EmpowerMe, an organization that provides health care services to more than 1,000 senior living communities across 38 states, regularly receives denials from its insurers for procedures or treatments. value that they must pay.
That means employees have to go through a lengthy process of appealing these denials to get the money the health care organization would have received.
PROBLEM
This is extremely time consuming and requires certified clinicians to spend hours researching each individual case to draft and submit the appropriate complaint. With the industry experiencing a labor shortage, the problem becomes even more difficult.
PROPOSE
The proposal from Crosby Health, a provider of artificial intelligence-powered technology called Apollo, was to handle most of the complaint letter drafting for EmpowerMe.
“Apollo will analyze each case and draft an appeal,” said Dr. Jody Mitchell, chief medical officer at EmpowerMe. All our clinicians have to do is review them instead of starting from scratch.” “By leveraging AI, EmpowerMe can target all of our requests, instead of having to prioritize bandwidth for the most important requests.
“This means more appeals are received and our clinicians are not overwhelmed with the workload,” he continued. “It also means we can apply AI technology further upstream once the appeal is complete.”
For example, the staff used to have regional directors who were trained clinicians to manually complete chart compliance checks. With AI, EmpowerMe can first solve the problem of objection management, understand the processes behind it, and then use the same technology to fix problems on the front end.
MEETING THE CHALLENGE
The provider organization needed something that could reflect what their practitioners were doing on a daily basis. It met with the supplier and everything went smoothly right away, Mitchell recalls.
“For EmpowerMe, adopting this technology was a no-brainer,” he explains; it can tap into the same knowledge base as our clinicians and process denials faster.”
“On the case management side, the provider has worked very closely with leadership and clinicians on our appeals team to ensure our integration is smooth, currently working on working with our two EHRs – first Clinicient and now NetHealth.
“We started looking at the technology and mapping out all the different use cases, from chart audits to clinical claims,” he continued.
“We decided to start with appeals, but it won’t stop there. With their integration into our EHR, there are many applications that will meaningfully impact the business and automate administrative workflows that would otherwise take up clinical resources.
The vendor worked with the vendor claims team for months to learn everything it could to apply its technology in the right areas. It continues to gather feedback from the vendor’s team to go further.
RESULT
Mitchell reports that this technology has completely improved EmpowerMe and saved the organization time and team bandwidth.
“It helps build clinician confidence in AI being used in healthcare,” he notes. “Using Apollo has increased the efficiency of our claims team and streamlined our revenue cycle management tasks at lightning speed.
“By leveraging AI, we enable our physicians to do what they do best: be doctors and manage patient outcomes,” he added. “In particular, we can now write appeals at three times the speed, allowing our team to focus on higher-leverage tasks.”
ADVICE TO OTHERS
That’s fair Be wary of AI in healthcare, but use proven technology to help with tasks that can be easily automated, Mitchell advises.
“We don’t use AI for anything patient-related,” he notes. “We’re using it internally to save our team time and effort so they can do what they were trained to do and what they love, which is taking care of people and not taking care of people,” he said. documents must be processed. “We were able to find an easy-to-use model that our clinicians quickly learned, and it helped them do a frustrating part of their work at 3x the speed while recovering. Recover lost revenue for our business.
“By choosing solutions with intuitive interfaces that can be quickly integrated into existing workflows, the success of an AI implementation will largely depend on the willingness of the team,” he continued. you in grasping and using technology”. “Providing adequate training and support will facilitate a smooth transition and ensure clinicians can effectively leverage this tool to enhance their productivity.”
Above all, he emphasized, it is imperative to continuously monitor and evaluate the impact of technology on both operational efficiency and patient care.
“Healthcare organizations must solicit feedback from clinicians and all staff to identify areas for improvement and optimization,” he concluded. “By fostering a culture of innovation and continuous improvement, health systems can harness the power of AI to streamline processes, enhance quality of care, and improve patient outcomes .”
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