Agility and Flexibility for Meeting Growing Demand
The agency 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 resources and an operating budget exceeding $5.6 billion, while integrating 19 health centers, four hospitals, and a vast network of community partner clinics.
Over time, the county’s population growth – and most recently the COVID-19 outbreak – put greater demands on the agency’s older, inefficient mainframe-based system. Its unscalable and labor intensive structure was creating costly 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.
Legacy Stagnation to Digital Transformation
Sutherland began partnering with the agency in 2013 and immediately started working on a digital transformation strategy that incorporated service delivery best practices to boost efficiency and drive better financial results. Leveraging their suite of internal assets, they began laying the foundation for a highly agile, scalable, and flexible solution featuring advanced analytics and AI technologies.
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 more efficiently with Sutherland SmartRev workflow tools.
Claim follow-ups occurred sooner, and errors were identified and corrected more quickly resulting in faster adjudication by applying front end claims editing software. Sutherland HealthAnalytics helped the agency improve analysis and reporting, while robotic process automation (RPA) and optical character recognition (OCR) made payment posting more efficient through Sutherland Extract. Throughput bots deployed using Robility – Sutherland’s innovative enterprise automation platform – effectively integrated the platforms enhancing the new suite’s quality and productivity.
Sutherland’s integrated digital solution provided a significant boost in efficiency. 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 $30-million increase in monthly collections.