Applying AI + HI (Human Intelligence) for Revenue Cycle

By Infinx
February 28, 2019
06:28 am

A HIMSS’19 Session by Infinx’s VP of Products, Navaneeth Nair

On February 14, Infinx’s VP of Products, Navaneeth Nair presented at the HIMSS’19 Lightning Session, “Applying AI + HI (Human Intelligence) for Revenue Cycle” in Orlando, Florida. Navaneeth addressed the rapid development and improvements in AI algorithms and how their ability to impact healthcare payment collections will have significant implications on prior authorization and revenue cycle management processes.

AI = Augmented Intelligence

A lot of people insist a machine can do it all, but that just isn’t the case.

Decision-making, as it applies to the healthcare industry at least, still requires human intelligence and human empathy. As a result, it is more accurate to call AI “augmented intelligence.” AI exists to help humans make better decisions in the field of healthcare, not to automate 100 percent of a task.

“Artificial intelligence constitutes a host of computational methods that produce systems that perform tasks normally requiring human intelligence. However, in healthcare, a more appropriate term is ‘augmented intelligence,’ reflecting the enhanced capabilities of human clinical decision-making when coupled with these computational methods and systems.” — American Medical Association

The healthcare industry is swimming in data. We are up to our eyeballs in it. As a result, the value proposition with the most potential is a tool that can take that data, make sense of it, and present it in a way that allows humans to make the best possible decision. It is important to point out that machines do not make the decision. The outcome is still very much a product of human determination.

Man + Machine Will Transform Healthcare

The best possible outcomes are the result of good intelligence and great execution. At the moment, administrative processes such as prior authorization or revenue cycle management processes are precisely the place where we think we can apply now AI and extract the greatest value.

In the graph below, Accenture has identified the top potential AI applications in healthcare in 2026. While robot-assisted surgery and virtual nursing assistants top the list, the administrative workflow is in third with a potential annual value of $18 billion. Most of that value will be created by creating easier integration with existing technology infrastructure.

The most significant value proposition for AI is not the machine’s ability to make critical healthcare decisions, but the ability to take administrative processes off the plate of humans who have more important things to do. The most valuable systems are those that help people make better decisions and actions while learning continuously.

Make no mistake, digital labor will upend the healthcare processes. How? It will accelerate current employee expertise, augment decision making, reduce manual processing costs and risk, increase consistency of output, and develop continuous self-learning processes.

A Complete Solution Requires Many Dimensions

In general, Infinx’s platform for the healthcare revenue cycle has three buckets: robotic automation, artificial intelligence and our deep domain expertise, otherwise known as human intelligence or our prior authorization, coding and billing specialists.

The robotic automation can handle the administrative “grunt work” — non-essential tasks that experts shouldn’t be wasting their time on. This results in significant reductions in process cost with improved quality.

The AI is in place to continuously learn and improve from all data and interactions and provide humans with an ever more accurate portrait of the process. Ultimately, its job is to enable intelligent decision by applying both human and machine learning including natural language processing and understanding. When decision making is more predictive, it improves outcomes.

The humans are required to make the decisions that robotic automation and AI cannot; i.e., to tailor the patient’s experience to their individual context and needs.

Domain Expertise and Transparency

Models are inherently simple to build but difficult to maintain. That’s because none of our healthcare processes remain stable enough that the data and patterns are unchanging. So you need the ability to be seamlessly integrated to the process and constantly accessing that data.

AI is useless without automation capability. If you don’t have a plan of action for the data, the data is not going anywhere. It is isolated and useless. This requires extensive domain expertise and transparency. What is the machine doing? What are you responsible for? And how are you going to be held accountable for the outcomes? This is a big change management problem for organizations and cannot be overlooked.

Prepare to Execute

  • Rethink your processes for a man + machine workflow
  • Instrument your systems to capture all “action” data
  • Spot Analytics solutions branded as AI
  • General purpose AI solutions will require significant investments with uncertain results
  • Products embedded with AI for specific problems are more tangible than AI first products
  • Evaluate actual results before believing in the hype

About Navaneeth Nair & Infinx

Navaneeth leads product vision and execution of a new generation of healthcare products designed to increase revenue capture and enhance patient satisfaction for Infinx’s provider clients. He has been in healthcare technology for more than 17 years focused on patient experience and access with the largest healthcare payers and providers, including Aetna, Anthem, Ascension, MD Anderson, and others. For the last six years, he has been focused on the application of AI to engage patients in their health and amplify business process improvements.

Infinx provides innovative and scalable prior authorization and revenue cycle management solutions for healthcare providers, hospitals, imaging centers, and laboratories. Combining intelligent, cloud-based software driven by artificial intelligence and automation, with exception handling by our preauthorization and billing specialists, we help clients preserve and capture more revenue, enabling them to shift focus from burdensome administrative details to billable patient care.

Click here to view the recording of Navaneeth’s HIMSS’19 presentation.

Schedule a demo today and learn how Infinx can maximize revenue in your payment lifecycle.

About the Author

Infinx

Infinx

Infinx provides innovative and scalable payment lifecycle solutions for healthcare practices. Combining an intelligent, cloud-based platform driven by AI with our trained and certified coding and billing specialists, we help clients realize revenue, enabling them to shift focus from administrative details to billable patient care.

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