{"id":27612,"date":"2024-06-13T08:44:17","date_gmt":"2024-06-13T12:44:17","guid":{"rendered":"https:\/\/www.3pillarglobal.com\/?p=27612"},"modified":"2024-11-18T16:13:58","modified_gmt":"2024-11-18T16:13:58","slug":"health-it-vendors-cutting-edge-technology","status":"publish","type":"blog","link":"https:\/\/www.3pillarglobal.com\/insights\/blog\/health-it-vendors-cutting-edge-technology\/","title":{"rendered":"5 Competitive Use Cases for Health IT Vendors to Leverage Cutting-Edge Technology"},"content":{"rendered":"\n<p>Health IT vendors have a unique view of the healthcare payment ecosystem. Working across multiple providers or payers gives you the ability to tease out data patterns and business needs a single entity could easily miss. \n<\/p>\n\n\n\n<p>Emerging technologies (like AI, ML, RPA, <a href=\"https:\/\/www.3pillarglobal.com\/services\/digital-product-engineering\/low-code-no-code-solutions\/\">codeless application development<\/a> platforms, etc.) can accelerate that process, allowing health IT vendors to move faster uncovering insights, introducing new value-add features, and automating internal processes.\u00a0 <\/p>\n\n\n\n<p>\nWith reimbursements generally flat, departments at providers are under pressure to improve the cost and speed to collecting revenue. This makes the need for these changes more urgent than ever.\n<\/p>\n\n\n\n<p>\nBelow are five opportunity areas where health IT vendors can leverage new technologies to innovate faster.\n<\/p>\n\n\n\n<p><\/p>\n\n\n<div class=\"wp-block-heading\">\n<h2 class=\"wp-block-heading\">5 use cases for advanced technology in digital health products<\/h2>\n<\/div>\n\n\n<p>\nOnce you have a technology partner in your corner who can help you navigate the challenges listed above, here are five opportunity areas to drive more value for your customers and make internal operations more efficient.\n<\/p>\n\n\n\n<p><\/p>\n\n\n<div class=\"wp-block-heading\">\n<h3 class=\"wp-block-heading\">1. Recreate the health plan algorithm<\/h3>\n<\/div>\n\n\n<p>\nProviders and their vendors all struggle to minimize claims denials. The inconsistencies and lack of transparency surrounding health plan rules has led to bizarre, low-tech troubleshooting <a href=\"https:\/\/www.3pillarglobal.com\/insights\/revenue-cycle-management-streamline-rcm\/\" target=\"_blank\" rel=\"noopener\">processes for managing and fixing denied claims<\/a>.&nbsp;\n<\/p>\n\n\n\n<p>\nAs a health IT vendor, you have an opportunity to solve this pain by building an\n<a href=\"https:\/\/www.3pillarglobal.com\/insights\/ai-ml\/why-the-marriage-of-llms-lams-is-the-missing-link-in-ai-utility\/\">AI and machine learning (ML)<\/a> engine that can recreate these health plan algorithms. This approach follows a three-step process:\n<\/p>\n\n\n\n<p><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Extract clients\u2019<a href=\"https:\/\/www.3pillarglobal.com\/insights\/data-quality-control-healthcare-interoperability\/\"> historical claims data<\/a> and tease out the rules<\/li>\n\n\n\n<li>Analyze available documentation (often hundreds of pages of PDFs that no one reads) to incorporate publicly available data into your rules engine<\/li>\n\n\n\n<li>Deploy configurable rules engines and subsequent robotic process automation (RPA) to capture and automate client institutional knowledge<\/li>\n<\/ul>\n\n\n\n<p>\nBecause this process deals with client-specific knowledge and data, you\u2019ll want to make sure you have proper security and data usage protocols in place to maintain security and privacy.\n<\/p>\n\n\n\n<p><\/p>\n\n\n<div class=\"wp-block-heading\">\n<h3 class=\"wp-block-heading\">2. Provide real-time coding assistance<\/h3>\n<\/div>\n\n\n<p>\nA recreated health plan algorithm can serve as a foundation upon which you can build a host of applications and functionality for the customer\u2019s entire organization. One of these is to build a real-time coding assistant powered by the rules engine.\n<\/p>\n\n\n\n<p>\nThere are three potential ways to operationalize this idea:\n<\/p>\n\n\n\n<p><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><b>Create a rules engine to flag potential documentation issues.<\/b>After providers document and generate claims, an RPA-based application and workflow prompts potential billing issues, suggesting ways to fix it.\u00a0<\/li>\n\n\n\n<li><b>Autocomplete and co-pilot billing.<\/b>The RCM system pulls historical data from the EMR and slots them into relevant fields. <\/li>\n\n\n\n<li><a href=\"https:\/\/healthjournalism.org\/blog\/2024\/03\/all-ears-what-to-know-about-ambient-clinical-listening\/\"><b>Ambient listening<\/b><\/a><b> + real-time questions. <\/b>These systems enable providers and their vendors to ask additional questions relevant to billing in real time, as well as give patients and doctors information about next steps, including real-time information about approximate costs.\u00a0<\/li>\n<\/ul>\n\n\n<div class=\"wp-block-heading\">\n<h3 class=\"wp-block-heading\">3. Engage patients up front<\/h3>\n<\/div>\n\n\n<p>\nAnother opportunity lies with the front office, where simple changes in the check-in process can have outsized effects on back-office claims success.&nbsp;\n<\/p>\n\n\n\n<p>\nLet\u2019s start with the current status quo: most providers don\u2019t collect member ID information until check-in. So prior to service, there\u2019s no way to check a patient\u2019s eligibility. And when front office staff do check patients in, they collect physical cards and enter insurance information manually, which provides ample opportunity for human error.&nbsp;\n<\/p>\n\n\n\n<p>\nFurther, all a front office staff member can do at this point is determine whether coverage is active. They don\u2019t take the next step to:\n<\/p>\n\n\n\n<p><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Verify if the current visit is covered<\/li>\n\n\n\n<li>Collect deductibles at the point of sale<\/li>\n\n\n\n<li>Prompt the patient to disclose secondary coverage<\/li>\n<\/ul>\n\n\n\n<p>\nEach of these details can seriously hurt the patient\u2019s experience\u2014namely by saddling them with unexpected bills.\n<\/p>\n\n\n\n<p>\nOkay, so that\u2019s the problem. What can you, as a health IT vendor, do about it? Since you\u2019ve built a rules-based engine to minimize claims denials, you can simply built a front office application (or applications) that incorporates that logic:\n<\/p>\n\n\n\n<p><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Digital check-in workflows to capture information relevant to claims submission process<\/li>\n\n\n\n<li>Verify both active coverage status and additional details to build a fuller picture of the patient\u2019s coverage<\/li>\n\n\n\n<li>Build a POS application that\u2019s built to handle deductible-based plans, which requires more advanced logic than a simple copay structure<\/li>\n<\/ul>\n\n\n<div class=\"wp-block-heading\">\n<h3 class=\"wp-block-heading\">4. Create interoperable, efficient internal work streams across Electronic Medical Records (EMRs)<\/h3>\n<\/div>\n\n\n<p>\nVirtually every digital health application touches Electronic Medical Records (EMRs) in some way. Unfortunately, these systems contain subtle differences in data definitions that can cause disruption and broken workflows.&nbsp;\nAs such, <a href=\"https:\/\/www.3pillarglobal.com\/insights\/emr-optimization\/\">data standardization across EMRs<\/a> is critical for digital health applications to function effectively and <a href=\"https:\/\/www.3pillarglobal.com\/insights\/interoperability-seamless-connections-healthcare-technology\/\">interoperably<\/a>:\n<\/p>\n\n\n\n<p><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Running common, efficient codes and processes across all vendors<\/li>\n\n\n\n<li>Working denials and accelerate claims acceptance<\/li>\n\n\n\n<li>Providing financial dashboards with accurate, real-time information<\/li>\n<\/ul>\n\n\n\n<p>\nBy building workflows that capture data in real time (as opposed to periodic transfers), health IT vendors can build workflows that provide a common reference for all EMRs and clients. This not only improves the experience for all users, but makes further data-driven innovation possible.&nbsp;\n<\/p>\n\n\n\n<p><\/p>\n\n\n<div class=\"wp-block-heading\">\n<h3 class=\"wp-block-heading\">5. Create open, platform RCM architecture<\/h3>\n<\/div>\n\n\n<p>\nMost revenue cycle management (RCM) products aren\u2019t built for interconnectivity. As a result, most clients and their data are locked into siloes\u2014making <a href=\"https:\/\/www.3pillarglobal.com\/insights\/healthcare-platform-modernization\/\"> platform modernization<\/a> difficult at best, impossible at worst.&nbsp;\nBy modernizing your technology stack and converting from a series of softwares into a holistic platform, you can build deep connectivity to RCM functionality:&nbsp;\n<\/p>\n\n\n\n<p><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Build deep connectivity to RCM functionality across EMRs and other third-party solutions<\/li>\n\n\n\n<li>Integrate with a variety of systems\u2014EMRs, collections, scheduling, digital patient check-in, billing managed services, financial reporting, etc.<\/li>\n\n\n\n<li>Build true platforms that transform the entire organization and fix revenue cycle breakpoints<\/li>\n<\/ul>\n\n\n\n<p>\nOf course, you can move faster in these five areas by partnering with a product development company like 3Pillar. Our experience building for RCM and claims management means we know which best practices to implement\u2014and the pitfalls to avoid.\n<\/p>\n\n\n\n<p>\nIf you\u2019re ready to start implementing these\u2014or any other\u2014modern technological use case, make sure you have the right expertise in your corner. <a href=\"https:\/\/www.3pillarglobal.com\/industries\/healthcare\/\">Learn more about 3Pillar\u2019s healthcare-specific offerings here.&nbsp;<\/a><\/p>\n\n\n\n<div style=\"height:100px\" aria-hidden=\"true\" class=\"wp-block-spacer is-style-small\"><\/div>\n\n\n<div class=\"wp-block-heading\">\n<h2 class=\"wp-block-heading\">About the author<\/h2>\n<\/div>\n\n\n<div style=\"height:20px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n<div class=\"wp-bootstrap-blocks-row row\">\n\t\n\n<div class=\"col-12 col-lg-6\">\n\t\t\t\n\n    <div  class=\"custom-block card-profile-block card card-profile card-image-offset card-image-offset-right card-image-offset-sm card-border-left text-bg-light-cyan\">\n        <div class=\"card-body\">\n            <div class=\"row flex-md-row-reverse\">\n                <div class=\"col-md-5\">\n                                            <img loading=\"lazy\" decoding=\"async\" width=\"532\" height=\"532\" src=\"https:\/\/www.3pillarglobal.com\/wp-content\/uploads\/2024\/07\/steve-rowe.jpg\" class=\"img-fluid\" alt=\"Steve Rowe, Industry Leader, Healthcare Portfolio\" data-aos=\"none\" srcset=\"https:\/\/www.3pillarglobal.com\/wp-content\/uploads\/2024\/07\/steve-rowe.jpg 532w, https:\/\/www.3pillarglobal.com\/wp-content\/uploads\/2024\/07\/steve-rowe-300x300.jpg 300w, https:\/\/www.3pillarglobal.com\/wp-content\/uploads\/2024\/07\/steve-rowe-172x172.jpg 172w\" sizes=\"auto, (max-width: 532px) 100vw, 532px\" \/>                                    <\/div>\n\n                <div class=\"col-md-7\">\n                    <h3 class=\"card-title\">Steve Rowe<\/h3>\n                    \n                                            <p class=\"card-text\">Industry Leader, Healthcare Portfolio<\/p>\n                                        \n                    <a href=\"https:\/\/www.3pillarglobal.com\/?post_type=leadership&#038;p=1116\" class=\"link-arrow link-arrow-dark\">\n                        <span>Read bio<\/span>\n                    <\/a>\n                <\/div>\n            <\/div>\n        <\/div>\n    <\/div>\n\n\t<\/div>\n\n\n\n<div class=\"col-12 col-lg-6\">\n\t\t\t\t<\/div>\n\n<\/div>\n\n\n\n<div style=\"height:100px\" aria-hidden=\"true\" class=\"wp-block-spacer is-style-small\"><\/div>\n","protected":false},"excerpt":{"rendered":"<p>Health IT vendors have a unique view of the healthcare payment ecosystem. Working across multiple providers or payers gives you the ability to tease out data patterns and business needs a single entity could easily miss. Emerging technologies (like AI, ML, RPA, codeless application development platforms, etc.) can accelerate that process, allowing health IT vendors [&hellip;]<\/p>\n","protected":false},"featured_media":27825,"template":"","industry-types":[7],"service-types":[],"topics":[20,33],"class_list":["post-27612","blog","type-blog","status-publish","has-post-thumbnail","hentry"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v25.4 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>5 Competitive Use Cases for Health IT Vendors to Leverage Cutting-Edge Technology - 3Pillar<\/title>\n<meta name=\"description\" content=\"Technology itself isn&#039;t a competitive edge. It\u2019s how you leverage it to serve your customers. 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