In the evolving landscape of healthcare, the implementation of value-based care has become a top priority for organizations striving to enhance patient outcomes while controlling costs. However, this transition comes with its own set of challenges, one of the most significant being the cost and complexity associated with contract management and data extraction from Explanation of Benefits (EOBs).
This blog will delve into the details of this challenge, the role of AI in addressing it, and the potential business impact. We’ll also explore Felix Solutions capabilities and their impact on healthcare organizations.
The Challenge: Managing Contracts and Extracting EOB Data
Value-based care requires healthcare providers and payors to continuously manage contracts, review renewals, and ensure compliance with payor rules. Managing the vast amount of data in these contracts is an arduous task, given the constant changes in regulations and contractual obligations. The same applies to EOBs, which contain crucial information that needs to be extracted accurately and efficiently.
Statistics:
- Industry standard for contract analysis coverage stands at 75%.
- Manual review is 100% accurate, but it is time-consuming.
- Felix’s contract analysis engine can process thousands of contracts per day, increasing efficiency by 250%.
- Potential for up to $7 million in cost efficiencies annually for Felix clients.
AI Solutions for Efficient Contract Management and EOB Data Extraction
Felix Solutions steps in with AI and machine learning-powered tools to streamline these processes. For contract management, their Felix Contract Manager enhances the existing systems by automating data extraction and analysis.
For EOB digitization, Felix Solutions offers multiple benefits:
- Quick setup and processing of EOBs.
- High accuracy and 100% manual review accuracy.
- Data available for analytics, dashboards, revenue forecasting, and leakage analysis.
- Adherence to HIPAA and other organization guidelines, ensuring data security and business continuity.
Expected Outcomes: Business Impact
The introduction of AI into these processes is expected to have profound impacts on healthcare organizations. By automating contract management and EOB digitization, organizations can expect:
- Significant cost reductions: The potential for up to $7 million in cost efficiencies annually is a game-changer for healthcare providers and payors.
- Operational efficiency: Teams can focus on exceptions and client interactions, ensuring business continuity during onboarding and renewals.
- Improved patient experience: Faster contract processing means faster response to patient needs and inquiries.
Felix Solutions: Transforming Healthcare Efficiency
Felix Solutions offers an array of AI-driven solutions for various healthcare challenges. Here’s a closer look at their offerings:
PAYMENT INTEGRITY
This solution helps identify discrepancies in payments compared to contractual terms. By automatically reviewing EOB transactions and maintaining up-to-date contract data, Felix can recoup funds and ensure healthcare organizations are paid correctly.
POPULATION HEALTH SOLUTIONS
Felix’s Population Health Solutions provide actionable insights for low-cost care, reducing admissions and readmissions, boosting Star Ratings, and improving health quality. Predictive models, care management, and quality optimization are key components that contribute to better patient outcomes and financial success.
RISK ADJUSTMENT SOLUTION
Felix’s Risk Adjustment Solution uses advanced NLP and data matching algorithms to identify undocumented conditions, helping organizations optimize risk-adjustable revenues. Member prioritization and provider education tools enable healthcare providers to close gaps in documentation and ensure accuracy.
In summary, the rising costs associated with value-based care implementation can be a formidable challenge for healthcare organizations. The introduction of AI, such as the solutions offered by Felix, can dramatically improve efficiency, reduce costs, and enhance the overall patient experience.
Healthcare organizations are encouraged to explore these AI-driven solutions to thrive in the era of value-based care and transform the future of healthcare. To learn more about how Felix Solutions can revolutionize your healthcare operations, act today and reach out for a consultation by writing an email at hello@felixsolutions.ai.