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Steven GerhardtMANAGING PARTNER, CEO

[email protected]

10615 Shadow Wood Drive, Suite 240 | Houston, Texas 77043 | (832) 532-4056 | ElementBlue.com

HEALTHCARE INNOVATION, DELIVERED .

PROV IDER AUTOMAT ION SOLUT IONS

Revenue Cyc l e Bo t s i n Ac t i on fo r Succes s fu lRPA Imp lementa t i ons

Introductions- Element Blue- RPA Technology

- Current state of RPA in health care providers

- Reference hospital related use case automations

- The backlog in patient access and pre-services - Developing bots in payor plan mismatch with EPIC- Other opportunities and work queues- Performance measures- Lessons learned

- Best practices in developing an RPA project and new automation program models

- Recent opportunities with COVID-19 related automation

Agenda

YOUR DIGITAL TRANSFORMATION COMPANY

Digital Engagement andOnline Portals

Providing mobile, contentmanagement, search and

portal applications for morethan 20 years

Admissions and ReferralManagement

Pre-admission automation,Authorization workflows,

referrals management; providingvisibility into patient satisfaction

and metrics with CRM

Digital Business AutomationExperts with significant projects in

customer experience andautomation; developing process and

re-engineering revenue cyclemanagement, admissions

Healthcare Practice

Being health-tech advisor

–interacting with business patients and providing coaching online, in real

time

Generating loyalty and patient satisfaction

by addressing needs and expectations,

nurturing relationships, and creating positive

word-of-mouth advertising

Using technology to become more

accessible to patients conveniently

–when they want, how they want

Creating better value for patients

-

at a more personal, tailored level

Accelerate the processes of the patient’s care and

improve quality–

family members,loved ones, home care professionals, referring

physicians

Engaging and empowering individuals

-to mange health,

increasing compliance and supporting

prevention and wellness

Supporting Patient Access To Care

YOUR DIGITAL TRANSFORMATION COMPANY

Customers & Partners

• Healthcare represents largest industry we support with 60% of revenues coming from healthcare providers

• Patient/Physician Portal integration capabilities and references with EMR integration

• Extensive experience working with Revenue Cycle, Marketing and IT in large providers and aligning organizations with project management and services

• Attend and speak regularly at HIMSS, Greystone HCIC and SHSMD conferences

• Patient referrals and admissions integrations

• Clinical communities enabling care coordination across multiple settings with physicians and nurses

RPA AND THE HEALTHCAREOPPORTUNITY

What Can Automation Deliver to a Healthcare Organization?

Robotic Process Automation Customer Outcomes

Accelerate Benefits From DigitalTransformation

Improve Customer Experience

Reduce Compliance Cost & Risk

Increase Employee Satisfaction & Engagement

Emulates a person by executing manual, repetitive tasks

Makes decisions based on set rules

Integrates with existing applications

Connect to system APIs

Move files and folders

Open emails and attachments

Make calculations

Log in to any application

Extract content from documents, PDFs, emails and forms

Read and write to databases

Scrape data from the web

Software Robots Can Mimic Humans

For example:

Ideal Process Candidates: High-Volume, Business-Rules-Driven, Repeatable

Healthcare Functions Prime for Automation

• Schedule Management

• Registration

• Insurance Verification

• Prior Auth/Pre-Cert

• Document Intake

• Financial Planning

Patient Access

• Screening

• Charge Capture

• Coding & Documentation

• Utilization Management

• Value-Based Care

• Clinical Data and

Analytics

Consultation & Care

• Insurance & Patient Billing

• Cash Application

• Payment Posting

• Denials Management

• Account Follow-Up

• Payment Audits

Revenue Cycle

RPA AND THE STATE OFHEALTHCARE PROGRAMS

Finance & Accounting Leaders face Three Major Challenges

Streamline financial and accounting operations

Minimize exposure to financial risk

Become a strategic partner with the

business

• Digitize operations to position the business for growth

• Optimize to remain relevant and competitive

• Predictable and sustainable growth

• Shift staff from swivel chair work to creative, critical thinking activities

• Reskill F&A talent to focus on advising and consulting

• Provide strategic insights, deep analytics and dynamic reporting

• Continuously evolving regulations are addressed with highly manual processes

• Compliance processes are error-prone and complex

• Support Merger & Acquisition Activities

“ 93% of finance leaders agree that their CFO actively supports an innovation culture by pursuing technology

initiatives that impact strategy.”2019 Grant Thornton CFO Survey

15Slide /

True Enterprise RPA

Current State of RPA

and Healthcare

Providers

Healthcare Innovation, Delivered.

• Revenue Cycle has captured front page news

• CFO, Finance, VP of Revenue Cycle

• Driving it Home: HFMA, Insurance, Finance Leaders

• Budgets and Ownership split with IT

• Tech knowledge and Support are Lacking

• Mixed Results

Providers Moving to Think Patient First with Automation First

• Identify Needs Aligned to the Patient Experience: Optimize Key Service Moments

• Patient Liaison, Patient Access, Nursing

The Automation First Blueprint Program Starts with Service Moment Automation

Healthcare Innovation, Delivered.

CURRENT RPA USE CASES

Cleveland Clinic

Process

Automated claim edits and registration eligibility

SystemEpic

Results

• Volume: 8000 avg per month

• $700,000 in benefits

• Resubmit Claims: 30% to 100%

• Cycle Time Reduction 80%

West Tennessee Healthcare

Process

Automated data entry of encounter information

SystemCerner

Results

• Volume: 3,500 – 4,100 per mth

• Labor Hours Saved: 1.0 FTE

• Reduced errors 30% to 2 %

• Improved Staff Satisfaction

Kaiser Permanente

Process

Automated EHR pre-migration regression testing

SystemEpic

Results

• Volume: 3000+ test scripts

• Labor Hours Saved: 6 FTEs

• Accuracy Up: 40% to 80%

• Cycle Time Reduction: 60%

Healthcare Use Cases – U.S.

https://uipath-my.sharepoint.com/personal/bryne_leggett_uipath_com/Documents/Documents/Demos/Videos/Healthcare_RCM_DeniedClaimsResubmission_EPIC.mp4

https://uipath-my.sharepoint.com/personal/bryne_leggett_uipath_com/Documents/Documents/Demos/Videos/WTH_RevCycleBot.mp4

1. Lab Order Processing

2. Patient Scheduling

3. Patient Pay Collect Reconciliation

4. Patient Referrals

Digitized lab order OCR with ABBYY infrastructure supported by UiPath intake directly into the EMR

Create new appointment in specialty EMR with patient schedule information from EPIC scheduling

Automated ledger balancing with 200,000+ accounts between outsource collection agencies and internal patient accounting system

Automated referral processing into EPIC from in-bound web forms or RightFax. 85,000+ out-of-network referrals processed annually

Process patient payor (self-pay) plan updates for payor coverage changes in an EPIC RTE mismatch work queue

5. Payor Plan Mismatch

Reference Blueprint Examples by Element Blue

PAYOR PLAN MISMATCH WORKFLOW PROJECT

October 2019

Uninsured Rates

total TX population

27.6 million

TX Expansion Status:

Adults in Coverage Gap:

759,000

Not Adopted

In TX, Medicaid Covers:

TX Eligibility

Levels

100% of FPL: $21,330 for a family of three; $12,490 for an individual

of adult Medicaid enrollees are working in TX

of children with special health care needs are

covered by Medicaid in TX

57%

50%

32% 17%

(as a % of FPL)

of TX population is low-income(<200% FPL)

of TX population is covered by Medicaid/CHIP

MEDICAID IN TEXAS

206% 203%

17% 0%74%

Children PregnantWomen

Parents ChildlessAdults

Seniors & Peoplew/ Disabilities

5 in 8 nursing home residents

2 in 5 children

1 in 12 adults, ages 19-64

1 in 3 individuals with disabilities

1 in 6 Medicare beneficiaries

25%

17%20%

10%

TX US

2013

2017

October 2019

Uninsured Rates

total TX population

27.6 million

TX Expansion Status:

Adults in Coverage Gap:

759,000

Not Adopted

In TX, Medicaid Covers:

TX Eligibility

Levels

100% of FPL: $21,330 for a family of three; $12,490 for an individual

of adult Medicaid enrollees are working in TX

of children with special health care needs are

covered by Medicaid in TX

57%

50%

32% 17%

(as a % of FPL)

of TX population is low-income(<200% FPL)

of TX population is covered by Medicaid/CHIP

MEDICAID IN TEXAS

206% 203%

17% 0%74%

Children PregnantWomen

Parents ChildlessAdults

Seniors & Peoplew/ Disabilities

5 in 8 nursing home residents

2 in 5 children

1 in 12 adults, ages 19-64

1 in 3 individuals with disabilities

1 in 6 Medicare beneficiaries

25%

17%20%

10%

TX US

2013

2017

Nationally Medicaid Pays For:

75%85%

65%

Total Democrats Republicans

National Share of Those that Hold Favorable Views of Medicaid

88% 86%85% 87%

57% 51%

Doctor Visit AmongAdults in Past Year

Satisfied with InsuranceCoverage in Past Year

Medicaid Private Uninsured

National Access & Satisfaction Measures

Eligibility

Delivery Systems / Provider Payments

Premiums / Cost Sharing

Benefits

Waivers

States Have Flexibility in Their Medicaid Design

Federal Standards

* Fee-for-Service

1 in 2 dollars on long-term services and supports

$$

$$$$$$1 in 6 dollars in the health

care system

TX Medicaid Enrollees & Expenditures Total TX Medicaid Spending by Service: $38.2 Billion

Elderly & Disabled

23%

Elderly & Disabled

63%

Adults & Children

77%

Adults & Children

37%

Enrollees Expenditures

Acute Care* 25%

Long-Term Care* 11%

Managed Care 56%

Payments to Medicare 3%

Disproportionate Share Hospital Payments 5%

Medicaid / Payor Plan Mismatch

Challenge

The Epic RTE function queues are provided on a plan by plan basis. A “plan mismatch” queue holds up patient scheduling or may affect back-end claims, and therefore requires resolution. This is a relatively simple bot operation to update a patient record with payor plan changes.


Solution

Pre-Service Status

Updated to Complete

Log into EPIC &

Navigate to Work Queue

Open patient record and inspect plan status info

Mismatch, Self-pay,

Estimation, Notes

Corrects with Updated

Information

Challenge



Results

400+ Hours

work per month

85%Cycle Time

Improvement

4-6 WeeksDesign to Production

90%Mismatch Claims

being processed –up from 30%

Challenge


Solution

Pre-Service Status

Updated to Complete

Log into EPIC &

Navigate to Work Queue

Open patient record and inspect plan status info

Mismatch, Self-pay,

Estimation, Notes

Corrects with Updated

Information

The bot uses its own, personal credentials to log into the Epic system. This enables status reports, productivity checks and other metrics to be used in order to assess the bot's performance as a digital worker.

This is the patient work queue which the bot will process

Bot pre-filters list based on similar statuses in the queue:

i.e. Mistmatch, Self-Pay, E-Rejected, E-Verified

The bot opens a patient record and, depending on the status of the patient, it will then add a new coverage, add a self-pay estimate, etc.

Upon closer inspection of the patient's response history, the bot identifies there has been a plan mismatch and sets to add the new coverage indicated in the response to the record.

If no alternate plan, another status is likely, and bot will continue with another path to resolve

This screen shows the bot using the coverage search function to find the plan indicated before

Once the bot is done adding a new coverage - or if it identifies the record as something other than a mismatch - it will navigate to referrals and add a note to verify that the record has been reviewed.

The bot changes the pre-service status of the record to complete, allowing the record to 'leave' the work queue before moving on to the next record

Revenue Cycle Bot Productivity

Plan Medicaid Mismatch 820 records completed

Self-Pay/Out-of-Network 2,550 records completed

Cumulative monthly reporting

§ 5 unattended bots – number of queues

condensed to one

§ 1 service account. Scaling to four bots soon.eVerified 621records completed

eRejected 296 records completed

Elapsed 451records completed

BEST PRACT ICES IN RPA PROGRAMS

Program Summary

HOSPITAL INTELLIGENT AUTOMATION

OPERATING MODEL

PIPELINE MANAGEMENT GOVERNANCE IMPLEMENTATION APPROACH WORKFORCE MANAGEMENT

QUALITY MANAGEMENT– Automation Reviews– Customer Surveys– Stakeholder Focus Groups

PERFORMANCE AND ANALYTICS– COE Performance– Employee Performance– Benefit Realization

SERVICE DELIVERY MODELTECHNOLOGIES

COMMUNICATION AND CHANGE MANAGEMENT

Digital Workforce

Mgmt.

Human Workforce

Mgmt.

Functions Process Owners Business Units

Program Organizaton Balance hierarchy with speed of decision-making

Intelligent Automation Program Steering Committee

• Aligns strategy and assets with decision-making authority

• Has overall program responsibility

• Reviews program status monthly

• Approves changes in program scope that require revising the level of effort, fees or time.

Intelligent Automation Program Management Team (Program Manager)

• Responsibility for all IA program activities.

• Meets weekly with business stakeholder, technology, project managers (Needs, Risks, Technical, Change, etc.) to review project status and major tasks.

• Project integration / Quality control

• Reviews new requirements beyond the initial project scope, that that do not require Steering Committee approval.

• Detailed program planning and status monitoring

• Identify problems and track resolution

Intelligent Automation37

Project Outcomes and Deliverables

• Overall solution is documented

• Test cases are built and test data is identified

• Automations are developed• Deployment plan is created

• Solution is tested and deployed on production environment

• Solution is stabilized and handed over to operations team

• Documentation is updated• Lessons learned are

captured

Analysis Solution Design Hyper-Support

• In scope processes are documented to the most detailed steps, including exceptions and how these are handled

• IT Security and Compliance requirements are identified

• Operating model components (e.g. Governance, Change management, Release Management) required for delivering the engagement are in place and clear to all parties involved

• Delivery team is assembled

• The plan for delivering the project is built

Planning TestingDevelopment

Out

com

esD

eliv

erab

les

Project Plan

Team charter

Risk matrix

Infrastructure architecture

Status Report

Process Definition Document (PDD)

Solution Architecture Document (SAD)

Test Cases & Data

Updated PDD

Updated Project Plan

Development Specifications Document (DSD)

Move to Production Document (MTP)

Updated SAD


UAT Report

Handover to Operations Document

Updated DSD

Updated MTP


Lessons learned

Updated Handover to Operations Document

Process Modeling


Modeling to Document Existing Processes

• Describe the existing process and design for the “to-be” and get user buy-in

• Use a tool such as MS Visio or Blueworks Live to communicate with stakeholders

Patient Pre-Authorization Workflow Example

Introducing New Tools from UiPath

• StepShot – document processes faster and generate the necessary document quickly

• ProcessGold – visualize your processes in motion. While BI tells you where your problems are, Process Minining tells you WHERE you need to go.

39

The Leading Enterprise RPA PlatformRPA COE types

ADVANTAGES:– Unified and centralized RPA IT support for all BUs– Expertise, lessons learnt & best practices easier to

disseminate – Standardized RPA processDISADVANTAGES:– Automation prioritization challenges – Relies on distant communication

ADVANTAGES:– The main COE handles the most complex

projects while the smaller COEs cover the rest– Decreased risk of prioritization challenges due

to smaller and dedicated RPA COEs– Higher process knowledge specific to business

units concentrated in the smaller RPA COEsDISADVANTAGES:– Discrepancy in know-how between main &

smaller RPA COEs– Potential incoherence in process

methodologies

ADVANTAGES:– Each business unit drives and is fully in control

of automation projects and their prioritization– All RPA COEs are close to each business unitDISADVANTAGES:– Regular exchange of best practice across

different business units must be enforced– High risk of incoherence in process

methodologies– Incoherent technical solutions may be applied – Certain RPA roles will be duplicated

Center of Excellence

(COE)

Business Unit

Business Unit

Business Unit

Business Unit

Business Unit

Business Unit

Business Unit Center of

Excellence(COE)

COE

COE

Business Unit

Business Unit

Business Unit

Business Unit

Business Unit

Business Unit

Business Unit

Business Unit

Business UnitBusiness

Unit

Business Unit

Business Unit

Business Unit

COE

Business Unit

COECOE

COE

COE COE

COE

There are various models for COEs ranging from a centralized delivery model, to a model where the COE empowers other business units to build their own COEs within a framework set out by a central COE, or totally independent of each other.

CENTRALIZEDOne RPA COE serving all Business Units.

HYBRIDOne main RPA COE, linked to several smaller

RPA COEs dedicated to business units

FEDERATEDIndependent RPA COEs within each business

unit.


Must Haves

PROCESS FEASIBILITY ANALYSIS

CLEAR PROCESSSCOPE DEFINED

CHANGE MANAGEMENT

CLEAR SUPPORT MODEL


Process Feasibility Study

PROCESS FEASIBILITY ANALYSIS

– Prevents working on processes that have very fragmented scope and low number of benefits associated with High development effort

– Considers future project activities, type of activities that will become obsolete versus new initiatives

– Analyzes the up stream and down stream effort and changes that intervene in the process, validations required and quality checks performed

– Analyzes the impact of the systems and applications used.

– Data availability of HC and volumes to be prepared and available, current and historic data.

Process Scope Definition

CLEAR PROCESSSCOPE DEFINED

– Linear process description is essential. Process explanations that are not fully captured in the deep dive will produce exceptions later impacting the designs and development timeline.

– Process alignment should be done by the business and IA team upfront to have an unitary view on the process steps and rules.

– Process deep dive sessions should be run face to face and SHADOWING, as much as possible. Developers should be involved in the process deep dive sessions.

– Stand up a Department of Intelligent Automation (DIA)

– Build the necessary IT infrastructure to support UiPath

– Work with the Application Leads to evaluate opportunities

– Partner with your departments on how to evaluate opportunities

– Embed developers within each department

– Engage HR early and often for change management and workforce transformation

Lessons in the Operating Model

RECENT AUTOMAT ION OPPORTUNIT IES WITHCOV ID -19

45

True Cost of COVID – Automation for Business Continuity

Healthcare System Capacity

Number of COVID Cases

Volume of Claims/Related Transactions

Cash and Equity

• Billing volume related to COVID19 could be 20x more than normal volumes seen at seasonal peaks. Furlough will create larger backlogs as the denied claims could go untouched

• Automation strategy as part of business continuity planning will reduce backlogs while handling ongoing volumes

• Current proposed legislation would encourage more telehealth operations and full patient access to their health data. Interoperability and full transparency will need be resolved knowing many platforms will not have API capability

Ops Staff

Automation Strategy is needed to manage volumes to keep Opex low allowing time for low risk recovery

46

Key COVID Trends:

Supply Chain Disruption –Reduction in Business Activity

Just in time to stockpiling has started. Quick onboarding of new vendors is difficult and not

fast enough

Health and safety of employeesTracking employee health to ensure front line

staffing is not a current process. Ability to ensure habitual response and analysis is important

Health Data interoperabilityState and federal level reporting on infection control and inventory is now 3x per day. Not

easy for a non-connected HIT

Healthcare InfrastructureHospital staff is typically not work from home and

HIPAA compliance is hard to control remotely. Infosec will need new audit practices

Rapid increase in queues & ClaimsFuture appointments for cancelled surgeries

and backlog of COVID related claims are quickly building (Avg pend is 10,000 claims as

of 4/1)

Reduced Financial Health & Liquidity

Cash flow has been reduced by 40% with mass furlough being necessary to sustain

cash

47

Mobilize: Immediate tactical automation to support the front line and ensure patient transparency and treatment (Attended Strategy)

Sustain: Automation strategy in conjunction with continuity planning to keep services and cash flowing(Unattended Strategy)

Evolve: Transformation to adapt to new Healthcare standards and tele/social health practice (Hyper Automation Strategy)

April – May: Next 30 Days May – October : Next 60 Days October – Q1: Next 120 Days

Front Office & Clinical

Operations and RCM

Supply Chain

• HR: Short Term disability questions and claim submission

• HR: WFH designation and tax adjustments

• Clinical: Testing registration• Clinical: Daily CDC and State reporting

IT/Application

• Staffing: Daily health survey• Staffing: Skill set re-alignment/matching• Contact Center: Chat bot surveys and

information requests. • Telehealth: Realtime telehealth solutions• Credentialing: Provisional reviews.

• NOC: SSO resets/self service• NOC: Chat bot for L1 technical questions• Infra: VM spin up/level loading• Compliance: Access and log audits• Testing: Rapid application testing (chat

bot, telehealth, EMR workflows)

• Procurement: Pass through ordering for authorized vendors (Stockpiling)

• Inventory: Inventory dashboards for real time shortages

• HR: Furlough adjustments for benefits and pay

• HR: Temp staff onboarding• HR: ST disability for Mental distress• Clinical: Digital appointment and UM

management

• Staffing: Timecard for temp staff• Contact Center: Eligibility/PreCerts• Contact Center: Adverse effects hotlines

for vaccinations. • RCM: U07.1/U07.2 mass claim billing• RCM: Cash/Credit Adjustments

• IT Procurement: L1 and L2 approvals and ordering

• NOC: Self service for account set-ups and onboarding/offboarding

• Testing: EMR quarterly update testing regression

• Procurement: Mass vaccination ordering

• Payments: 3-way PO match• Inventory: Inventory balancing across

storerooms

• HR: Quick rehiring and onboarding• HR: COVID Testing/Vaccine tracking• Clinical: Medicare Eligibility and PAP

services• Clinical: Predictive reporting on

readmissions and pop health

• Credentialing: Full credential renewal at 180 days

• Contact Center: Referral coordination• RCM: Prior Authorization • RCM: EOB/835 Insurance changes• RCM: Medicare mismatch and rebill

• Infra: FHIR conversion for API end point (CARES)

• Infra: Onboarding service account provisioning• Testing: Platform and mobile testing• Testing: Process testing/failure reporting

• Inventory: Supply decommissioning/reclamation

Continuity Planning with Automation for COVID19