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IDC PlanScape: Deriving Payer Outcomes with Robotic Process Automation

IDC PlanScape: Deriving Payer Outcomes with Robotic Process Automation

This IDC study discusses the aspects of robotic process automation (RPA) initiatives for the payer community."Robotic process automation is marketed as the hot cost-reduction strategy this year, setting the table for cognitive computing, autonomics, and artificial intelligence in payer operations and analytics," states Jeff Rivkin, research director for Payer IT Strategies at IDC Health Insights. "New paradigms in optimizing legacy investments, streamlining call center desktop automation, optimizing claims adjudication, and increasing employee satisfaction are being marketed by vendors advertising these technology-enabled process changes. Attended and/or unattended robotics, which build upon business process modeling (BPM) fundamentals, will change how workflow is perceived across the enterprise. Radical automation of selected human functions and rethinking of legacy integrations are creeping in. RPA is being executed surgically by payers, preferably in a governed way."

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IDC PlanScape Figure
Executive Summary
Why Is Robotic Process Automation Important?
LOBs Cannot Wait for IT Backlog
Payers Have Unprecedented Cost Pressures So Manual Processes Must Have Improved Quality, Predictability, and Speed
Advertised FTE Reduction/Redeployment Is Evident and Attractive
Siloed Groups Can No Longer Execute Siloed Processes
Employee Satisfaction and Retention Is Waning in a Skills Shortage Environment
Legacy Systems Are Not Easily Replaced
Some Processes Are Complex But Are Surrounded by Processes that Are Simple
What Is Robotic Process Automation?
Capture Information — Automate the Acquisition of Structured and Unstructured Data
Seamlessly Execute the Integration of Information
Automate Processes by Replicating Actions of a User
Claims
Care Management
Transform Data into Valuable Information
Enable Digital Transactions
Who Are the Key Stakeholders?
CIO
Enterprise Architecture
Data Architecture
Business Process Management Center of Excellence
Vendor Management
Target LOB Executive Management
How Can My Organization Take Advantage of Robotic Process Automation?
See Greater Than the Obvious Task, See the Transformation
Consider RPA for Situations That Are About Capabilities, Not Direct Outcomes
Consider RPA for Situations That Are Disruptive and Time Sensitive
Ensure Legitimate IT Governance and Change Control
Use the Value-Based Reimbursement Initiatives as an Excuse to Invest in Ubiquitous Workflow and RPA
Consider RPA to Parse Claims and Encounters, and Route Them to VBR and FFS Engines Simultaneously
Consider RPA Instead of Data Lakes and Data Warehouses in the Context of Enhancing Member360/CRM Databases with Temporal Data
Essential Guidance
Related Research
Appendix: Attended and Unattended Bots
What Is an Attended Bot?
What Is an Unattended Bot?
Since Unattended Bots Are Not Invoked by the Desktop User, What Are the Most Common Invocation Methods for Unattended Bots?
Summary

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