Latest / Becker’s Payer Issues Podcast / Leveraging AI and Digital Transformation to Improve Medicare Advantage with Vinay Kulkarni

Transcript

Leveraging AI and Digital Transformation to Improve Medicare Advantage with Vinay Kulkarni · Becker’s Payer Issues Podcast

• 0:00
  Hello, everyone. This is Jacob Emerson with the
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  Becker's Payer Issues podcast. Thrilled today to be
• 0:05
  joined by Vinay Kulkarni, who is the chief
• 0:07
  information officer at Scann Group. Vinay, thank you
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  so much for taking the time to be
• 0:12
  with me on the podcast today.
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  Awesome. Great great to be here. Excited to,
• 0:16
  talk about, the things that we wanna talk
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  about. Yeah. Likewise. And and before we dive
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  into all of that with you, Vinay, can
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  you first tell us a little bit more
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  about yourself, your background in health care, and
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  what it is that you do today at
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  SCAN?
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  Sure.
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  My name is Vinay Kulkarni.
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  I am the CIO at SCAN Health Plan.
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  I'm accountable for technology transformation and also adoption.
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  I'm committed to driving business transformation by strategically
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  aligning
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  technology with our enterprise goals.
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  I worked in healthcare payer systems and provider
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  systems.
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  Throughout my twenty five years of experience in
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  technology leadership,
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  I have dedicated to using technology for strategic
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  enablement,
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  delivering a secure and a seamless digital experience,
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  improve outcomes, and create a better clinician experience,
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  and ultimately improving our member lives.
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  Fantastic. Well, Vinay, we're really excited to have
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  you with us.
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  I I first wanna get started by talking
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  about, you know, the buzzword that everyone is
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  consistently talking about nowadays within within the health
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  insurance industry and and certainly within most industries.
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  But given your extensive experience that you just
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  outlined for us within digital transformation within the
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  insurance space,
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  how do you see artificial intelligence, automation shaping
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  the future of Medicare Advantage?
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  Yeah.
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  You know, you rightly called it out as
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  a as a buzzword,
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  but I see it as
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  a as a an evolution to a next
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  step from where we started with the industrial
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  revolution.
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  AI and automation aren't going to replace people.
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  That's the first thing that I wanna tell
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  everyone. Our approach at SCAN is to advance
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  our mission
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  to keep older adults healthy and independent.
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  Technology is a tool that enables us to
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  make more personal, proactive, and accessible
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  to all these members.
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  We are using AI to identify members at
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  high risk for hospitalization,
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  improve care coordination,
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  and enhance member experience through smarter
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  service tools
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  that help our teams respond faster and more
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  and with more empathy.
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  Our our approach is human plus machine and
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  and notice that I say
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  humans first
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  because
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  that's what really
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  is the core of our
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  ethic.
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  Core of our our way of approaching,
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  automation and AI.
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  Automation handles the administrative work, so our clinicians
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  and service teams can focus on what matters
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  most,
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  which is relationships,
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  care quality, and member trust.
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  We take a cautious and ethical approach and
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  prioritize explainability,
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  fairness and privacy.
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  AI at SCAN is designed to support decisions,
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  not to make decisions
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  in isolation.
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  As an industry evolves,
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  AI and automation will separate
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  the plans that deliver both quality and compassion,
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  and we want to be on both quality
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  and compassion.
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  Absolutely. And and, Vinay, what role do you
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  think that emerging technologies,
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  like the ones we just mentioned, what role
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  are they gonna play in scaling, you know,
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  your your clinical models effectively across your diverse
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  member population? How are you addressing the unique
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  health care needs
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  of the Medicare beneficiaries
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  that you serve?
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  Yeah.
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  Until recently,
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  you know,
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  health care was delivered as as a cohort,
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  you know, where you are you're actually bringing
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  a cohort of or a persona kind of
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  thing and saying
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  this persona of having, you know, somebody like
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  a diabetes or having,
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  other diseases, then we always used to cohort.
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  But health care is much more personal than
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  that.
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  We need to have an n of one,
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  which is basically just saying that everybody's
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  health care
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  needs are very different from the other person.
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  Yes. There is a general
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  layer of, okay, for this kind of setup,
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  we need something
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  in common.
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  But at a person level, it has to
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  be unique. That's what we are striving to
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  get to.
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  We we want to tailor care for the
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  healthier seniors as well as those managing multiple
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  chronic conditions or living in complex care settings.
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  Talking about the complex care settings,
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  we have a plan called Embrace.
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  It's an I SNP plan, which is a
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  special needs plan,
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  that serves patients requiring higher level of care
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  as they reside in institutional settings, such as
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  skilled nursing facilities or nursing homes.
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  The needs of these patients are high touch.
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  You know, for a for example, for that
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  that population, we spent more than fifteen hundred
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  hours
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  getting medical records retrieved.
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  We are pursuing an automated outbound
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  way of doing this. That's one example of
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  how we are using AI, especially around the
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  b to b use cases.
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  We are also working on improving medical records
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  summarize summarization for hospital discharge,
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  for case management team, patient summaries for APCs.
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  All these improve coordination of health care,
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  and patient panel sizes for
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  for for our entire clinician population.
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  This gives them a picture of what is
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  that they are going to see for each
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  of their patient.
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  Control the population,
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  health at a smaller level. So that's the
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  scale that we are trying to achieve.
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  We also implemented some clinician co pilot to
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  improve care coordination
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  by surfacing
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  incomplete tasks, you know,
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  where people forget to do things. So bringing
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  up those things, small little things,
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  that matters a lot for our members.
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  That's where we are going with that.
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  Understood. So a lot of technology investments,
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  both internally and and in things on the
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  front end, facing facing your members, Vinay.
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  Also, as you know, I wanted to ask
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  about, the Medicare open enrollment period. It just
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  started,
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  in in the month mid October.
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  And, you know, there's been a lot of
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  changes this year, with with the Medicare Advantage
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  market going into next year and what seniors
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  are gonna be seeing. So where is SCAN
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  leveraging new technology to not only enhance,
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  payer provider relationships, but also streamline the care
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  delivery as you expand into more markets?
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  Yeah.
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  It's a exciting time for all the Medicare,
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  Advantage
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  companies,
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  enrolling newer members and, making sure that we
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  retain our existing members.
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  You know, we are using technology,
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  especially AI, in multiple places.
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  You know, we we have to serve these
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  new members.
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  So in our contact center environment, we have
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  deployed generative AI and automation tools,
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  that allow our members to reduce after call
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  work.
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  We are not using
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  the technology
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  to,
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  to talk to our members, but we are
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  using technology and AI to be able to
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  enhance our
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  members'
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  experience with our call centers
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  and support more personalized conversation with members. That's
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  where we're investing from a member services or
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  a contact center environment purposes.
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  I talked a little bit about embrace.
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  You know, this is where we have our
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  clinicians seeing our patients.
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  We we want to have our clinicians
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  have more face time with those patients,
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  reduce screen time.
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  As part of this, and you are
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  through, ambient dictation and automated care ops flow,
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  this is new thing that we have introduced
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  here, which is care ops. We we have
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  significantly reduced the administrative burden for our clinicians.
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  For example, through an AI based risk stratification
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  approach,
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  we empower providers to visit patients
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  based on their clinical needs and allow clinicians
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  to have
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  larger patient panels without actually sacrificing the quality
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  of care.
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  We also used ambient dictation alongside.
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  This is this is helping us
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  to be able to have
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  our clinicians have more face time and also
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  summarization of the documentation.
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  This this allows a super important thing within
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  health care, which is building a relationship between
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  the patient and the clinicians.
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  This also reduces some of the cost that
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  that is
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  that we incur when you actually see a
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  patient. So this is this is our way
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  of introducing technology slowly that can help our
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  clinicians and our member services to be able
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  to have give a better experience for our
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  members.
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  Well, Vinay, we've we've covered a lot of
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  ground.
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  Any any final thoughts or final bits of
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  advice you wanna offer the other health plan
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  leaders listening in?
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  I think it is important to stay close
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  to the business,
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  and not just changes in technology.
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  There are changes
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  in regulatory too, but
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  the landscape
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  in technology has has been changing a lot.
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  And
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  this year, we are seeing a lot more
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  changes in the health care.
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  Example of that is, you know, we are
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  looking at
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  how how you can increase the
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  better have better coverage through interoperability.
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  There are some regulatory changes that are coming
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  for that,
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  and there are more,
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  networks that are being established.
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  How can we utilize those things,
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  better in in our own health systems?
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  We need to look at how how can
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  we use the data that we already have
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  and the new things that we are going
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  to acquire through this interoperability.
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  Second thing I would, I would say is
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  keeping it very simple.
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  When you are close to your business, you
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  can predict a lot of problems
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  that they're gonna face.
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  We need to be empathetic to to our
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  providers and members.
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  Make it better for them. So these are
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  some simple things that I would advise,
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  anyone who's listening
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  to make sure that we have a better
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  experience for our members and providers.
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  Fantastic. I think that's some great last bits
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  of advice to leave on. So, Vinay, I
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  wanna thank you for taking the time to
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  sit down with us on the podcast today
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  and for sharing your insights with our audience.
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  We really appreciate it. Thank you. It was
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  my pleasure too.
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  And to our audience, if you'd like to
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  listen to more podcasts from Becker's Healthcare, you
• 10:47
  can visit beckershospitalreview.com.