Exiting the healthcare labor crisis: Measures to assess the value of automation

Growth in healthcare labor expenses has been rapid and unsustainable. Since 2019, the labor expense per adjusted discharge has risen 28%. Turnover rates have only been increasing, particularly for RNs, nursing assistants, and patient care techs. Each departure adds a third of an FTE in cost to acquire and train new talent. The vacancy itself carries a cost in the form of limited scheduling capacity, increased overtime spend, and rising wait times.

As costs mount, many hospitals resort to closing departments or ending services they can no longer sustain due to staffing shortages. Undoubtedly, hiring, developing, and retaining talent is a top priority for health systems of all sizes. Yet many executives discount the ability to fill open requisitions and retain top talent as soft measures of returns, and refuse to include them in their value calculation. Labor is the greatest expense for any health system. The impact of efficiency can’t be ignored. 

Public and private payers continue the march toward value-based payment strategies, meaning future revenue gains will come from building the capacity to manage the healthcare needs of larger volumes of at-risk patients. Today, and for the foreseeable future, that means that provider fortunes will rise and fall based on their ability to move more patients through the same system of care. 

Savvy organizations are turning to intelligent automation as one way to address this need. By automating repetitive, manual workflows, health systems are able to free up staff to focus on higher-value tasks, while simultaneously increasing speed, accuracy and delivery. Any healthcare organization that is evaluating an automation solution must first determine how much value is to be derived from an implementation. While easier said than done, there are three core components that allow for a true assessment of the value of automation: efficiency, staff capacity and revenue.

Value delivered through efficiency

Staff savings are a critical measure of efficiency. Notable measures labor gains through both actual FTE reductions over time as open roles are closed, and through FTE time savings, a precious performance metric when labor capacity is dear. On average, our intake solution delivers 4.2 minutes in front-desk FTE savings for every patient who completes their digital intake. At Intermountain, where over 2 million patients complete their digital intake per year, that amounts to over 134,466 front desk hours saved annually. 

By automating not just intake but front-end revenue cycle processes like authorizations, intelligent automation can free staff time for complex work. At Care New England, deploying Intelligent Authorizations reduced their authorization-related write-offs by 55%, saving 2,841 hours of staff time, allowing that time to be reallocated to compliance with the No Surprises Act.

We only estimate changes in metrics that our solutions directly impact. However, when our solutions are fully deployed, our customers report indirect benefits as well. For example, automation can improve employee experience and satisfaction. Repetitive manual tasks are among the top three contributors to burnout. Health system leaders among our clients cite the value that Notable delivers by reserving clinically trained staff time for complex or top-of-license activities. NKCH's CIO Kristen Guillaume reported, "We have saved thousands and thousands of hours of productivity and reallocated our staff time to more higher-order functions within the health system. It's truly been a wonderful gift to our staff."

Castell experienced similar benefits. “The chart review process can be very tedious. It’s like looking for a needle in a haystack… And with Notable we’re able to streamline that process and make it more efficient. I’ve definitely seen a boost in morale,” said Ashley Trost, a Business Operations Coordinator, noting that care coordinators were able to reduce their time spent chart scrubbing from four hours to one hour or less per day.

Value delivered through increased capacity

With patient demand exceeding provider supply nationwide, health systems need to maximize the use of the current facility footprint by reducing no-shows. At Notable, we analyzed comparative no-show rates at clinics where patients are confirmed using our digital intake solution with those that did not yet have the solution turned on. The difference was remarkable. At clinics that had deployed Intelligent Intake, the no-show rates were 50% lower than at clinics relying on traditional confirmation systems.

One indirect benefit is the added encounter volume. When schedulers have advance notice of cancellations, they are able to backfill open slots. The automation that drives Intelligent Intake links directly to the EHR, showing staff when providers have available capacity for same-day visits.

Beyond no-shows, every moment of staff capacity comes at a premium price. The imperative for faster and smarter patient processing is greater than ever.  Today, health systems can least afford paying overtime or allowing patient satisfaction to suffer. When patients complete their intake paperwork onsite, it clogs the waiting room and compromises clinical support staff capacity.

When Intermountain deployed Intelligent Intake for pediatrics, the department saw 77% of their intakes completed digitally ahead of the appointment. Over the course of three months, 12,500 well child forms were completed via automation, freeing up the waiting rooms and saving time for staff. These savings come with significant patient satisfaction gains as well, with the experience receiving a 98% satisfaction rating. Parents and guardians like being able to complete these forms in advance online, instead of with small children in tow. One parent said, “I like having it done before I am there and can do it when kids are not pulling on me.”

Value delivered through revenue

Last, automated digital intake drives faster, more accurate, and more efficient revenue capture, plus eases compliance with growing price transparency and surprise billing requirements. Intelligent automation can overcome the limitations of traditional revenue capture methods.

First, Notable drives high-fidelity data capture by updating patient records automatically, without the need for revenue-cycle talent downstream to key in data and risk transposing digits. This is accomplished through asking the patient to verify insurance by taking a photo of their card. Our automation platform then uses optical character recognition (OCR) to capture key data elements, and then verify or correct payer-plan matching in the EHR. The record is updated automatically. Our machine learning routinely performs basic payer-plan matching faster and more accurately than trained staff, meaning few eligibility-related denials.

Next, digital intake automatically prompts patients to reconcile prior balances, coinsurance amounts, and copays or set up a payment plan. Therefore, patients arrive for their visit with prior balances paid and copayments already queued for immediate processing. Clinics using Notable’s platform report an average 76% improvement in prepayment collection rates, enjoying faster revenue capture and improving cash on hand.

How Notable thinks about value

There are thousands of digital health companies on the market, which can make evaluating potential vendors challenging. At Notable, we believe in transparency and goal-setting, backed by data, to drive results. We aim to accurately represent our value to prospective partners, and to measure our progress against our goals.

We do this through a formalized process called Health Check, a qualitative and quantitative assessment of the potential gains an automation solution will deliver. Developed by revenue cycle and clinical operations experts, the Health Check process includes an onsite assessment of status quo processes. Our experts recommend a solution or set of solutions and compare baseline performance to a peer cohort. The team then estimates annual value gains based on the impact seen across 23.5M patient interactions at client health systems.

The outline below lists sample revenue and cost metrics we evaluate during a Health Check for Intelligent Intake. A complete assessment provides conservative estimates of the revenue, efficiency, and capacity gains once automation is fully deployed across the project scope.

Sample metrics of success for Intelligent Intake

Revenue gains

Direct impact

• No-show rate
• POS copayment collection rate
• POS prepayment collection rate
• POS prior balance collection rate
• Eligibility/demographic denials rate

Indirect impact

• Encounter volume
• Clinic or unit revenues
• AR days
  

Cost reductions and efficiency gains

Direct impact

• Savings from alternative vendor elimination
• Front-desk FTE capacity and savings
• Revenue-cycle FTE capacity
• Clinical FTE capacity
• Time per MA rooming
• Digital registration rate

Indirect impact

• Turnover costs
• Staff equipment costs
• Training costs
• Team productivity

Automation is critical to filling the talent gap

Workflow automation has proven its value in increasing efficiency and productivity across many industries. Just recently, the Office of the National Technology Coordinator designated clinical workflow automation as a critical priority. Inefficient workflows slow the delivery of health care, forcing talent in too many roles to spend too much time on low-value, manual tasks over point-of-care patient interactions. In their words, “it is time for the healthcare industry to benefit from automation on a larger scale.”

To date, Notable has automated over 55 workflows and we estimate there are hundreds that remain. As an intelligent automation platform, many clients choose Notable for its ability to address multiple workflow challenges like digital patient registration, payment capture, prior authorizations, clinical intake, scheduling, referrals, and care gap closure. 

To learn more about how Notable’s intelligent automation platform can deliver value for your organization, start a conversation with one of our product specialists.