Our ambition is clear: We want to achieve a 90% reduction in admin/triage costs and facilitate better, less costly pathway decisions for CCGs, prime contractors and providers. At psHEALTH we are on an exciting automation journey with our Referral Management/Single-Point-of-Access software solutions.
How far have we come? Our triage engine can automatically kick off the analysis of incoming referrals and make automated decisions or suggestions – currently we are eliminating 50% to 65% of the admin cost from the total process. For some parts of the process we are achieving ‘three nines’ (=99.9%), for some parts the automation rate is 30% to 40% and other parts of the process is still largely manual.
Our objective is not to remove all human input. We are looking for automation to take over jobs that don’t require empathy or the ability to brainstorm with colleagues. Over time we recognise that computing power will increase our ability to automate new domains, but this is a long journey.
So what can automation software do today? At Level One, we are configuring technology to remove repetitive jobs such as re-keying information or the manual upload of documents from one system to another. Most humans are not great at these jobs – that is why it is hard to recruit and even harder to keep staff in such roles. To top it off, humans in these roles tend to make silly mistakes. Most Operations Directors I speak with say that it is very, very hard to recruit people to do complex but repetitive jobs.
Time is increasingly of the essence. If you are operating under a strict SLA, the speed of automation can be breath-taking. Automation starts when the referral is received at 8.30pm, not when the next shift comes in the following day. Automation can check and upload 100 referrals in maybe 10-15 minutes; it would probably take a human 3 to 4 hours.
At Automation Level Two it is getting more interesting: Here we are looking for the automation software to make decisions or recommendations based on detailed rules. For example, the software can be fed a list of ‘Procedures of Limited Clinical Value’ and either reject or escalate such referrals. A human is very capable of making decisions (albeit slowly) based on complex and ambiguous ‘fuzzy’ rules; however, a mere mortal will find it hard to make straight forward exclusion/inclusion decisions if there are a large number of relative straight forward rules. It is hard for a human when a CCG has several hundred items listed on a list of ‘Procedures of Limited Clinical Value’ or when providers have exclusion criteria based on a BMI of 35 or 40 or 43.
So what are the benefits of Automating Referral management? Benefits are on several levels. There are straight forward cost savings from reducing manual input – often 50% or more can be saved. Secondly there are benefits in referring to more appropriate, lower cost pathways. Our work would suggest that an average CCG should be able to save more than net £1 million.
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