caregiver Point System

   Implementing an automated point system through an AI bot serves as an effective strategy to recognize and incentivize caregivers. This system rewards positive behavior, ultimately contributing to the retention and longevity of caregivers within the organization. This AI bot seamlessly integrates with various data sources, offering live dashboards that enable providers to monitor performance in real time.
   The automated point system enhances provider outcomes by improving hiring rates, enhancing reporting capabilities, and facilitating precise tracking of caregiver performance. Additionally, it empowers providers with insights into top-performing caregivers and offers a multitude of other benefits for optimizing caregiver management and overall healthcare service delivery.

Conclusion

Automating routine and manual tasks is an absolute necessity in today’s competitive healthcare market. Hospitals and other health agencies that engage in in-home care need to embrace this phase of their digital transformation. With reasonable effort and investment, your medical facility can become significantly more agile and resilient, ready to weather any new storm that may come your way.