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RPA Automation &Calculating ROINovember 2021Joanne GalimiSenior Managing PartnerHealthcare Consulting Practice Lead 2021 Gartner, Inc. and/or its affiliates. All rights reserved. Gartner is a registered trademark of Gartner, Inc. and its affiliates. This presentation, including all supporting materials,is proprietary to Gartner, Inc. and/or its affiliates and is for the sole internal use of the intended recipients. Because this presentation may contain information that is confidential,proprietary or otherwise legally protected, it may not be further copied, distributed or publicly displayed without the express written permission of Gartner, Inc. or its affiliates.

AgendaRPA & Hyperautomation in HealthcareIdentifying & Prioritizing RPA OpportunitiesCalculating Cost Savings & ROI2RESTRICTED DISTRIBUTION 2021 Gartner, Inc. and/or its affiliates. All rights reserved.

RPA &Hyperautomationin Healthcare

Market dynamics are affecting the healthcare industry and drivinga greater need for rapid advancements in innovative technologyResource Constraints:Hospitals, clinics, and first respondersalready operating at or near capacity will beoverwhelmed.ResourcesConstraintsSupply & Equipment ShortagesCritical shortages will become thenorm: routine drugs, durable medicalequipment, medical devices, protectivepersonal equipment, nurses andclinicians are all in short supply today.SupplyShortageRevenue ReductionsProviders are seeing falling revenue asdisruptions occur and non-elective surgeriesand routine procedures and visits arepostponed.4RESTRICTED DISTRIBUTION 2021 Gartner, Inc. and/or its affiliates. All rights ReductionsSupplyChainInsuranceCostsInsurer Regulations:For insurers, common cost containmentmethods such as limiting care access tospecific providers will be harmful to publichealth – and will likely run afoul of emerginggovernmental mandates to open networks.Insurance Market Valuation:Medical expense increase may exceedreinsurance or government subsidythresholds – and will affect marketvaluation for insurance plans.Supply Chain DisruptionsSupply chain disruptions affect rawmaterials for drugs; life science companies’manufacturing and distribution facilities, andimpact the availability of manufacturingequipment as well as PPE and labinstruments for R&D.

RPA is one digital innovation among several hyperautomation toolsand technologiesHyperautomation involves the orchestrated use ofmultiple technologies, tools, or platformsInclusive of, but not limited to: Robotic Process Automation (RPA) Chatbots/Conversational Platforms CoRPA/iBPMS/iPaaS Event-Driven Software Process Mining/Discovery Tools Process and/or task automation tools Machine Learning Artificial IntelligenceBusiness driven hyperautomationAn approach in which organizations rapidly identify, vet and automate as manyapproved business and IT processes as possible through a disciplined approach.5RESTRICTED DISTRIBUTION 2021 Gartner, Inc. and/or its affiliates. All rights reserved.

Top performing healthcare organizations are leveraging RPA, andthe “New Normal” is accelerating the need to scaleA Perfect Storm Driving the Need for Automation in Healthcare. Why act NOW?Supply Rapid Market Maturity of RPA &Complementary Technology Low entry barrier: Dropping of cost oftools, capital expense, time to implementand payback period6RESTRICTED DISTRIBUTION 2021 Gartner, Inc. and/or its affiliates. All rights reserved.Trigger Event Increased focus on revenue preservation,margins and speed due to COVID-19 Public health risk needs reduced relianceon manual processesDemand Resource constraints in Healthcare drivethe need for increased capacity andbandwidth Reduce process and technical debt

Gartner expects RPA to be a significant win in the near future forhealthcare enterprisesFifty percent of all U.S. healthcare delivery organizations will invest in robotic processautomation by 2023, up from 5% today.By reducing the costs associated for various processes, RPA can lead to a direct impact onhealthcare organizations’ bottom lines.By 2024, organizations will lower operational costs by 30% by combining automation techwith process redesignSuccess stories from other sectors, such as manufacturing and banking, have furtherfueled already hyped RPA in healthcare with high hopes to achieve the same or evenbetter outcomes in improving efficiency and cost saving.7RESTRICTED DISTRIBUTION 2021 Gartner, Inc. and/or its affiliates. All rights reserved.

Healthcare Hype Cycle Innovation Profiles Enabled By AutomationEmerging Technologies that Incorporate AutomationThe endgame includes the broadapplication of smart advisors, virtualcustomer assistants, virtual personalassistants and Internet of Things (IoT)signal processing.It won’t be long before end-to-endautomation becomes an expectation,rather than an outlier, and digital issimply business.8RESTRICTED DISTRIBUTION 2021 Gartner, Inc. and/or its affiliates. All rights reserved.

Identifying &Prioritizing RPAOpportunities

Healthcare organizations spend more than their peers in otherindustries on IT operationsCost Optimization with RPA10RESTRICTED DISTRIBUTION 2021 Gartner, Inc. and/or its affiliates. All rights reserved.

Process discovery guidelines to identify RPA opportunitiesThe following guidelines should help identifythe initial list of processes from adepartment’s full list that may be potentialcandidates for further RPA evaluation:1. Processes that require integration ofdata or moving data from one place toanother Low skill, high cost — monthlyprocessing of government programenrollment data load Well-defined rules — governmentprogram eligibility determination High volume — electronically submittedclaims processing2. Processes and/or sub-processes that areadministratively heavy and repetitive Repetitive — customer service calldisposition3. Processes where the effort to completeeach step in the process is highlymanual and time consuming Structured data — HIPAA X12transactions (such as 834 and 278),spreadsheets or flat files4. Processes that include high volumetransactions that have to completedmanually by several FTEs (e.g. Providerdirectory update requests, overpayments,accounts payable/receivable, etc.) Manual — provider call center recordretrieval across claims, provider networkmanagement and utilization managementsystems Routine — provider data load Stable — general ledger entries11RESTRICTED DISTRIBUTION 2021 Gartner, Inc. and/or its affiliates. All rights reserved.

Each business unit in healthcare organizations has an opportunityfor RPA and its many applicable use-casesSupply Chain110Internal AuditTaxHealth Plans9 Due to a lack of clear awareness, thedemand for RPA solutions will notalways be evident by y Compliance& ControlsRESTRICTED DISTRIBUTION 2021 Gartner, Inc. and/or its affiliates. All rights reserved.FinanceCall Centers5612Identifying applicable use-cases willrequire connecting IT closely with thebusinessRevenue CycleITSample list – Not meant to be exhaustive The IT roles will not always have thespecifications and requirements clearlylaid out in a RFP-ready format. The need for RPA will be identified whenanalyzing overall departmental ororganizational performance. Therefore it’s important to closelyconnect individual departments, IT andbusiness roles.

Sample RPA Use Cases for Healthcare PayersStrategic, Market, Product PlanningRisk Adjustment and Revenue Management RPA – Aggregating data from disparate systems to facilitate riskscore analysisAI – Reviewing clinical documentation to identify overlooked revenueopportunities 110 RPA – Network Adequacy data validation and Regulatory FilingAI – Customer Data Aggregation and Reporting to support strategic planningNetwork Development and ManagementAppeals and Grievances RPA – Process claim appeals from the provider and generatecorrespondences per outcome of appealRPA – Automating claim reversals, claim adjustments and claimrefundsRPA – Process coverage determination appeals (e.g. prior auths,quantity limits, step therapy etc.) RPAUseCasesClaims 28 RPA – Automating the provider credentialing processRPA – Leverage automation to collect health population statistics forpredictive analyticsRPA – Automating the fee structure implementationRPA – Manage and update provider directory 9RPA - Automating the claims adjudication process performed byback-office personnelRPA – Manage and update claim editsRPA – Automating reimbursement for manual clean claims usingOCR technologySales3 Chatbot - Direct to Consumer sales for Individual and/orMedicare products RPA - Calculation and processing of rebatesRPA – Download detailed sales data and calculation ofcommissionsRPA – Production and e-fulfilment of contracts4Clinical Management Case Installation7RPA - Automating the utilization management review process; evaluate medicalnecessity and appropriateness of services and treatmentRPA – Leverage automation to collect clinical outcomes data for reportingpurposesRPA – Managed and updated health plan clinical guidelines 6Customer Service 13Chatbots – Provide answers for most common inquiries (e.g., benefits, claims)AI – Integration of customer interaction points with health care system to anticipatemember / provider needs to reduce inbound inquiries5RPA – Data validation from sales, product, and benefits platforms toconfirm sold specificationsRPA - Data transfer from sales, product, and benefits platforms intooperations systemsEnrollment and Eligibility RPA – Perform real-time eligibility and benefits updates to master file to prevent memberreimbursement for lapsed coverageRPA – Automating eligibility verification of supplemental coverage to determine COBRPA – Production of e-fulfilment of enrollment materialsRESTRICTED DISTRIBUTION 2021 Gartner, Inc. and/or its affiliates. All rights reserved.Sample list – Not meant to be exhaustive

Use Cases and Discrete Processes That Are Good Candidates forRPAUse Case14Discrete Process ExamplesKPI ExamplesClaim Validation tomate 50% of the current volumeof manually processed claimsNew MemberAcquisition EligibilityAccount SetupEnrollmentAutomate 95% of eligibilitydeterminationsMember ServiceInteraction Retrieving billing informationProcessing address changesGenerating templated communicationsReduce customer service call time by50%Provider DataManagement Credentialing new providersLoading provider contractsProcessing directory updatesReduce provider credentialing by50%RESTRICTED DISTRIBUTION 2021 Gartner, Inc. and/or its affiliates. All rights reserved.

Calculating CostSavings & ROI

A high-level business case is needed to show estimated businesscost savings potential for each process identified on the RPA list ofopportunitiesData Inputs for the business cost savings calculation:1.Monthly transaction volume – Average monthly volumes reported based on a 8 to 12 month period.2.Time to perform process (mins) – Total time to complete the end-to-end process by a single FTE at an average speed.3.Average blended salary (Annual) – Average salary figure based on staff mix and inclusive of benefits.4.Automation achievable factor (%) – Percentage of the process that can be automated. Estimates are set at 50% (Low), 75% (Med), 100% (High).Business cost savings calculation methodology:STEP 1: Calculate annual hours saved(Monthly Transaction VolumeXTime to perform process inminutes)/60X% Automationachievable factorX Annual Hours Saved at X%AutomationSTEP 2: Calculate estimated annual savings potentialAnnual Hours Saved at X%Automation16X(Average Blended SalaryAnnual/2,080 hours per year) Savings Potential in /yearbased on X% automationRESTRICTED DISTRIBUTION 2021 Gartner, Inc. and/or its affiliates. All rights reserved.* Cost savings calculation does not include the investment required to build and maintain the RPA Bots