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Muthu Alagappan of Notable talks about automation in healthcare: ‘It’s a lifeboat’


The chief medical officer of Notable spoke with us about the company, and why hospitals and healthcare companies are going to have to move some tasks away from people.

Muthu Alagappan says it’s time to move beyond thinking of automating some healthcare tasks as a luxury or a long-term goal.

The chief medical officer of Notable, a healthcare automation company, Alagappan said hospitals and health systems are going to have to move some tasks away from people out of necessity.

With the labor crunch in the COVID-19 pandemic making it more difficult to fill openings, health systems are going to have to utilize automation for some workflows, he told Chief Healthcare Executive.

“The proposition isn't to replace a human with a bot,” Alagappan said. “Oftentimes, there is no human to replace. These are vacant jobs that no one is filling … Why not automate it and do it for a fraction of the cost?”

Alagappan spoke with Chief Healthcare Executive about the growth of Notable, the future of automation in healthcare, and how healthcare leaders should be thinking about digital solutions.

“Every other industry has and is using more and more of it,” Alagappan said of automation. “Healthcare is going to be no different and may lag, but it won't be any different.”

“And there's no other way out for healthcare from a cost perspective,” he continued. “I mean, there's no way to do what healthcare does today with only people running it for the next decade. And so, when you have a technology that is sort of inevitable in a massive industry, I think it's easy to get excited about what the potential is there.”

(See excerpts of our conversation with Muthu Alagappan in this video. The story continues below the video.)

Becoming imperative

A physician executive, Alagappan joined Notable nearly three years ago, becoming the first doctor to join the company. He said the company has brought in top minds from healthcare and outside healthcare, from tech giants such as Google, Apple and Microsoft, to develop automation solutions powered by artificial intelligence.

Based in San Mateo, California, Notable works with some large systems such as CommonSpirit Health, Intermountain Healthcare, and MUSC, but also works with smaller systems and Federally Qualified Health Centers. The company’s platform has been deployed at more than 1,000 sites, and automates nearly 1 million workflows each day, Alagappan says.

Notable has designed automation solutions for more than 100 workflows, but Alagappan says there is potential for more.

“The types of problems we solve for FQHCs may be different than the problems we’re solving for CommonSpirit Health,” Alagappan says. “But they're using the same core platform behind the scenes. And that platform is one that can take data, ingest it, make sense of it, determine what action needs to be taken, and then take that action.”

Some of those solutions involve automating processes for prior authorization, a thorny problem for providers. Doctors and hospitals routinely cite the process of gaining approval from payers for drugs or treatments as one of the most time-consuming and frustrating processes of healthcare. While payers say it’s a critical mechanism to control costs, doctors and health systems say the process delays important treatments and adds to physician burnout.

Automation allows authorization requests to be filled without taking so much time from staff, and can weed out some requests that aren’t necessary. “We start by just automating the work queues, getting rid of authorizations, that turns out, you didn't need an authorization for that procedure or for that particular patient,” Alagappan said.

Health systems are expressing more interest about moving forward with automation, Alagappan says.

“I think everyone has been excited about automation,” he says. “You know, it seems to be a very popular topic amongst C suites and boards these days.”

“The labor crunch and market downturn has made it from a ‘nice-to-have’ to a sort of ‘must have,’ and I think we're seeing now healthcare systems are not wanting to dabble. They're really wanting to go all in,” Alagappan says.

As health systems do more long-term planning and project needing additional staff at higher costs, they’re seeing the math is pointing toward automation.

“It’s an antidote,” Alagappan says. “It’s a lifeboat. It's become sort of imperative.”

At the same time, healthcare organizations are recognizing that they’re going to need help automating workflows, and turning to Notable, he said.

“If you're training for a marathon, and you've never ran before, you're probably going to hire a coach or someone who's done it before,” Alagappan said.

Find where mistakes are happening

Hospitals have suffered steep financial losses this years, as they’ve endured higher costs during the pandemic and revenue losses as some patients delayed care. More than half of all hospital systems could end the year in negative margins, according to an American Hospital Association report.

Health systems have had to look closely at expenses, and that has delayed some from moving forward with new technology initiatives. But systems are expressing more interest in investing in digital solutions, Alagappan said.

“What the pandemic taught them is that they have to have technology that is as nimble as they need to be in these types of situations,” he said.

Healthcare leaders weighing the pros and cons of automation should examine the areas where they have people doing “lots of manual repetitive work,” Alagappan said. They should also look at areas where they are having trouble finding workers.

Executives should also be asking where staff are making mistakes more often, a question that Alagappan said is often not asked when it comes to automation.

“Let's also ask the question of where are humans just making mistakes? They’re error prone,” he says. “And where can we introduce digital assistants that are more accurate, less error prone, higher fidelity?”

The claims process is a good example of an area where human errors are common, Alagappan said. Sometimes employees enter the wrong insurance plan or identification number, and then claims are denied.

Digital assistants can handle claims with less likelihood of mistakes, he says.

“Those are the two questions: Where am I doing work? And then where am I working incorrectly? And especially that second category turns out as a great area where, often, machines can reduce your error rate,” Alagappan said.

Looking ahead, Alagappan said he expects to see the automation of more workflows. He's especially excited about the prospect of empowering providers to help create their own automations.

“What if we could give every health system its own interface, its own studio to automate their own workflows, where we didn't have to do it for them,” Alagappan said. “We could give them almost like a Lego building block can say, hey, here are the building blocks you need to automate.

“You take the workflows you think are most important,” he said. “And using these building blocks, you can automate them without any of our expertise or help needed. And when we get to that point, which we're very quickly moving toward, I think, we're just going to see an explosion in the adoption of automation, as people can start to do it themselves.”

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