Revolutionize Healthcare Dynamics with Robotic Process Automation

Revolutionize Healthcare Dynamics with Robotic Process Automation

With the growing population of Care receivers, healthcare providers are confronted with managing, member data, billing, medical coding and processing claims. To outsmart these operational roadblocks, more and more healthcare providers and payers are adopting Robotic Process Automation (RPA) to address challenges and steer enhanced growth and efficiency. Healthcare is forecasted to have an automation potential of 36% (Source: HfS Research 2017). It implies that more than one-third of healthcare operations—largely back-office and managerial tasks can be automated, enabling healthcare providers to provide enhanced and value-based care to the patients at reduced costs with even more efficiency.

RPA Industry Overview

RPA is a software development framework that facilitates the quick and easy creation of “software bots” or “robots” that can automate the entire business processes following preset rules. At an elementary level, RPA replicates the human interactions with the internal systems. It is an advanced application that needs simple integration with the existing IT systems, helps eliminate the need for human intervention to finish the tasks. Organizations that involve high-volume and labor-intensive processes find the best applications of RPA.

Though the healthcare industry isn’t the first thing that comes to our mind when it comes to implementing RPA, it can competently eliminate the repetitive tasks involved in healthcare workflows and optimize efficiency. The ever-increasing patient inflow over years, the need for effort-free, competent and cost-effective processes such as billing, coding, claims processing, etc., has gained importance— RPA can cater to these needs.
“According to HfS Research, the global RPA market will reach a $1.2 billion mark by 2021 at a CAGR rate of 36%.”


According to HfS study “Healthcare industry is foreseen as one of the fastest adopters of RPA and carries huge growth potential in the years to come.” RPA presents an opportunity to reorder the administrative tasks for the healthcare sector by substituting dreary tasks that restrain the information flow.
RPA Market- United States

According to Grand View Research, in the United States, “Healthcare is one of the early adopters of RPA and is anticipated to experience tremendous growth.”

RPA offers significant opportunities across industries by optimizing the inefficient business process and facilitating improved services. RPA helps to streamline the administrative processes for the healthcare segment by replacing repetitive tasks that hinder information flow.

The regional insights of recent studies revealed that north America has dominated the RPA market in 2016, and the same trend is likely to continue over the projected period (2014-2024). The key reason for its dominance is the increased diffusion of automation and process management solutions in this region. Besides, the virtual workforce sector is also developing, with many virtual workforce agencies increasing their footprint in the U.S. market.

Challenges in the Healthcare Industry

With many players in the healthcare landscape, i.e., Providers, members, insurance companies, pharmacy networks, suppliers etc.; the road to streamlining has many barriers. Some of the major Opportunities for improvements within the Healthcare industry include

1. Labor shortage         

When it comes to healthcare, quality of care is more important as members start to use their right to select the healthcare provider they want according to their needs and preferences. As the demand for clinicians is increasing rapidly, the population of clinical staff is not in line with this rising demand. All these factors contribute to the lack of quality patient care and overwhelm the doctors with more patients along with other office needs they need to look after.

2. Healthcare Costs

According to the research of Medical Sociology & Public Health:

“U.S. being the world’s biggest healthcare industry is spending approximately $3 trillion every year.”

A new study by Journal of the American Medical Association reveals that

“In 2016, U.S. had spent almost 17.8% of its GDP only on healthcare itself which is almost twice the average of other developed nations”.

Facts disclosed by other studies are:

  • 30% of the overall costs are due to Medical errors
  • Unavailing end-of-life treatments, additional tests, deceit and misdiagnoses are steering up costs

Both providers and receivers of healthcare are facing challenges with macroeconomic factors such as aging populations and inadequate public funding. So, it is imperative to for healthcare systems to restructure the processes, optimize the resources and reduce the healthcare costs.

3. Varying Demographics    

Healthcare is a growth-centric sector that constantly evolves with the increasing number of patients year by year.

A recent report from Census Bureau reveals that.

“By 2035, the population of people aged 65 or more is likely to reach 78.0 million in U.S., outnumbering the children population.”

It’s an alarming increase and the key concern here is the shortage of healthcare staff to accommodate this abrupt increase in patients. So, the healthcare providers realized the increasing need to opt for more accurate and efficient processes for better utilization of resources, providing quality care for an increasing number of patients.

 “Healthcare Automation + Robotic Process = Improved Care”
RPA’s Value Addition to Healthcare

4. Data Entry & Migration

Following footprints of other industries, healthcare is also embracing digitalization. Patient information is now available online and can be easily accessed by the doctors and patients as well. RPA effectively automates the data transfer from legacy systems to advanced digital systems. It provides easy access to the patient’s medical history and facilitates transparency.

5. Revenue Cycles

The technology’s capability to boost revenue cycle and administrative practices is valuable for organizations. Often, outdated systems have to manage code changes that occur during the billing cycle. However, RPA can effortlessly and seamlessly adapt to these changes. It automates the tedious, repetitive and time-consuming processes, for example, accounts payable, data digitization, which can highly reduce the error rates and enhance the billing efficiency. Hence, providers can save a lot on the resources.

6. Claims Management

Claims handling is one of the time-consuming tasks that healthcare administrators face. This includes entering and processing claims and modifying them and handling the appeals. The RPA-equipped systems help the organizations stay ahead of the curve of claims digitization. Though the technology has just made its entry, in the future it holds a great potential to transform the manner the healthcare industry works.

7. Claims Adjudication

Adjudication, in healthcare, refers to the process of paying the submitted claims or denying them after weighing claims against coverage requirements. It can be an expensive, complex and extensive process.

Using RPA, a rule-based code can be developed to automate this process and enable decision-making based on the established terms and conditions enclosed in the contract. So, it dramatically reduces the time and effort in carrying out this complicated process.

A recent report by Alsbridge debates that the “cost savings alone by using RPA solutions is reason enough for the healthcare sector to notice process automation.”

8. RPA as an Integral Part of Healthcare

With more people entering the healthcare system in the coming years, RPA is a critical tool for healthcare providers, Payers to better restructure the processes, cut-down on labor costs, achieve efficiency and increase the quality of patient care. There are different areas in healthcare where RPA finds its applications including, claims processing, account management, revenue cycle management, customer support, underwriter support, reconciliation, billing, reporting and analytics.

The potential applications of RPA in healthcare according to HfS Blueprint Report are: Claims administration, Member management, Provider management, Health and care management and administration.

Smart automation is making its way to the business world, and Financial Heads are happy as RPA is proving its cost benefits. Though top executives are not satisfied with only cost-benefits, instead, they look for the value-proposition that comes along with cost-benefits.

The quest has reached beyond quality, cost reduction, innovation and engagement. This new wave of sourcing will manage resources to transfer workers from the routine tasks to activities that need better customer interactions.

Healthcare leaders are using robotics as an instrument that steers the next phase of the transformation, with significant cost-benefits. Robotic Process Automation is no more the thing of future—it here already!