The healthcare revenue cycle management (RCM) BPS market is becoming technically more advanced as vendors experiment with RPA to drive greater efficiency and productivity, and to improve competitive positioning. Here I look at one such vendor, Access Healthcare, and the lessons they have learned from their own RPA initiatives.

Access Healthcare generates ~$145m in revenue delivering RCM BPS through 11,000 employees, with operations based mainly in India. Both its President and founder, Shaji Ravi, and its Chairman, Anurag Jain, had worked for Perot Systems’ (and then Dell Services’) healthcare practice prior to Access Healthcare being established in 2010. Access began to make strategic technology investments after Anurag joined in 2012, with the objective of improving productivity significantly beyond what was possible with its India-based labor arbitrage business model.

Lesson 1: Assess whether to build or buy your own RPA platform

Initially, Access Healthcare experimented with various RPA packaged software such as that offered by the leading horizontal vendors. According to Jain, his company discovered that trying to apply RPA packaged software to healthcare RCM processes ultimately proved inefficient. “[Packaged RPA software] is like a big Lego set with no instructions,” he said. “Efficiency with IT assets is the key and we found it more efficient to build our own technology platform.”

Ultimately, the company decided to build RPA capabilities onto the company’s existing IT platform (based on Microsoft.NET and SQL Server), calling the platform arc.in.

Lesson 2: Broaden your perspective when identifying efficiencies from RPA

Experimentation with RPA prompted Access Healthcare to think more broadly about the efficiency of its internal IT function and other areas of its organization, including HR management, data management, and workflow. The company resolved to integrate these considerations into the development of its enterprise platform to simultaneously streamline the management of people, data, and finally, customer-facing RCM processes.

As Access Healthcare worked to move beyond labor arbitrage and a transactional business model, Chairman Anurag Jain said he realized that “the real objective is not to make the customer’s processes and transactions more efficient but instead to make their work disappear.” The implication, he continued, is that it requires deeper partnerships with clients that incentivize all parties to generate and share the benefits from the work that disappears.

Lesson 3: An effective, scalable technology platform can generate M&A and partnership opportunities

An RCM BPS company with an efficient and scalable technology platform can expect to benefit by extending its technology capabilities across the operational functions of other RCM BPS companies and across other RCM market segments. And this can create opportunities for acquisitions of, or partnerships with, other RCM BPS companies.

Jain has pursued this line of thinking as he considers what he believes to be his firm’s cost advantage over other, less technologically advanced, RCM BPS vendors. He groups these cost advantages into two categories: workforce management and automation/analytics.

Workforce management

Access estimates that this category generates a 7-10% operational cost advantage over competitors. The costs of Access Healthcare employees equal those of management, which together far outweigh all other costs. Hence, technology that reduces management and employee costs is prioritized for investment. Access has developed proprietary technology for:

• Workflow tools: data and tasks from 150 payers and 300k+ providers are routed to appropriate teams and individuals, resulting in greater per-seat productivity
• Performance analytics: monitoring systems predict when employees are likely to be dissatisfied, when management intervention is necessary, and how managers can address dissatisfaction
• Automated incentive program: employees are motivated and monitored through use of a reward program that can equate to 20% increase in salary and accelerate promotions
• HR systems: help automatically manage a 2% per month attrition rate while simultaneously growing headcount. Every month, Access uses its software tools to manage 4k candidate assessments and 2k people in the recruitment process.

Automation/analytics

Access estimates that this category generates an 18-23% operational cost advantage over competitors. It estimates that when a bot is successfully deployed, a CSR can be spared 30-40% of his or her effort in executing a given process. After experimenting with tools from UiPath, and having evaluated Blue Prism and Automation Anywhere, Access discovered that it gets better results from its proprietary “echo” RPA software suite developed on its in-house arc.in platform. And because the platform is developed on Microsoft.NET using SQL Server databases, it is relatively easy to find the talent necessary to build and maintain its systems. Points of note here include:

• Process improvement team: The Six Sigma team operates with a holistic view of enterprise and client processes. This team identifies/prioritizes/writes requirements for automation opportunities
• 100+ developer team: This team builds and maintains the proprietary platform and tools, and includes 40+ developers to configure and deploy the proprietary “echo” RPA software suite
• Modular architecture: The company believes that the automation architecture should be built with process components in mind. Micro-bots should be able to automatically hand off work to each other if necessary, and micro-bots added to a library by process SMEs should make the architecture scalable
• Bots: The flexible platform enables a 4-6 week build and deploy period for new bots, and 1k+ bots are in production. Automatic logs enable measurement of the impact of bots on transactions and clients
• ML: Machine learning tools predict payer responses to specific transactions over time, enabling Access Healthcare to define and customize more effective workflows. ML tools also help prioritize investment in building and deploying new bots
• Point solutions: The company has also created platform-compatible applications for payment posting, claims follow-up, and denial management.

Confident in the advantages conferred by its own technology platform, Access Healthcare acquired Pacific BPO, another RCM BPS company in an adjacent healthcare market segment, in September 2018. Having assessed that company’s functional processes to be largely manual, Access believes it can use its platform to generate significant efficiencies. Access also believes that it can bring a new level of technology sophistication to a market segment ripe for the introduction of process re-engineering and automation.