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10 Steps to Revitalize Healthcare Payer Automation

Cognizant U.S. Health Insurance Payers: How & Where to Acelerate the Automation Journey Our recent study reveals practices that may be preventing automation's promise and potential from being fully realized in the healthcare insurance space, and provides strategic vision on how automation can be approached with clarity and purpose. Automation is often touted as an important solution to standardize processes, reduce costs and improve the quality of care. Yet there may be a gap in recognizing the potential of automation and achieving it. Our study of 200 business and technology executives across U.S. health plans revealed that while payers see automation as important for improving processes and delivering better member service, they may be missing its potential to reshape business and operating models and enable new products and services. Overall, what we see is an industry dabbling in automation vs. wholeheartedly embracing it. 1% 100% Nearly half of payers have defined an automation strategy 5% 49% Don't know – 1% No - 5% 50% We are in the process - 49% Yes - 46% 46% 0% Less than half of respondents have automation programs in production 5% 1% 9% Fully deployed live application 14% • Testing proof of concept/pilot 46% • Developed MVP (minimum viable product/ demo/prototype) Identified use cases 25% Nothing currently, but may start in near future • No plans for automation 011010 Top three areas where AI is driving the greatest benefit Clinical workflow O Treatment planning Health benefits administration O Data infrastructure and interoperability O Population health management 40% O Disease diagnosis Clinical decision support & precision medicine O Disease monitoring R&D catalyst Care coordination Nonclinical workflow Patient adherence 0% The majority of benefits are expected from operational efficiency Rank the top three benefits you believe Al would bring to your organization. 40% Achieve operational efficiency • Cost savings and revenue growth LL • Improved performance • Others • Improved care management • Customer satisfaction Enhanced security 0% • Competitive advantage Rank 1 Rank 2 Rank 3 Many internal barriers stand in the way, most notably the difficulty of evaluating cost-benefits, ensuring data security, and understanding legal and compliance challenges Evaluating cost-benefit of use cases Understanding automation and use cases Culture and change management Integrating legacy systems with existing enterprise architecture Communicating automation to key decision-makers Other technology investments are taking priority 20% Ensuring data security 40% Uncertainty around time needed to start reaping benefits Securing budgets 60% Gaining buy-in from organizational leaders and internal divisions Reengineering business processes Understanding legal and compliance issues Procuring talent and expertise 100% Health plans have high hopes for automation Not sure - 13% 50% Will not resolve any pain points - 2% Maybe, to some extent - 17% Yes, to some extent - 42% Yes, to a great extent - 28% 0% Senior management is more optimistic about automation's future than middle management 1 60% 60% 56% 53% 54% 46% Critical 44% Important 37% Somewhat Important 25% Not Important 12% 9% 3% 0% C-Suite C-Suite Executive Middle Business IT Management Management Prescriptions for a Healthy Automation Journey The following steps can help ensure that payers' automation endeavors remain on track and deliver significant business benefits. 1 Re-assess use case inventory to validate which cases are fit for automation. Ensure automation is a strategic priority, with support and commitment throughout the organization. 3 Establish joint business and IT ownership and encourage cross-functional collaboration. 4 Create a governance structure that enables an enterprise approach to automation. 5 Institute an organizational change management strategy. Utilize a metrics-driven methodology to ensure the right processes are selected for automation. 7 Design the structure, resource and support models as early as possible. Define and agree on criteria for success at the enterprise and individual process levels. 10 Ensure internal competencies and capabilities are scalable. To learn more, read our whitepaper "Applying Automation to What Ails Healthcare" Source: Cognizant Survey base: 200 respondents from U.S. healthcare payers industry © Copyright 2019, Cognizant. All rights reserved. No part of this document may be reproduced, stored in a retrieval system, transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without the express written permission from Cognizant. The information contained herein is subject to change without notice. All other trademarks mentioned herein are the property of their respective owners. Codex 4966 OIIIII Al

10 Steps to Revitalize Healthcare Payer Automation

shared by cognizant on Oct 08
Automation is making inroads into U.S. health plans to improve efficiency, care and benefits administration, yet many payers are struggling to realize meaningful returns.




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