The Challenge
Updating Legacy Systems for a Constantly Evolving Future
Our client represents the nation’s second-largest municipal health system, which processes more than 800,000 inpatient visits, 260,000 emergency room visits, and 2.5 million outpatient visits annually. It employs 21,650 people and has an operating budget of more than $5.6 billion, spanning 19 health centers, four hospitals, and a vast network of community partner clinics.
The client’s legacy mainframe-based patient processing system had become overburdened and was unable to cope with its catchment area’s population growth – an issue that was exacerbated by the COVID-19 outbreak. The system’s unscalable and labor-intensive structure was creating expensive obstacles for processing payments, insurance billings, and payment credits and refunds. There were also complications in processing clinical and administrative appeals, along with medical coding and auditing.
The Outcome
Holistic Digital Transformation Leveraging People, Processes, and Platforms
Sutherland began its partnership with the agency in 2013 and immediately started working on a holistic digital transformation strategy, with the aim of turning the legacy environment into a state-of-the-art business enabler. Leveraging our deep domain expertise and digital consulting capabilities, we set the stage for a full BPaaS solution, combining our proprietary platforms and the power of advanced analytics and AI to increased operational efficiencies.
With Sutherland’s Electronic Data Interchange (EDI) Eligibility Hub, the agency leveraged the power of AI to quickly determine patients’ insurance eligibility, while also distributing tasks and monitoring productivity with Sutherland SmartRev workflow tools. In addition, our front-end claims edition tool enabled faster claim follow-ups faster error identification and rectification , and thereby faster adjudication.
Sutherland HealthAnalytics helped enhance analysis and reporting, while Sutherland Extract made payment posting more efficient through robotic process automation (RPA) and optical character recognition (OCR). Bots deployed using Sutherland’s intelligent automation platform, Robility®, integrated the platforms, delivering enhanced accuracy and productivity, and enabling a 20% reduction in resource costs.
Our digital transformation strategy delivered significant outcomes for the client. Over the last year, the agency’s accounts receivable (A/R) days dropped by more than half with 140% of increased cash collections, including a $26-million increase in monthly collections. That’s digital performance unlocked and measurable results delivered!
Decrease in A/R days
Increase in monthly cash inflows (from $24M to $40M)
Decrease in overall cost-to-collect
Discover Sutherland’s BPaaS Model for Healthcare
Services
Business Process as a Service, Digital Consulting, Sutherland HealthAnalytics, Extract, Robility®
Industry
Healthcare
