Using Artificial Intelligence to Optimize Payer Contracting Processes in Healthcare

Agreements between healthcare providers and health insurance companies cover critical terms that greatly affect services and revenue. Payer-provider contracts can include reimbursement rates, provider networks coverage, medical necessity reimbursement processes, and provider credentialing. Negotiating these payer-provider contracts typically involves a complex, lengthy and time-consuming process. Larger organizations can often be involved in multiple contract negotiations at the same time and often lack visibility into the information in existing contracts.

Contract analytics solutions that include artificial intelligence can help streamline the document generation and negotiation process by helping professionals understand what’s in their contracts. For example, a contract solution that includes AI can help them more effectively renegotiate rates and equip them with the data and transparency necessary to understand what the rates include.

In this blog, we’ll share how Grant Thornton helped a healthcare system client digitally transform a large volume of contracts into a central, searchable database to analyze the data contained in them.

Bringing benefits to life

Grant Thornton, one of the world’s largest accounting firms, was once approached by a healthcare system client that had thousands of contracts–the most recent executed in the early 2000s. Its largely hard copy filing system required employees to manually search and compare documents to ensure Tricare compliance, a cumbersome process that provided little value to the business or its customers. When Grant Thornton took the client on, it began the process of digitizing the contracts in PDF format and then leveraging DocuSign Insight to extract information from them.

DocuSign Insight makes it possible to compare legacy contracts to new ones and create a normalized, searchable database from information contained within the contracts. From there, the organization could create customized analytics and understand where terms in the contracts align to company policies or compliance requirements or where there was a need for an update.

“The ability for us to quickly compare over 2,000 contracts against a regulatory document to identify compliance–and more importantly noncompliance–was something the client has been trying to achieve for multiple years,” said Tony Dinola, technology transformation partner at Grant Thornton. “It was something that previously they had started and stopped multiple times. We were able to execute it in a six-week window.”

The power of analytics

DocuSign Insight uses a proven combination of AI technologies—including natural language processing, machine learning and rules-based logic—to help find, filter and analyze agreements across your enterprise.

When evaluating compliance across healthcare contracts, Insight offers an efficient way to identify terms that have changed over time and ensure contracts include the appropriate clauses and language.

The DocuSign Insight platform includes more than 125 pretrained models that drive analytics. It also allows users to customize and add additional machine learning models into the platform. When Grant Thornton was working with their healthcare client, the team created more than 25 highly-customized models to meet the organization’s need for specific insights.

“It’s very easy to create the models, it’s very easy to train the models,” Dinola said.

He encouraged organizations who’ve yet to embrace such processes to make the leap to more effectively process and manage contracts.

“The most important thing we stress to our clients is the importance of getting started and leveraging these products to surface value quickly. That’s really where the value of the artificial intelligence components come in,” Dinola said. “You can gather up the documents, we can quickly ingest them into the platform and start seeing value right away. You can start seeing analytics as soon as those documents are ingested, you can start to search, you can start to centralize.”

Benefits of a contract management solution with AI

Here are three ways your team can use AI to improve everyday workflows:

• Focus legal, contract and network manager resources on more strategic work. Searching through hundreds of contracts manually to identify risks is tedious and time-consuming. Using automation can free up legal resources to focus on real value-add activities that take advantage of their unique skills. In one case, a DocuSign customer was able to save $1,750 per contract by reducing reliance on outside counsel and using DocuSign Insight.
• Mitigate risk with increased control. To maintain value in a dynamic landscape, a contract cannot merely be a static document. With ever-changing regulations and unexpected new variables, it’s impossible to stay on top of risk mitigation without an army of experts constantly searching. AI can transform agreements into living documents and help raise the alarm to point employees to relevant copy for a fast, well-educated response to new conditions.
• Increase visibility. Better understand historic reimbursement rates to inform new negotiations and leverage the data in your existing agreements
• Reduce contract value leakage. Without proper visibility into contract obligations, an organization could fail to collect payment or enforce obligations, resulting in missed opportunities for additional revenue. Additionally, missed obligations related to compliance or regulatory requirements could result in fines or other penalties. Contract analytics can help uncover these risks and opportunities to return value to the business.
• Maintain compliance and stay up-to-date with government regulations. Use AI to identify contracts that have fallen out of compliance with current regulatory standards.

Learn more about the value of contract analysis in our recent research study, Contract Analysis Trends: Smarter Search.