Evernorth CEO Eric Palmer

Digital Health

The Cost of Manual Workflows, and Where Automation Can Help

We cover new solutions promising to swap manual workflows for automated operations on a weekly basis, but it’s rare that we get a chance to devote a full deep dive to the motivations driving the innovation:

• What workflows would see the biggest benefit from automation?
• What areas are healthcare orgs hoping to evolve in their operations?
• What teams stand to gain the most from automation? 

Medallion’s 2024 State of Payer Enrollment and Credentialing Report gave us that chance, shedding light on those answers through a survey of nearly 350 healthcare executives.

Among the key findings from the report was the fact that 45% of respondents say their staffing levels are “inappropriately low,” yet 34% also feel the need to further cut headcount expenses.

• Those numbers are a recipe for burnout. 57% of enrollment and credentialing teams have experienced turnover in the past year, along with 36% of CNAs, 15% of NPs, and 11% of PAs.

One of the main reasons why enrollment and credentialing teams are feeling the pressure so acutely is because of the manual nature of their workflows.

• The payor enrollment process involves wrangling information from providers to fill out applications, staying on top of the evolving requirements of various health plans, communicating the enrollment status of every provider, and constantly following up with payors by email or fax. 

• Those slow turnaround times directly impact the bottom line, with 46% of respondents reporting that unoptimized enrollment workflows cause them to miss out on revenue.

That isn’t even half the battle, with the credentialing process taking just as long to gather provider data, check qualifications, and complete primary source verifications.

• 84% of credentialing teams experience turnaround times of 15 days or more, which unfortunately isn’t too surprising considering that 30% manually verify credentials by visiting individual sites.

• Every day wasted waiting on credentialing is a day the provider isn’t seeing patients, and that missed reimbursement turns out to cost an average of $10k each day.

If those problems hit a little too close to home, automation is more than likely going to play a major role in the solution. An end-to-end platform like Medallion might be the right way to make that happen, and you can check out our coverage of the platform for a complete overview of how it can help fully automate payor contracting and enrollment, credentialing, and licensing.

The Takeaway

It’s no easy task to balance operational costs with a mission to provide high-quality care, but with the US healthcare industry spending over $800B every year on administrative tasks, it’s time to find a way to thread that needle. For a closer look at these issues and how Medallion might be able to help, make sure to head over to the full report.

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Tune into Medallion’s Webinar on April 4 to delve into the intricacies of managing providers’ CAQH profiles during payor enrollment and learn the best practices to prevent any lapses. They’ll be walking through the end-to-end process, as well as the solutions that can help elevate your credentialing workflow.

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The Wire

• First DTx for Major Depression: The FDA has officially cleared the first digital therapeutic for treating depression, with Click Therapeutics and Otsuka Pharmaceuticals announcing that their Rejoyn app-based prescription therapeutic for major depressive disorder scored clearance for use alongside clinician-managed care. Rejoyn is a six-week program to help enhance emotional control through a combination of cognitive emotional training and therapeutic exercises, but Otsuka and Click will still have their work cut out for them generating traction with payors when the app is released later this year.

• SnapCare Acquires Medecipher: SnapCare acquired staffing analytics company Medecipher to expand its suite of healthcare workforce solutions. Medecipher automates staff scheduling through a  decision support tool that provides patient census and workload predictions before prescribing optimal shift plans. The acquisition seems like a natural fit given that Medecipher can first help providers optimize their internal staffing and float pools, then offer visibility into SnapCare’s staffing marketplace to fill any remaining positions.

• Racial Bias in Portal Responses: A study in JAMA Network Open found that doctor responses to patient portal messages vary greatly by race and ethnicity. The analysis of over 57,000 portal messages sent by patients at Boston Medical Center showed that Black and minority patients were just as likely to receive a response, but were less likely to get one from an attending physician. White patients were 21.1% of the overall study participants, but received 46.3% of physician responses. 

• Epic Planning AI Validation Software: Epic is gearing up to roll out an AI validation software suite to enable healthcare orgs to evaluate AI models at the local level and monitor those systems over time. Epic’s SVP of R&D Seth Hain revealed to Fierce Healthcare that the “AI trust and assurance software suite” automates data collection and mapping to provide nearly instant analysis on model performance. It sounds like we could get a look at the new capabilities in the next four to six weeks, with more updates to come throughout the summer.

• Pager + Google Cloud: Pager Health and Google Cloud announced a trio of new GenAI solutions to enhance payor productivity and member experience as part of their deeper partnership announced last April. The solutions include FAQ Bot (answers common health and benefits questions while recommending next best steps), Sentiment Analysis (assists care and service teams in better understanding how member emotion is changing), and Chat Summation (as the name suggests, it summarizes patient-provider chats).

• Doctors Are (Less) Overworked: A Doximity poll of 2.7k physicians found that four out of five physicians say they are overworked, and that 60% are considering a career change. While it’s unfortunate that 81% of physicians viewed themselves as overworked in 2023, that’s actually a decent improvement from 86% in 2022 (but still higher than 73% in 2021). Cardiologists were the most likely of 26 specialties to view themselves as overworked (93%), followed by neurologists (91%) and pediatricians (90%).

• InStride Series B: Two years after launching to make mental healthcare more accessible to families, InStride Health landed $30M in Series B funding to move into new markets and forge more payor partnerships (currently in 8 states working with 16 health plans). InStride provides virtual specialty treatment for pediatric anxiety and OCD, pairing each child with a psychiatrist, therapist, and exposure coach to integrate support into their daily lives.

• 3M Completes Solventum Spin-Off: 3M completed the spin-off of its healthcare business into Solventum, a stand-alone company that’s now publicly traded under the ticker SOLV. Solventum’s business lines produced $8.2B in 2023 revenue and notched low single digit growth across service lines in healthcare information systems, dictation, medical-surgical supplies, dentistry, and filtration.

• Messages Don’t Boost Flu Vaccinations: Text and patient portal messages don’t seem to improve flu vaccinations, according to new research in JAMA Internal Medicine. The study of over 260k patients at UCLA Health System found that vaccination rates were roughly 47% between September 2022 to April 2023, regardless of age, sex, and whether the patient received either portal or text message reminders. 

• Eko’s Low EF AI: Smart stethoscope company Eko Health took a key step towards addressing heart failure’s early detection and diagnostic access challenges, announcing the FDA clearance of its Low Ejection Fraction AI algorithm (Low EF AI). The solution expands heart failure detection to stethoscope exams at primary care offices (vs. specialist-performed echo exams at clinics/hospitals), while identifying patients with low EF within 15 seconds. Eko’s Low EF AI solution will be added to its SENSORA Platform, alongside FDA-cleared algorithms for Afib and structural murmurs.

• How to Spot GenAI in Research Papers: The recent spotlight on the use of large language models to write academic papers prompted a new analysis of the practice from Stanford researchers, which found that 6% of research papers (and a whopping 18% of computer science papers) are now written with AI. Telltale words to look out for as signs of LLM authorship include “showcasing,” “pivotal,” and “realm,” and it’s wild to see how much the appearance of these terms has skyrocketed since the launch of ChatGPT in November 2022.

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