“One SME is contract management at our organization” is a statement we’ve heard countless times. This go-to person is surely the inspiration for the character Janet on The Good Place—we’re talking encyclopedia-levels of knowledge regarding the organization’s contract universe. Janet can name the most favorable billing and appeal limit terms, the contract next up for renegotiations, and provide precise rate types all at the same time.
We love Janet; we need Janet. But, time are changing. Thanks to modern tech, AI can now provide the same level of information dissemination as contracting connoisseurs like Janet. That doesn’t mean the people with vast contracting knowledge are obsolete! On the contrary, they are even more important. In this era of using technology to up-level the payer/provider contracting process, organizations shouldn't aim to replace their best SMEs with AI. Instead, they should focus on harnessing AI in ways that enable SMEs to kick apples on the Real Big Initiatives.
As we've continued working to simplify the contract negotiation process, we've asked ourselves how we can better enable both the mission-critical contracting SME and the entire organization to successfully tackle contracting. After some thought and a few episodes of The Good Place (long live shrimp cocktail), we realized the key is to free the SME.
Why we need SMEs: a contract chaos history
Healthcare contracting, like many business processes, is partially dictated by legally binding contracts that outline the relationship, responsibilities, and rights of the involved parties. In managed care, these contracts are between payers and providers, and specify how the provider will participate in the payer’s network. They also cover the typical legalese that accompanies any contractual relationship. Keeping these healthcare contracts organized can be an exercise in futility since most span a long and winding paper trail (sometimes actual paper, though usually electronic) that document a complex chronicle of payer-provider relationship changes. From adding and removing health plans/providers or services to adjusting nuanced variables in reimbursement calculations, redlines and contract terms are buried in shared drives, desktop files, and rusty cabinets. Enter, contracting Subject Matter Experts (SMEs). They’re the people who know all those changes like the back of their hand. They own the shared drives, they answer all your questions, and usually spend most of their time disseminating their knowledge to others, not necessarily wielding it themselves. SMEs are critical to an organization…and right now, we think their talents are critically wasted. Information ownership and dissemination are a process ripe for thoughtful AI and technology to help organize and optimize, not SMEs.
The content of contracts is viewed as sensitive and easy to misinterpret, so making sense of an organization's contractual relationships falls to a trusted and specialized few. That level of nuance is why we think about thoughtful AI as a solution. No one benefits when AI recommends glue as the solution to keeping cheese on pizza, just as healthcare orgs don't benefit when their best SME gets put on a never-ending hamster wheel of question answering team-wide. SMEs and AI alike do their best to represent the complexity of a contract multiverse with the tools at their disposal, and our hunch is that a simplified future state involves both SMEs and game-changing technology. Sounds compelling…minus the glued pizza. How can AI enter the mix?
Contract mania, meet contract metadata
The foundational work to onboard an AI solution is laid when an organization digitizes its mania of paper documents. Most larger hospitals, health systems, and payers are already reviewing digital versions of their contracts. However, their “digital filing cabinets” each have their own ground rules for adding and sorting documents. Some organizations have defined a folder structure and file naming conventions, and others do not, but either way, the results are often a tangled web of inconsistent file names, folders, and product lines.
Automated rate and terms extraction can help digitally organize these documents. There’s no single agreed-upon way to sort contracts, though, like alphabetically or by page count—they are complex, and that makes them suitable for converting into metadata (aka data about data…aka context and TL;DR-type info about a larger data set). We’re building toward a world where the launch pad to get negotiated rate and terms data is digitized metadata your SMEs can wield, not own.
AI for an enhanced workflow and workforce
In that world, anyone with the right permissions and access could filter by payer name, document type, or effective date and immediately see relevant information. What used to require opening several scattered contract documents or filtering multiple columns across different Excel files now occurs in one place in a matter of seconds. This centralized metadata eliminates dependence on detailed folder and file naming conventions and disparate, often conflicting contract data reports. Both contracting SMEs and the broader healthcare organization unlock a new level of efficiency with the confidence that information within contracts remains secure. When AI is useful and accurate, it creates exponential opportunities for a more efficient workflow and workforce. The result is an empowered organization and, better yet, SMEs with time on their hands. SMEs with bandwidth! That laundry list of “backlog” items won't know what hit it.
AI frees the SME
There’s no getting around the fact that contracts can feel low-tech and unsophisticated. Despite that, the information within the contracts is a highly strategic asset that must be understood and appreciated in order to be optimized. When you free your SME of a paper trail, you leverage their knowledge at scale.
Turquoise is investing in resources and technology in a few areas to create transaction efficiency, and one of those areas is the improved ability to succinctly and accurately access key data points. Since the rates in these contracts are also the core of machine-readable files, we cannot continue to separate contracts from data itself. If we want to truly eliminate the financial complexity of healthcare, we need both clear, organized access to rate data and a better contracting experience.
If you’re ready to free your SME, or just want more phrases that rhyme, schedule a demo of our contracting solution.