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Hello, everyone, and thank you for tuning in

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into the Becker health care podcast series. Today,

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I am pleased to be joined Barr as

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we focus on payers and some of the

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administrative challenges they are facing in light of

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Cms

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regulations, pertaining to Medicare Advantage, including compliance with

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state and federal prior authorization, requirements, and interoperability

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and increasing transparency and accountability

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reporting.

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These changes are accelerating the need for health

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health plan payers to accelerate, optimize and automate

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many administrative functions would some estimate to make

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up 25 percent of the 4700000000000.0

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total health spending in the Us.

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Before I begin, I'm going to introduce today's

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speaker, Paul, Senior industry practice director of view

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uipath.

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Uipath is a enterprise scale intelligent automation platform.

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That combines Id, Rpa, process mining, task mining,

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process,

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orchestration, and Ai ml based capabilities

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including communications mining for Nlp and unstructured data

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processing.

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Uipath customers appreciate the scalability,

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flexibility of the solution, along with ease of

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use in configuring and training ml models. Paul,

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thank you so much for joining us today.

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How are you? Thanks for happy me, Terrific.

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Yeah. Wonderful. What's 2 gonna started. I first

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wanna thank you again for joining the podcast.

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He's also a bit more about yourself and

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a little more about you uipath.

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Sure.

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So I've actually had the privilege of serving

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in the health care industry now for upwards

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of 35 years. And I've had the opportunity

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to really traverse

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the various sectors. I started in medical education,

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jumped over into medical

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information systems.

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And then got into disease management,

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jumped over then into consulting where I spent

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the better part of 14 years with a

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big 4 firm, consulting to the various sectors

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of health care. And by that, I mean,

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bio pharma,

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payers and providers really working with them to

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optimize their business.

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And then spent the last 6 years really

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up these this intersection of High tech and

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healthcare care with some of the hyper dealers

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leading

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industry strategy for companies like Google, and Amazon

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Aws.

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In terms of Uipath, and thank you for

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the the kind remarks in the intro,

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Uipath really is is a platform for innovation

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and automation. And within healthcare, we see so

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many point solutions that exist and there's a

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lot terrific innovation going on. But a lot

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of the customers that I speak with day

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in and day out, and it's a big

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part of my role is really to beat

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with executives of payers specifically. And

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our responsibilities

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overseeing payers and providers in the Americas. Is

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really to meet with executives and understand what's

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on their mind relative to their strategic

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transformation initiatives. A lot of business processes have

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been digitized, but we're capturing information, but we're

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really not able to unlock

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the value that's contained within that information. So

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Uipath as a platform really serves as a

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unification capability

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that kind of meets customers where they are,

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can tap into the source systems they have

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and then begin to introduce

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automation, intelligent automation and some of the more

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advanced technologies, large language models, etcetera

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on the data so that it can be

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freed and used in in meaningful ways. And

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we're finding this is really particularly relevant and

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applicable with a lot of the regulations that

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have both been published in our fourth coming

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from Cms and others just in terms of

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the challenges that payers have, and the need

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to really move faster

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in a safe and effective way leverage the

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technology in the right place at the right

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time, but then also do so in an

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explain in an accountable way, and we've got

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some ways that we've been thinking about that.

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That's a little bit about Uipath.

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Yeah. Yeah. Wonderful. Thank you so much for

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giving us that explanation. So what are the

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major trends you are currently seeing and how

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are you helping our customers?

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Sure.

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So there's really 5 domains that we find

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ourselves

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talking with our customers about. And and we

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assist in different ways. Again, we're about meeting

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customers where they are and

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really being

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scaffolding, if you will to stripe across the

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different systems. But medical cost management

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is a is a large area

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that we focus on. We're helping customers and

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everything from care pathway

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optimization to disease and

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care management.

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Programs.

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The area we've really seen a lot of

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emphasis recently is in the operational cost management

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side of things. And these our areas having

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to do with higher

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authorization. There's been a lot of discussion around

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that, particularly with the Cms

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0057

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dash f.

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Regulation coming down

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and the adaptations needed to comply with that

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by 20 27.

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Looking at high dollar claims is another area,

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really the audit aspect of claims and cost

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recovery. And we've got examples where we've helped

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customers recuperate tens of millions

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in over payments,

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in instances where they've been able to go

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back and and do the reviews, using

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automation and using machine learning and an Ai

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to start to look at,

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those. And then looking at provider credentialing, you

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know, keeping the records up to date, there's

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a lot of paper involved, typically. The average

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provider will have anywhere between 3 and 5

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pieces of paper that get filed every year

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that have to be

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absorbed somehow. A lot of them aren't doing

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it online, but there's still a remarkable amount

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of business that still gets conducted via effects.

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And we see this also in both prior

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authorization and in claims where the information that's

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coming in is is digital, but it's digital

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Pdf documents or or fax documents

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that they have to be ingested. They have

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to be understood,

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routed appropriately and then ad educated.

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And then the last area that we've seen

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quite a bit of progress is in more

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of the fixed cost aspect, more technical and

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that is in the automation of testing.

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Uipath has some part of its platform,

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testing capabilities, and we've seen upwards of 5

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x increase in throughput.

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By taking advantage of of the automated

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script writing and testing capabilities that are part

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of our platform. So that's kind of the

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automation aspect of operational cost management.

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The 3 remaining areas, member engagement tends to

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be a very big area, and this is

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around,

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eligibility checks, personalized

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communications and recommendations

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the provider experience, and there's a lot of

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talk in the industry about the ab operation,

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and we're doing some work around intake and

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correspondence

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and

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the referral networks and and working with our

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payer customers and our provider customers to more

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efficiently share

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information as joint stakeholders in the care

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of, of a member slash patient. And then

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finally, you know, the area of around quality

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risk and compliance And again, top of mind,

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particularly in light of some of the regulations

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that have come down. But assisting customers really,

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again, getting back to

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understanding the data they have the analytics against

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that, and then being able to take actions

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on those insights that are generated

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and really start to look at ways from

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which they can improve their business not only

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from compliance perspective, but then also start to

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mine that data to better understand their member

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population where the risks may be

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present and how they may be making adjustments

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not only to their current business, but then

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also looking for opportunities to introduce new products

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and services that are gonna add more value

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to their end member and be more competitive

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ultimately in the market.

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Wonderful. Thank you so much for giving us

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that explanation.

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So with Ai

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occupying the majority of recent headlines and new

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advancements seemingly announced it every day,

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as I'm sure you know. How are you

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helping customers transform their operations with automation that

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includes Ml, a, and L m at scale?

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Sure.

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Well, there's a lot of experimentation that's going

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on. You know, we're coming up. This November

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will be the 2 year mark when open

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Ai shook the world with its announcement.

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And and really democrat

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large language models to the to the general

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public.

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There since then, there's been a lot of

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experimentation But we're finding that upwards of 70

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percent of the pilots that are undertaken

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fail. And it's not for great work that's

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being done. A lot of it has to

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do with the need for training. We just

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announced a study. We did a global knowledge

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worker study

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we announced those results this this preceding Monday,

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the eleventh of June.

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And that, it found upwards of 85 percent

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of those surveyed

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were not given

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structured training, particularly related to,

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the use of large language models in their

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business

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and then also looking at Ai, Ml, large

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language models in combination with automation.

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So there's there's a big gap there, and

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that's 1 of the learnings that that we've

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seen is that while the technology is interesting,

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there's definitely a right place and and our

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right time for it.

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In terms of what Uipath, we spent, since

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2005 when we are founded,

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we've been looking very deeply at at Ai

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and n ml. And as part of our

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platform, you know, there is certainly a number

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of different capabilities as was mentioned around the

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understanding of information and the context

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but there's something that we've built into it,

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which is key for regulated

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industries like health and financial services, and that

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is an Ai trust layer.

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And what that really allows our customers to

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do is establish the guard rails and the

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mechanisms to explain

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to report,

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offer transparency over what these models are actually

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doing with respect to their their data.

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We're finding some some great use cases around

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the,

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what we call context branding as a part

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of this. And that is the model is

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pointed very

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specifically

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at a finite corpus of data that is

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approved by the customer.

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And,

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by doing so, it reduces a lot of

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noise. It gives you great guard rails around

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and great explain ability in terms of the

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answers.

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In terms of another aspect of how we're

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working with customers is guard there has not

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been a lot of thought

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given to process from the standpoint of a

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combination of human plus digital worker.

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You think about how businesses have evolved since

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the fifties, really it's been

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designed

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hierarchical

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around the capabilities and in some cases limit

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limitations of human workforce. And what we're finding

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is that as important as the technology is,

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there's also a change management component

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that's that's

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also needed to be looked at as part

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of any kind of transformation. And part of

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what we have intrinsic to our platform is

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the really the ability to look at a

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process digitally.

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And in the old days, you would typically

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commission a study and you would you would

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model out

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what a process might look like. This is

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a way to do that basically a way

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to instrument a process automatically where we were

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point an agent at a particular process.

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Allow that process to be,

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worked

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across a wide

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disparity of workers that are that are performing

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that task, And then from that, using analytics

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derive what the optimal pathway might be. And

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then from that, we're able to then optimize

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a process.

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Some cases taking things that took days and

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sometimes weeks and bring that down to minutes

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because we've understood really precisely what's being done

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why it's being done and then started to

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look at those tasks that are optimally suited

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for the human, like decision, like reasoning, and

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those things that are more done by

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automations, you know, things like

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deter

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logic where there are particular rules and and

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other

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mechanisms in place where you can

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look at facts and data and then derive

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and and output.

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All of these things though

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really result in, the need for what we

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call human and the loop And there is

315
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a desire in healthcare care to try to

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automate as much as possible, but what we're

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finding

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is that by having a human in the

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loop, it actually accomplishes 2 things at once.

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The first is as you're bringing in your

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process experts, the humans that have done the

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work

323
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and starting to introduce

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automations that optimize, we're able to get that

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expert insight and you're able to cod that

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expert insight in a way where

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essentially, the machines are ticking away a lot

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of the the dr or the

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from from that process. And then allowing

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the knowledge worker or human to focus on

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those things that are higher order value,

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focusing on the member experience, focusing on truly

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those things that are strategically important to the

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business versus those things that are just simply

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time consuming and moving data from 1 place

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to another. So we're finding that when having

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a human in the loop, we use machines

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for what they're really prayed at, which is

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repeatable,

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dependable processes, safe and effective, and then humans

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for the reasoning and the creative aspects in

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which

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add a lot of value to the overall

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experience.

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And then I mentioned before that the trust

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framework that makes

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makes part of it. And part of that,

348
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of course is the interoperability

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across 4 systems. The nice thing about Ui

350
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uipath is we are easily

351
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able to work with all the core systems

352
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from

353
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the the source systems that you may have,

354
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the systems of records would to speak. And,

355
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either by

356
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Api

357
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or fire interfaces or

358
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even reading the screens. We we have

359
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a number of patents in our portfolio that

360
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are all about document understanding, natural language processing

361
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and, you know, the ability to truly read

362
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what's on a screen and understand what's happening

363
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at that level of granularity.

364
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And that offers really again, our customers to

365
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back to the Guard rails conversation, be able

366
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to start to use these automation capabilities and

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intelligence capabilities

368
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really holistically at the enterprise level a way

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that's very transparent and scalable.

370
00:13:59,397 --> 00:14:00,986
Yeah. Yeah. Thank you so much for giving

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00:14:00,986 --> 00:14:03,528
us all of that information. Paul, before I

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00:14:03,528 --> 00:14:04,799
let you go. The last thing I really

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wanted to ask you is,

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If you have any advice for our listeners

375
00:14:08,399 --> 00:14:09,697
who are seeking to transform

376
00:14:10,154 --> 00:14:12,729
and optimize how they operate with Ai led

377
00:14:12,787 --> 00:14:12,947
automation.

378
00:14:14,718 --> 00:14:15,037
Sure.

379
00:14:15,755 --> 00:14:17,591
And you know, there there's always this natural

380
00:14:17,591 --> 00:14:19,666
tendency when there's new technology. You know, first

381
00:14:19,666 --> 00:14:21,662
and foremost, you know, even though there's a

382
00:14:21,662 --> 00:14:24,229
lot of talk about Ai, large language models

383
00:14:24,229 --> 00:14:26,142
and so forth, it's it's a part of

384
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a larger solution.

385
00:14:28,294 --> 00:14:30,606
In terms of, the other elements that you

386
00:14:30,606 --> 00:14:34,471
need to take action on on insight. So

387
00:14:34,609 --> 00:14:36,544
what we like to advise our customers

388
00:14:37,002 --> 00:14:38,996
as we're working with them is really focus

389
00:14:38,996 --> 00:14:41,563
on the right problems. Those those instead of

390
00:14:41,563 --> 00:14:43,419
thinking particular use cases

391
00:14:43,796 --> 00:14:46,029
and and the industry right now is, I

392
00:14:46,029 --> 00:14:47,545
don't wanna say littered, but there's a lot

393
00:14:47,545 --> 00:14:50,097
of standalone use cases out there, But they

394
00:14:50,097 --> 00:14:53,135
don't really connect anything. So we encourage our

395
00:14:53,135 --> 00:14:55,463
customers to really think more from a systems

396
00:14:55,678 --> 00:14:57,665
perspective. What does the end to end process

397
00:14:57,665 --> 00:14:59,428
look like? Anything And then how can we

398
00:14:59,428 --> 00:15:01,415
look at that process in each sub component

399
00:15:01,415 --> 00:15:03,640
of that process? And where is it best

400
00:15:03,640 --> 00:15:04,776
work to add

401
00:15:05,468 --> 00:15:05,707
automation?

402
00:15:06,756 --> 00:15:08,983
Intelligent automation and the the different tools that

403
00:15:08,983 --> 00:15:11,130
are available through the platform. And then where

404
00:15:11,130 --> 00:15:13,119
is it best for having a human actually

405
00:15:13,119 --> 00:15:13,993
take care of that work.

406
00:15:14,963 --> 00:15:17,115
The other is there's also a rush we've

407
00:15:17,115 --> 00:15:19,425
seen to just simply automate what you have

408
00:15:19,425 --> 00:15:21,439
in current state. And

409
00:15:22,228 --> 00:15:24,372
we're seeing really a resurgence and kind of

410
00:15:24,372 --> 00:15:26,834
this back to basics, and that is let's

411
00:15:26,834 --> 00:15:29,613
let's be excellent at doing simple things well.

412
00:15:30,263 --> 00:15:32,883
And it's everything from receiving information from our

413
00:15:32,883 --> 00:15:36,082
provider, processing claim, etcetera. But really

414
00:15:36,694 --> 00:15:39,210
simplify and streamline the process as much as

415
00:15:39,329 --> 00:15:41,239
possible before you really start to go down

416
00:15:41,239 --> 00:15:43,013
that path of trying to automate it,

417
00:15:43,388 --> 00:15:45,139
and orchestrated at an enterprise.

418
00:15:45,776 --> 00:15:47,845
And that know, certainly the right tools at

419
00:15:47,845 --> 00:15:50,013
the right time for the right problem. Gen

420
00:15:50,013 --> 00:15:52,490
ai is a tool. Large language models are

421
00:15:52,490 --> 00:15:54,328
a tool, Ai and Ml. They've been around

422
00:15:54,328 --> 00:15:56,646
for a while. There are tools. Keyword search

423
00:15:56,646 --> 00:15:59,371
is a tool in These tools are effective

424
00:15:59,371 --> 00:16:02,896
in in particular cases. So it really requires

425
00:16:03,113 --> 00:16:05,715
a a thought process to be very critical

426
00:16:06,153 --> 00:16:09,418
thinking critically about the process asking of why

427
00:16:09,418 --> 00:16:11,728
questions around the process. Why is it this

428
00:16:11,728 --> 00:16:13,879
way? Is there perhaps a different way or

429
00:16:13,879 --> 00:16:16,763
a better way to go about accomplishing something.

430
00:16:17,162 --> 00:16:19,315
And that leads kind of going more into

431
00:16:19,315 --> 00:16:22,424
an engineering principle of engineering concept around first

432
00:16:22,424 --> 00:16:24,995
principles, and that is really break down the

433
00:16:24,995 --> 00:16:25,495
processes

434
00:16:26,034 --> 00:16:27,875
into small digestible components.

435
00:16:28,434 --> 00:16:30,595
And and again, be critical and ask yourself

436
00:16:30,595 --> 00:16:32,434
the question if knowing what I know today,

437
00:16:32,849 --> 00:16:34,996
the technology I have access to the people

438
00:16:34,996 --> 00:16:36,666
in the training and where they are right

439
00:16:36,666 --> 00:16:38,336
now and the other systems that I have,

440
00:16:38,813 --> 00:16:40,483
what might be the right way to go

441
00:16:40,483 --> 00:16:43,280
about, transforming this process. And we're finding as

442
00:16:43,280 --> 00:16:45,449
customers really start to take a step back

443
00:16:45,585 --> 00:16:47,969
and think about things more holistically. They're able

444
00:16:47,969 --> 00:16:48,708
to really

445
00:16:49,018 --> 00:16:52,041
achieve excellent results in terms of simplification and

446
00:16:52,041 --> 00:16:52,541
then

447
00:16:53,234 --> 00:16:54,609
acceleration. It's kind of

448
00:16:54,984 --> 00:16:57,305
inverse that people typically have gone about this.

449
00:16:57,464 --> 00:16:59,293
And that is they automate quickly to try

450
00:16:59,293 --> 00:17:00,883
to, achieve an Roi.

451
00:17:01,519 --> 00:17:03,984
And, unfortunately, it it it may work, but

452
00:17:03,984 --> 00:17:05,470
as I said before, a lot of cases

453
00:17:05,509 --> 00:17:06,865
it doesn't. You know, this is a way

454
00:17:06,865 --> 00:17:08,700
to spend 2 thirds of your time really

455
00:17:08,700 --> 00:17:10,694
looking at the process and and breaking it

456
00:17:10,694 --> 00:17:13,268
down and then 1 third applying the technology.

457
00:17:13,645 --> 00:17:15,001
You know, the last bit I would say,

458
00:17:15,814 --> 00:17:18,388
is don't forget about change management. This is

459
00:17:18,845 --> 00:17:21,021
particularly now as much about

460
00:17:21,478 --> 00:17:24,778
the knowledge worker and the knowledge worker experience

461
00:17:24,913 --> 00:17:26,738
as it is the technology. You know, the

462
00:17:26,738 --> 00:17:29,198
tech is moving very quickly, and there's a

463
00:17:29,198 --> 00:17:31,998
lot of overload fatigue I would say, amongst

464
00:17:31,998 --> 00:17:35,266
customers where they're... There's a new innovation or

465
00:17:35,266 --> 00:17:37,578
a new way of doing something literally announced

466
00:17:37,578 --> 00:17:39,826
every day. But Again, kind of taking a

467
00:17:39,826 --> 00:17:42,539
step back, thinking critically about the process and

468
00:17:42,539 --> 00:17:44,852
the outcome, the business outcome you're trying to

469
00:17:44,852 --> 00:17:47,575
achieve, then also think about the people involved

470
00:17:47,575 --> 00:17:49,485
in the change management and the education,

471
00:17:50,280 --> 00:17:52,031
people are a little and you read the

472
00:17:52,031 --> 00:17:54,520
surveys and the literature suggests that generally

473
00:17:55,229 --> 00:17:57,623
knowledge workers a little nervous right now because

474
00:17:57,623 --> 00:17:59,618
they they don't quite understand where they fit

475
00:17:59,618 --> 00:18:02,650
in what these new automated systems might look

476
00:18:02,650 --> 00:18:04,998
like. The good news is it's gonna definitely

477
00:18:05,215 --> 00:18:07,127
super charge, and we like to use that

478
00:18:07,127 --> 00:18:10,074
word, super charge their ability to add value

479
00:18:10,074 --> 00:18:12,167
to the business and value to the members

480
00:18:12,719 --> 00:18:14,877
while also taking those things that are low

481
00:18:14,877 --> 00:18:16,415
value or repeatable

482
00:18:16,875 --> 00:18:18,952
things that could be coded and take that

483
00:18:18,952 --> 00:18:21,325
off their plates that can think strategically and

484
00:18:21,444 --> 00:18:23,836
creatively. And and reason in ways that perhaps

485
00:18:23,836 --> 00:18:25,989
they haven't had time to do before. And

486
00:18:25,989 --> 00:18:28,960
when it's brought about in that way and

487
00:18:29,018 --> 00:18:31,903
education has provided We find that there's greater

488
00:18:31,903 --> 00:18:33,279
acceptance and greater

489
00:18:33,656 --> 00:18:35,887
participation frankly as these programs are are rolled

490
00:18:35,887 --> 00:18:37,402
out within the enterprise.

491
00:18:38,054 --> 00:18:39,730
So there'll be some takeaways there that that

492
00:18:39,890 --> 00:18:41,805
I would suggest, our listeners think about.

493
00:18:42,603 --> 00:18:44,061
Yeah. Yeah. Absolutely.

494
00:18:44,519 --> 00:18:46,115
Well, Paul, that is all the time we

495
00:18:46,115 --> 00:18:48,284
have. For today. So on behalf of Becker

496
00:18:48,284 --> 00:18:50,219
health care. I wanna thank you very much

497
00:18:50,278 --> 00:18:52,670
for your time and thought provoking discussion today.

498
00:18:52,989 --> 00:18:55,723
We also wanna thank our podcast sponsor, you

499
00:18:55,941 --> 00:18:59,168
uipath. For further information about Uipath, go to

500
00:18:59,545 --> 00:19:02,019
uipath dot com or contact paul at the

501
00:19:02,019 --> 00:19:04,028
address provided in the show notes. You can

502
00:19:04,028 --> 00:19:05,940
tune into more podcast from Becca healthcare care

503
00:19:05,940 --> 00:19:08,729
by visiting our podcast page at becker review

504
00:19:08,729 --> 00:19:10,084
dot com slash podcast.