HIMSSCast: The next wave of automation will save healthcare $30 to $40B

Edifecs, founded in 1996, focuses on interoperability and automation in workflows. Over the last 20 years, the healthcare industry has seen 90 to 95% automation, saving avoidable costs of about $150 billion, according to CEO Venkat Kavarthapu.

What’s next is the “second leap is automation” that will perhaps save tens of billions for the industry – an estimated $30 to $40 billion, he said.

While the first wave automated workflows, enrollment, claims and eligibility, the second wave will tackle the harder tasks of prior authorization and complex claims, giving providers and payers the “biggest bang for their buck,” Kavarthapu said.

For more on what’s ahead, listen to Kavarthapu’s conversation with Susan Morse, executive editor of Healthcare Finance News.

Talking points:

• COVID-19 acted as an interoperability accelerator as paper-based interactions decreased.
• AI will advance the level of automation, but there is a lack of clarity on what, when and how.
• Full automation of prior authorization processes will get patients the care they need, faster and advance proactive engagements of people with chronic conditions.
• Reimbursement and automated payment will change the status quo.
• Value-based arrangements, first embraced by payers are now being taken up by providers who are taking on risk.
• New use cases for AI will improve value-based care model predictability.
• Edifecs topped Best in KLAS for CMS Payer Interoperability Category for second year.

More about this episode:

AI’s automation can transform the revenue cycle 

AI is creating a complex landscape for healthcare executives

Automating prior authorizations through a stand-alone EHR workflow

CMS releases Interoperability and Prior Authorization Final Rule 

The essence of VBC lies in data-driven decision-making

Vermont ACO model ties payer, provider payment to care quality

Email the writer: SMorse@himss.org