Up to 36% Improvement in PBM Task Completion Through RPA

Jana Exconde
February 27, 2017

In 2016, Pointwest aimed to showcase to one of its US-Based Healthcare Information clients the benefits of Robotic Process Automation (RPA) in reducing costs. A Proof of Concept (PoC) project was initiated and the details of the case are detailed below.

Overview

Industry: Healthcare
Application Type: Robotic Process Automation
Service Type: Consultation
Project Start Date: July 2016

Robotic Process Automation (RPA) is one of the top to-watch developments within the Healthcare Information Management (HIM) industry, promising increased efficiency and accuracy alongside major cost savings.

Pointwest initiated a Proof of Concept (POC) with one of its US-based Health Information clients who was struggling to lower its costs. RPA was also seen to concurrently enhance the quality of the client’s Pharmacy Benefit Management (PBM) services.

Pointwest demonstrated through the POC that the client could experience a 36% reduction in Resource Loading, with Task Completion and Work Hours Spent each improving by 35%.

To more fully reap the business value of RPA, Pointwest proposed establishing an RPA Center of Excellence (CoE) for the client to centrally oversee the automation of different processes. The CoE also enables the US healthcare firm to better manage and integrate the virtual workforce to its current set-up.

Details of the Requirement

The POC aims to measure the end-to-end automated process of applying RPA to the back office work of healthcare PBM, and compare it with the existing process. This gives a clear idea of the client’s possible savings in terms of time and resources when RPA is applied.

Challenges

Pointwest faced two major challenges in applying RPA to the client’s PBM processes: technical and organizational.

From a technical standpoint, two pain points needed to be addressed before RPA could be applied effectively:

• Bridge the gap between outdated staff competencies and the latest in automation. The time needed to update skills, knowledge, and techniques would vary across roles, and how quickly the firm can can upskill its staff.
• Ascertain business processes  most suited for RPA prior to implementation. Although the premise is to automate as much of one’s processes for optimal  efficiency, the POC stands to gain more support and momentum if those with a best fit for RPA were the first to be set in motion.

From a management perspective, Pointwest identified a need to (re)define team roles and to create a new group for the client to govern and own the RPA practice. It is quite an organizational change to introduce software algorithms for tasks that humans can perform. As such, an oversight group is needed to monitor and manage the hybrid workforce.

The Solution: Technical and Organizational

Pointwest determined two general technical solutions to RPA implementation. One would be to create its own automation tools for the client’s use, as Pointwest has both the experience and technical expertise to build one. Alternatively, Pointwest could partner or obtain an already-established third party platform.

Pointwest proposed UiPath for the POC implementation rather than make its own, since the objective was to obtain an idea of cost savings while maintaining task completion quality, rather than explore a build or buy decision. Pointwest identified the client’s Clinical Rules Update and Creation, a repetitive front-end process, as a ready fit for automation using UiPath.

The tools used in UiPath Automation were the following:  

• Web automation
• Desktop automation
• Excel Integration and automation
• Email automation
• User Events and Trigger Manager
• Workflow Designer using Flowcharts and Sequences
• VB Scripting / Programming
• Screen Scraping
• Action Recording

Furthermore, Pointwest pointed out that many, if not all, of the concerns about RPA implementation could be addressed by creating a Center of Excellence (CoE) for RPA.

The CoE would ideally be a lean governance body composed of key representatives from IT, operations, and the senior business sponsor for the RPA initiative.

As the “champion” for RPA at the US healthcare firm, the CoE would provide IT governance to effectively minimize risks associated with automation, while managing and reporting on its benefit realization. Specifically, these include:

• Developing, managing, and delivering on the demand pipeline for process automation;
• Operational management of the virtual workforce;
• Oversight of the technology platform;
• Interaction with the infrastructure team as required; and
• Management of third parties and internal and external dependencies to maintain business continuity.

Benefits: 36% Reduction in Resource Loading

Based on the table below, there are several clear benefits to implementing RPA within the organization:

* CRIT – Clinical Rules Integration Team (Pointwest team name)
** assuming resources have 8 hours per shift

The clearest benefit is the significant reduction in Resource Loading: 36%. Without automation, 83 tasks in a day required 25 resources to complete. With automation, the organization only needed 16. Total work hours were also reduced by 35.3%, while task completion was much faster, increasing by 35.1%.

Insights

RPA can be a competitive advantage of almost any business because it introduces significant cost savings through efficiency and accuracy. With RPA, fewer resources are required to complete the same amount of tasks, but at a faster rate and with a higher degree of accuracy. The benefits can be observed to be compounding as more complex tasks are standardized and automated.

One of the most important things learned by the POC team is that coming up with a technical solution to a business problem is not enough. Properly harnessing the potential of a disruptive technology such as RPA requires setting up an organizational infrastructure that will support and advance it.

Pointwest foresees that by creating an RPA CoE, its client will be able to sustain and grow its automation efforts. This not only addresses the technical and governance-related issues behind RPA implementation, but also, provides for sustainability and business agility.

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Founded in 2003 by pioneers of the Philippine Global Sourcing industry, Pointwest creates value for its list of satisfied clients — including top Fortune 100 and local companies — with world-class IT and BPM services backed by international-standards methodologies and innovative practices.