Healthcare systems today are under immense pressure—balancing rising patient volumes, complex care coordination, and stringent compliance requirements. Administrative inefficiencies not only burden staff but also impede patient outcomes. Enter case management and workflow automation tools: digital platforms designed to reduce that burden by streamlining decision-making and enabling providers and payers to deliver coordinated, efficient, and patient-centered care.
Automation has the potential to save billions in healthcare costs
Every day, patients, providers, and health plans navigate a dense web of administrative tasks such as verifying insurance, securing approvals for treatment, submitting claims, processing payments. In the U.S. alone, this type of work costs $440 billion annually.
The 2024 CAQH Index identified a staggering $20 billion opportunity to reduce costs by shifting from manual processes to automated ones. Workflow automation solutions could eliminate 22% of administrative waste and free up valuable time and resources so providers can focus on patient care instead of paperwork.
The payoff is multifaceted:
- Patients experience fewer delays and barriers to care.
- Providers spend more time treating patients and less on manual data entry.
- Health systems benefit from improved access, speed, and staff satisfaction as lower complexity tasks are offloaded.
Why healthcare workflow automation is critical for value-based care
Administrative volume continues to rise each year, with health plans reporting growing memberships and greater service demand. At the same time, the industry is under increasing pressure to deliver on the promises of value-based care, which focuses on three pillars:
- Improving patient outcomes
- Reducing overall costs
- Ensuring accountability (from providers and payers)
To succeed, healthcare organizations must be able to make faster, smarter, and fairer decisions—especially in areas like prior authorizations, claims reviews, and appeals.
Alithya Rapid Suite: purpose-built automation for healthcare
For healthcare organizations looking to accelerate transformation, Alithya Rapid Suite delivers an intelligent, scalable solution designed to streamline and automate time-consuming manual processes. Leveraging the power of artificial intelligence, machine learning, and intelligent document processing (IDP), the platform turns unstructured content—like PDFs, handwritten forms, or faxes—into structured, actionable data.
The Alithya Rapid Suite simplifies complex document handling through intelligent automation that:
- analyzes and classifies incoming documents,
- extracts key information with high accuracy, and
- routes content automatically into the right systems or workflows.
The platform extends the value of your existing enterprise content management (ECM) systems by enabling you to:
- ingest documents from email, fax, or physical mail;
- clean, assemble, and analyze both printed and handwritten images; and
- extract key data to instantly trigger downstream workflows.
From prior authorizations to claims and appeals, Alithya Rapid Suite ensures that critical data flows quickly and accurately through your organization—minimizing delays, reducing error rates, and empowering staff to focus on what matters most: delivering better care.
From rules to orchestration: the future of healthcare automation
Traditional workflow automation relied on static, rules-based logic—"if this, then that" structures that made systems predictable but often rigid. And every rule, as we’ve learned, becomes a potential point of failure.
The next evolution is orchestration: the ability to unify data across systems and departments, apply dynamic rules and business logic, and infuse generative AI to make decisions in real time—based on context, not just code.
The shift to orchestration involves:
- Unifying data: pulling provider, member, claims, and clinical information into one platform
- Role-based experiences: sending tasks to legal, clinical, or operations teams seamlessly
- Rules + GenAI: blending hard rules with AI that adapts based on organizational policies, CMS guidelines, and evolving health standards
- Fewer rules, fewer bottlenecks: relying less on brittle logic and more on contextual intelligence
Gen AI in workflow: not just smart, but ethical
One of the most powerful use cases for AI in healthcare operations isn’t just efficiency—it’s fairness.
With the right analytics and orchestration layers, generative AI can:
- Detect bias in decision-making across race, gender, location, or socioeconomic factors
- Highlight fraud trends, such as inconsistent coding patterns from specific providers
- Auto-adjust rules based on trends, while sending a percentage to QA for human review
- Surface bottlenecks, showing where decisions are delayed—e.g., comparing turnaround times in Indiana vs. Georgia
- Balance compliance and care by flagging potentially harmful decisions before they reach patients
Where most healthcare payers are today
The majority of payers are still operating within a rules-based automation framework. While it’s a solid foundation, it’s quickly approaching its ceiling. With growing volumes, increasing regulation, and public pressure for better accountability, now is the time to explore context-driven orchestration and AI-infused workflows.
The most common pain points AI workflows resolve include:
- Delayed responses to expedited requests (especially when faxes or unstructured forms are involved)
- High appeal rates, indicating rushed or inconsistent decision-making
- Overreliance on specialists for low-complexity cases that could be automated
- Regulatory risks and bias concerns across departments and systems
Workflow platforms like Alithya Rapid Suite can help eliminate these pain points—streamlining operations while supporting transparency, compliance, and better patient outcomes.
Getting started with healthcare workflow automation
The path to intelligent automation doesn’t start with software. It starts with understanding your challenges, your workflows, and your value-based care goals.
At Alithya, we partner with healthcare payers and providers to:
- Identify and analyze process bottlenecks
- Map out automation opportunities
- Implement scalable solutions like Alithya Rapid Suite to bring immediate impact
Whether your team is bogged down by paperwork, struggling to keep up with demand, or exploring how AI and automation could improve decision-making, we’re here to help.
Let’s start the conversation. Learn how Alithya Rapid Suite can help you modernize your workflows, reduce administrative burden, and deliver healthcare that’s faster, fairer, and more efficient.