Latest / Zero Friction / AI vs AI: How Insurance Claim Bots and Provider Bots Are Now Fighting Each Other | Deepak Borole

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AI vs AI: How Insurance Claim Bots and Provider Bots Are Now Fighting Each Other | Deepak Borole · Zero Friction

• Terry: Hello, Zero Friction Podcast. This is Terry Coutsolioutsos I have a great guest today that's gonna bring us some perspective from the platform and the AI space. I have Deepak Borole He is the director of operations for the healthcare vertical at Chetu And basically what they do in the marketplace is they are a technology developer and his group is focused on how to bring new technology, new efficiencies, and now AI to the healthcare vertical. So Deepak, welcome to be here today. Can't wait to learn more about you and your your history in healthcare care and what you're doing, and then let's talk about AI and healthcare and work what Chetu is doing to help shape the future of that. Deepak Borole: Thank you. Glad to be here. Terry: Well good. So why don't you tell us a little bit about your background? how did you get started in technology? how long have you been with Chetu Deepak Borole: So about me, I'm Deepak Borole. I'm the Director of Operations here at Chetu managing the healthcare vertical. Something more about me that I did my education back in India in my engineering, and that's how I got into technology. I started as a developer and then went across becoming... and performing other roles like team lead, project managers, and then the director. With Chetu, I've been working for more than 12 years now and purely focusing on healthcare. So we have been doing a lot of interesting and different kinds of projects here in Chetu when it comes to healthcare, whether it is for general healthcare, EHR, EMR, remote healthcare, specialty healthcare, and even the pharmacy and life sciences. Terry: So you've seen a lot of changes with you know the emergence of EMR automation and now AI is on the forefront of things. So tell us about how Chetu engages healthcare providers today. And and what are your biggest, most promising offerings to healthcare in today's marketplace? Deepak Borole: Sure. So Chetu is more of like AI and the transformation company. So we help customers to build solutions and products. So we have engineers who work with customers to build their vision, build their workflows, build their solutions. which they own it. So all the intellectual property is owned by the clients. That's our model. And again, apart from that, the main differentiators, what we have is that we, as a company, when we work with a client, we provide a team who have extensive experience in that particular domain, area, and we understand the standards, protocols in healthcare like HIPAA. PHI, any other guidelines and all, which we use and provide feedback and consultation to the client while working with them. Terry: I'm guessing the customer is having experiences with some sort of friction, right? What are the biggest friction points that you and your team are dealing with healthcare and what problems are you helping them solve today? Deepak Borole: So the top most challenges which the industry, especially in healthcare, they are facing is basically the burnout problem, right? The providers, nurses and other staff members, they have so much of work, manual task and all, they don't get time to do everything, right? So that's where these systems, digital transformation and AI is helping. So where we can automate their task. Some of the routine tasks which they do on a repetitive basis can be automated pretty easily through AI. That way, some of the load can be taken off them. Example like ambient listening, right? That's a successful thing which has been in the market for some time now. But previously, the providers or the nurses used to take notes and then enter them in the system. Even they used to call something called as pajama time where they used to go home. and do that activity. So now with the help of ambient listing, this can be easily recorded, translated into a proper format, and then it can be integrated in the EHR. So they just need to review it once and approve it. That's it. Terry: Excellent. So you take the requirements from the customer, right? Like you figure out what the problems are, you then take an inventory of what they need in order to solve that problem. where are the most problematic areas of the project that you know keeps them from moving forward? Deepak Borole: So, you rightly said that we work with them end to end. We work with them to gather requirements, Then plan that out into project plan and there are even the task and all, execute them, deliver them and even provide support and maintenance. And again, obviously there are some challenges which come across while working with in this particular format right sometimes the the client is not able to finalize the requirements or they keep on changing it due to which the time and the cost increases that's one of the thing sometimes they themselves are not sure about what they need and they don't want to spend time on the user acceptance testing which is very key component of any sdlc life cycle So all these challenges which we see while working with the customers, but over the period of time, we have seen a lot of clients. We have worked in different industries, including health care. So we understand what questions to be asked to the client from the get-go to capture all that. That way we can reduce the friction as much as we can. Terry: Understood. So, one thing that you mentioned earlier in the conversation after the problem has been solved, you said the client owns the IP and and they can white label it. what does that unlock for the provider itself? Deepak Borole: Right. So basically, imagine that you basically have an idea, right? And you want to build something. You're starting a business, you have an idea, you want to build a product, right? So we as a company, we help that particular client to build that product the way they want it. So we kind of take their vision, build that product for them by closely working with them. and they own the intellectual property of it. So they can use easily white labelled application to get more users, subscribe and all those things can be done. Even they want to sell this product tomorrow, they can do that. So it's like off the shelf software versus a custom solution which they own. Terry: Right. So tell me about the repetitive work areas in the hospital. where are the big areas where that's found the most? Or with the healthcare provider? Deepak Borole: Sure. Right. So some of the common use cases which you can see is that the front stuff, right, where they get a lot of calls and not only calls, but they get a lot of faxes, emails, text notifications, right, from the patients or the users, right? That's one of the repeated tasks which that particular group has to work every day. So if we can automate some part of the work for them, they can use that time to focus on something else. At the same time, what we do is we build human in loop component, which can be used for some critical scenarios or workflows. So that's one area. The other areas is documentation, where different members have to document the work that they do, whether it is providers, nurses, or even the staff. So that is where AI can be used to automate that. Apart from that, there are also areas where they want to generate some reports. Sometimes they might be doing it manually. Or they want to get some data on the fly. So previously, had to you create a request, somebody who's to work up on it, and then give the feedback. So all these things can be automated, or AI can be leveraged to give them easy access to that data. So they can easily query, the response, and use that data for their ongoing task. Terry: Got it. So one thing you mentioned to me before in our earlier conversation really was revolving around the medical practice itself. And so let's talk about the front desk and what you do for for practices, right? I think that's a a big part of a marketplace that has strong demand for these types of products, correct? Deepak Borole: Mm-hmm. That's correct. So basically the burnout problem everybody is facing in the industry, the shortage on resources also, right. They may not get the front staff, right, or even the, they need back office staff also. So back office is nothing but who does some task ahead of the schedules. Example, they wanted to generate some data. and have it ready for the appointment. Vice versa, they also work on billing and coding. So all that things basically are back office and the front staff is basically who is working with the patients. So the idea is that is nothing but a workflow. They do it for every patients. There are kind of scenarios which need to be covered. What we can do is we as a company can help them to understand those workflows, do the automation for them by going from step one to step four and so on so forth. But the idea is that we also integrate that data with the EHR they're using. So what we can do is we can not only automate the task, but also integrate that data with the EHR. That is, end-to-end automation is achieved. And as I said earlier, that for some of the tasks, we will also give them options to do human in loop, where we can provide them dashboards or screens. where they can review that data content and then approve it. Terry: Very good. how long does it take to, you know, build a platform for the front desk typically? Deepak Borole: So I would say it depends on what the features they're for. But I would say in the range of five months. That's the average I have seen by working with different kinds of clients. Yeah. Terry: Right. So if I were to come in and say I need a a front office or front desk solution, what does that process look like? Tell me a little bit about what how does it start, what happens in the middle and then what happens at the end. Deepak Borole: Sure. So what we do is we first understand what practice that is, right? What are their patients look like? What is their workflow look like? What is their ongoing things and what is their pain points, right? So we capture all those details, right? And what they're looking for, they're looking for some voice integration, right? As I said earlier, of email, fax, or even text messages. So we capture all these details. We create design documents where we detail down everything that's required as part of this process. Then we create a project plan, which is nothing but a breakdown of that scope of work, which will give a clear visibility to the client. Okay, this is what that workflow or the task would be and how much time it would be. And then we work upon those tasks. through using that project plan and show the progress every week to the client. That way they know what's happening, any questions, those can be answered. And we also provide them intermediate releases. That way they see what's going on and they don't have to wait till everything is completed. And we have a clear plan of testing, then going live, which is a production environment, and then providing the support. after that because it's a software, right? You will need some support on ongoing basis. So we do have different offerings around that. If a client's want to continue with a smaller team, we can do that. But otherwise, we also offer a block of our services, our packages to support them as part of support and maintenance. Terry: Got it. So when it's all said and done, how how does the practice trust AI today? Like, you come in, you're trying to develop a new solution to create efficiency, to make life better. How does that all go and like what are the pluses and minuses when it comes to you know working with the practice? Deepak Borole: Correct. they said earlier that they will not know exactly what they want. Right. They just say come here. Okay. I we want to have because they have heard about it. Right. So we narrow it down exactly what you need. Like what is your pain points? And then according to that, we understand their business services they provide and come up with the high value use cases. which apply to them. But in some cases, we also do proof of concept, right? First, try to show them, okay, this is your pain point. This is your high-value use case. This is what we will do. And once they are like onboarded with that, then you kind of expand that to scale it up and implement that for the full practice or even multi-practice scenario. depends on practice to practice. But it's not like just a product we give them. Okay, this is your product. You take it and just plug it and start using it. Terry: Got it. tell me about like billing and filing claims and like what's going on with that in the world of AI today? Deepak Borole: Sure. So yes, there have been a lot of issues of AI in this particular space because a lot of these activities are repetitive, right? The building and the coding activities are repetitive. At the same time, there's a whole process that goes in the background for claims, right? So basically the providers have to file claims, which goes to the payers of the clearing house, which takes time. And there's a lot of complex data involved over there. There's a of denials, there's back and forth. Even you must have heard about prioritization, right? Which takes a lot of time to get approved and so on. So all that thing can be now automated by the help of AI. So what happens is that with these denials and errors can be reduced using AI to achieve the accuracy. That way, the claims can be approved quickly. Reimbursement can be done sooner. And with this, especially this helps in of hospitals, especially the rural ones who already have challenges with the funding and expenses, right? So it helps them a lot. Apart from that, any repetitive work, which I said now can be done through AI. And again, it's kind of around the clock. Terry: You know, I heard that insurance companies have been using AI for file for claims denials as well. So now we have doctors offices fighting with the insurance claim AI. So it's AI versus AI. How does that how does that work? Deepak Borole: I would say that overall the accuracy is improved, right? With the time and all would be reduced because imagine that somebody is doing it for days and then submitting it, then they use process it. So overall, we are using AI on the provider side. On the payer's side also AI is using. So obviously the process has become faster and the response is also. So we are able to catch those issues and errors pretty quickly, that's how AI versus AI is working now to move faster. And even the same thing like the prioritization case. That has been a huge pain point in the industry. now instead of taking a lot of days to approve that and then keep the patient waiting or even admitted in the hospital, which increases the cost, right? So now that is reduced a lot. So it process to AI and also on the other side, there's an AI which who checks a lot of things and then approves it. Terry: Understood. And then tell me about your integrated decision support and how does that work in the EHR, the EMR these days from a workflow perspective. Tell me what's important there. Deepak Borole: So yes, in the EHR world, like every hospital, every clinics have been using EHRs. Now, EHR themselves are having some AI features in the platform, AI agents, which are commonly used across different providers and practices and all. But there are still areas where AI is not there or there is some custom thing which a practice need. That's where we come into play. We help them to build that AI and also integrate that data which is required for the AI into the EHR, to standard like HL7, FHIR and so on. So we use that extensively to do the end-to-end integration and build that AI component for our clients based on what they need and they can then use it or even enhance it as they need Terry: I come from an imaging background space and I know there's a lot of AI used in imaging. So tell me how AI is helping to automate the clinical decision making, clinical workflows in the imaging space, because I think that's an area that has a tremendous opportunity for efficiency as probably Deepak Borole: Yeah. Terry: as well as quality. Deepak Borole: Correct. Yeah, again, imaging has been used a lot, everywhere in healthcare. So a lot of scans happens every day. A lot of so many radiologists especially has to go through a lot of scans. They have to work on their side and give the results back. So all that thing now can be automated through AI. So example, we're not saying like replacing the radiologists, but the common things which they do. Example, if they are going to scans and categorizing the different areas, right? So what we can do is through AI, we can do that and categorize those scans into two different buckets or different problems. Like the example, is for pneumonia, this is for this area and all that thing. That way, 70 to 80 % of work of religious can be automated. and they can then take a look at the end and then work on other areas. So in short, they can process more scans in a day, which they used to do earlier. At the same time, if a human is involved, error can be there, There can be negligence and so on. With AI, it's more of a accuracy. So the more better data which we have to train the models and all, the better is the accuracy. So obviously data plays a very important role. And we have been working on lot of such projects where we have taken lot of such images or scans to train the models and get the accuracy or even fine tune the models to achieve it. And by the end of the day, the result is that it improves the accuracy and also the time for the providers or your registrar. Terry: Got it. so if you're a healthcare leader, where do you start? how do you even initiate an AI engagement process? Deepak Borole: Right. So yeah, so if you are a provider, right, so I would say that in some cases, just know about AI. I heard about AI. don't know where to start. In some cases, they know what exactly they want. Right. But the idea is that most of the companies are what I have seen they have been focusing upon working with vendors like us. In some cases, they also have one or two resources in-house. But it's a combination or a hybrid approach where they use a vendor like Chetu plus Eternal Team to work on their high-value use cases, maybe do a proof of concept, and then expand that and scale it up, and then move on to the other use cases. That way, they start getting the outcome, and then they see other areas where AI can be used to automate things. Terry: Got it. So of everything that Chetu builds, where do you think in your world, in the healthcare world, where's the fastest payoff when they invest in automation? Deepak Borole: So I would say it is the time and money, right? Terry: Okay. Deepak Borole: For the healthcare providers, right? If you imagine that if they had some five people working on a task on a repetitive basis, now that Terry: Right. Deepak Borole: can be reduced to one person job who is kind of more of like doing human in loop, right? So that's where the time is reduced. And also at the same time, they are paying those resources. So the money is also saved in a way. But the good part is that those same resources can be doing some other work. So that's what value I have seen on all across different projects on different clients. Terry: Got it. And what's the first friction point you think they should tackle? Like the most repetitive? task that they have. I mean we're if you put like your problems in a box, right? Like in four boxes. So you have high impact, repetitive things, you have low impact repetitive things, you have high impact, not repetitive and low impact. So focus on the high impact or focus on the high activity, high residual activities. Is that where they you you tend to tech have your customers start? Deepak Borole: Correct. So I would say it's a combination depending on which area it is clinical versus administrative. Right. If it's like administrative, if it's high impact and repetitive, obviously that should be the way to go. Sometimes clinical need to be taken carefully because it deals with patients and also maybe that can be dealt with after we do the administrative task because now we know this is automated. So now there's focus upon the other clinical use cases where we can do automation but may not be 100 percent, it will be 60 percent. That's totally fine, right? Because we have to be careful. At the same time, we have to follow the compliance and the governance. We have to put some guardrails. That way, we get the required output. At the same time, the health is maintained of the patients the providers are dealing with. Terry: especially in healthcare with administrative burdens, I just think that there's so much opportunity in the physician office space. How much work do you do for physician offices today? Deepak Borole: A lot. I would say a lot of our customers are physician offices, Terry: Okay. Deepak Borole: Our providers who can be a single practice or a multi-practice facility. But yes, they do lot of have lot of needs around modernization, right? Or transformation where they're doing a lot of manual tasks where we help them to transform it or even automation integrations with different platforms, not only EHR, but they might have other systems also, which are working in silos. So Terry: Right. Deepak Borole: they need help to talk to each other and that also helps them solve lot of their problems. Terry: so tell me, are there any other points you want to make to the audience before we kind of start closing things up? Deepak Borole: So yes, as I said that we have been working in this space for the last 26 years, so we have extensive experience in healthcare. And there's a lot happening with AI in healthcare, especially out of scope to automate and modernize things. So try to work on those areas and work with a company like us who can help you to achieve that. Terry: Good. So one last question for you. Deepak, if you could go back to your younger self coming out of uni or university, right? What would be the one piece of advice that you would give yourself? Deepak Borole: I would say for people who are passing out, right, my message would be be curious, right, be hungry and have adaptability because things have changed so fast and keep on learning, right, because that's the way to go. Otherwise you will easily fall behind. Terry: Well, Deepak, I appreciate you being here today. If anybody in our audience, Chetu is a bespoke developer for healthcare practices. They have a big portfolio, but Deepak runs the healthcare vertical. And if you have a doctor's office or a practice that is looking for front desk support, administrative support, EHR handling, claim filing, all those things kind of fall into the umbrella where AI can really create some value for. Practice, correct? Deepak Borole: That's correct. Terry: Alright, excellent. Thank you, Deepak. Great to see you today. I appreciate it. Deepak Borole: Thank you.