The Next Step in UnityPoint Health’s Revenue Cycle Technology Journey

Machine learning in the revenue cycle

As providers move along the revenue cycle technology journey, they can start to connect automated tasks through multi-step automation and prime their processes for machine learning and other more sophisticated analytics capabilities.

Multi-step automation includes multiple automated tasks or actions sequenced and interconnected to accomplish a more complex workflow or goal. Each step or tier in the automation hierarchy builds on the previous one while adding more sophisticated intelligence to the automation system.

“We are looking to allow machine learning to facilitate some of our multi-tier automation,” Shirley said. A good use case for this at UnityPoint Health is denials management.

“We use machine learning to help us understand which types of denials are likely to win an appeal or have a strong likelihood of ultimate final denial, those sort of things,” Shirley stated.

Machine learning can use historical claims data to identify trends in denials by type of claim or payer, as well as pinpoint factors contributing to claim denials. The algorithms take patient demographic data, coding errors, documentation inconsistencies, payer-specific rules, and other data sources to then predict the chances of denials for future claims.

With support from automation and machine learning, UnityPoint Health has been able to prioritize claims and resources.

“We’re able to prioritize denials to get those that are most likely to be overturned or most likely to yield cash back to one of our patient account representatives to work on,” Shirley explained. “Whereas denials with lower likelihoods, we deemphasize chasing them or, even in some instances, elect not to pursue an additional appeal because the likelihood of additional reimbursement is not worth the cost of labor.”

Patient-facing technology

The back end of the revenue cycle has been ripe for automation because of its repetitive nature. But as providers move along the revenue cycle technology journey, there comes a time to tap technology to optimize front-end processes. At UnityPoint Health, that moment has come and the revenue cycle has focused on using technology to reduce friction in the patient experience.

“We want to be able to meet our patients wherever they may be, whether that’s through self-service or a high-touch, in-person communication,” Shirley said. “We recognize our patients want to engage with us in different ways and we need to be able to deliver opportunities for patients to do that.”

The health system has leveraged its Epic EHR system to provide self-registration kiosks in some facilities, as well as self-scheduling and registration via the patient portal. Additionally, patients can leverage self-service tools in the emergency department using their own devices. This avenue can reduce stress in an emergency medical situation by allowing patients to skip the patient access visit and, in some cases, prevent a follow-up for paperwork.

“Rather than a patient doing a deep interview with one of our team members in a facility, we are allowing patients to walk through the admissions questionnaire or our pre-registration packet in the comfort of their own home in their own time at their own pace,” Shirley elaborated. “It has been really well-received by our patients, too, so we expect to roll out more digital connectivity tools across our organization over the next few months.”

Patient-facing technologies have also supported staff by making some front-end revenue cycle processes more efficient. The tools free up skilled staff from having to complete paperwork, especially during more difficult-to-staff times like overnights and weekends and in more rural areas where the health system sees more workforce challenges.

Taking a step back

The natural next step in the technology adoption journey is to implement more sophisticated technologies. However, digital transformation should not happen overnight, especially in the revenue cycle. UnityPoint Health has ensured that the organization understands how to manage existing automation before taking the next step.

“We need to ensure that we are comfortable and that we understand what we were doing with our existing automation,” Shirley asserted. “We have structures in place to monitor those automations, so we really know what we were trying to accomplish by moving to those next levels of automation.”

Shirley also realized that automation could not streamline every revenue cycle process.

“There’s a unique, human touch required for clinical denials, for example,” Shirley explains. “We can take away some of the menial parts of interpreting medical records and being able to deliver appeals in an appropriate way, but automation didn’t really make us more efficient with utilization management reviews.”

Some patients also prefer to speak with a patient access representative for scheduling and registration, and UnityPoint Health understands that. The health system still offers in-person or telephonic options for those patients.

UnityPoint Health ensures that its digital transformation of the revenue cycle is intentional so the health system is never “automating for automation’s sake,” according to Shirley.

As for the health system’s next step, the revenue cycle is looking inward now that it has established front and back-end automation.

“The next frontier for us, I think, is the middle of the revenue cycle within the clinical documentation improvement space, so we are looking at opportunities to use automation there,” Shirley said.