Intelligent operations in today’s health care landscape

Facing growing pressure to drive down costs, increase quality outcomes, and improve member and provider satisfaction rates, today’s health care organizations are looking to digitize operations to streamline business processes. By doing so, stakeholders hope they’ll exponentially increase efficiencies and make it possible to deliver next-level care

Both payer and provider organizations struggle to hire and retain enough employees to meet care-quality standards and maintain efficient operations, a problem that’s likely to worsen in the coming years.

According to U.S. Census Bureau data, the American population is growing older. Over the past decade, the 65 and older population has grown by 34.2%, and the agency forecasts that the number of U.S. residents 65 or older will exceed 82 million by 2030. This will increase the overall demand for health care, including geriatric care and treatments for chronic diseases and comorbidities that rise as people age. At the same time, nursing schools around the country struggle to expand their capacity to meet the rising demand for their graduates. The American Association of Colleges of Nursing (AACN) reported that accredited nursing programs in the U.S. turned away more than 80,000 qualified applicants in 2019 due to faculty shortages, lack of classroom space and having too few clinical sites.

Meanwhile, the average age of registered nurses has climbed from 42 to 48 since 2000. Nearly half of the nurses working today are over 50, leading experts to predict that a large wave of retirements will soon occur. It’s forecast that more than one million nurses will leave the workforce by 2030. As a result, the United States Registered Nurse Workforce Report Card predicts a shortage of over 500,000 RNs by the end of the current decade.

Given the severity of the nursing shortage — as well as that it’s unlikely to improve anytime soon — it’s imperative for health care organizations to improve their employees’ on-the-job experiences and enable them to practice at the top of their licenses. It’s also critical for health care organizations to continue to deliver high-quality, patient-centric care.

Driven by surging enrollment in Medicare Advantage and Medicaid plans as well as regulatory pressure to implement value-based reimbursement models, care quality measures such as Healthcare Effectiveness Data and Information Set (HEDIS) scores and Centers for Medicare & Medicaid Services (CMS) Star ratings are becoming increasingly important in enrollment decisions.

So, too, are net promoter scores and customer-satisfaction ratings assigned to a health plan or provider practice by the patients who use it. To survive and even thrive in this challenging business climate, health care organizations must take advantage of every possible opportunity to create new operational efficiencies. One of the best ways to do this is to digitize operations.

By applying artificial intelligence (AI) and cloud computing technologies to streamline processes, simplify clinical workflows and eliminate manual administrative tasks, companies can improve patient and employee satisfaction at the same time.

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