1 00:00:00,080 --> 00:00:02,159 Hello, everyone. This is Jacob Emerson with the 2 00:00:02,159 --> 00:00:05,200 Becker's Payer Issues podcast. Thrilled today to be 3 00:00:05,200 --> 00:00:07,759 joined by Vinay Kulkarni, who is the chief 4 00:00:07,759 --> 00:00:10,400 information officer at Scann Group. Vinay, thank you 5 00:00:10,400 --> 00:00:12,000 so much for taking the time to be 6 00:00:12,000 --> 00:00:13,380 with me on the podcast today. 7 00:00:13,985 --> 00:00:16,385 Awesome. Great great to be here. Excited to, 8 00:00:16,704 --> 00:00:18,785 talk about, the things that we wanna talk 9 00:00:18,785 --> 00:00:20,945 about. Yeah. Likewise. And and before we dive 10 00:00:20,945 --> 00:00:22,545 into all of that with you, Vinay, can 11 00:00:22,545 --> 00:00:23,904 you first tell us a little bit more 12 00:00:23,904 --> 00:00:26,064 about yourself, your background in health care, and 13 00:00:26,064 --> 00:00:27,505 what it is that you do today at 14 00:00:27,505 --> 00:00:28,005 SCAN? 15 00:00:28,829 --> 00:00:29,310 Sure. 16 00:00:29,710 --> 00:00:31,170 My name is Vinay Kulkarni. 17 00:00:31,550 --> 00:00:33,810 I am the CIO at SCAN Health Plan. 18 00:00:34,270 --> 00:00:37,810 I'm accountable for technology transformation and also adoption. 19 00:00:38,590 --> 00:00:41,890 I'm committed to driving business transformation by strategically 20 00:00:42,109 --> 00:00:42,609 aligning 21 00:00:43,245 --> 00:00:45,104 technology with our enterprise goals. 22 00:00:45,565 --> 00:00:47,885 I worked in healthcare payer systems and provider 23 00:00:47,885 --> 00:00:48,385 systems. 24 00:00:49,245 --> 00:00:51,325 Throughout my twenty five years of experience in 25 00:00:51,325 --> 00:00:52,465 technology leadership, 26 00:00:52,844 --> 00:00:55,825 I have dedicated to using technology for strategic 27 00:00:55,885 --> 00:00:56,385 enablement, 28 00:00:57,550 --> 00:01:00,210 delivering a secure and a seamless digital experience, 29 00:01:01,070 --> 00:01:04,750 improve outcomes, and create a better clinician experience, 30 00:01:04,750 --> 00:01:07,010 and ultimately improving our member lives. 31 00:01:07,630 --> 00:01:09,870 Fantastic. Well, Vinay, we're really excited to have 32 00:01:09,870 --> 00:01:10,394 you with us. 33 00:01:11,114 --> 00:01:13,034 I I first wanna get started by talking 34 00:01:13,034 --> 00:01:15,435 about, you know, the buzzword that everyone is 35 00:01:15,435 --> 00:01:18,634 consistently talking about nowadays within within the health 36 00:01:18,634 --> 00:01:21,215 insurance industry and and certainly within most industries. 37 00:01:21,834 --> 00:01:24,155 But given your extensive experience that you just 38 00:01:24,155 --> 00:01:27,159 outlined for us within digital transformation within the 39 00:01:27,159 --> 00:01:28,060 insurance space, 40 00:01:28,439 --> 00:01:31,719 how do you see artificial intelligence, automation shaping 41 00:01:31,719 --> 00:01:33,979 the future of Medicare Advantage? 42 00:01:34,920 --> 00:01:35,319 Yeah. 43 00:01:35,719 --> 00:01:37,659 You know, you rightly called it out as 44 00:01:37,879 --> 00:01:38,859 a as a buzzword, 45 00:01:39,479 --> 00:01:40,859 but I see it as 46 00:01:41,615 --> 00:01:43,775 a as a an evolution to a next 47 00:01:43,775 --> 00:01:46,415 step from where we started with the industrial 48 00:01:46,415 --> 00:01:46,915 revolution. 49 00:01:48,415 --> 00:01:50,895 AI and automation aren't going to replace people. 50 00:01:50,895 --> 00:01:52,495 That's the first thing that I wanna tell 51 00:01:52,495 --> 00:01:55,395 everyone. Our approach at SCAN is to advance 52 00:01:55,534 --> 00:01:56,195 our mission 53 00:01:56,579 --> 00:01:58,840 to keep older adults healthy and independent. 54 00:01:59,780 --> 00:02:01,859 Technology is a tool that enables us to 55 00:02:01,859 --> 00:02:05,000 make more personal, proactive, and accessible 56 00:02:05,619 --> 00:02:06,679 to all these members. 57 00:02:07,379 --> 00:02:09,974 We are using AI to identify members at 58 00:02:10,055 --> 00:02:11,435 high risk for hospitalization, 59 00:02:12,055 --> 00:02:13,275 improve care coordination, 60 00:02:13,974 --> 00:02:16,314 and enhance member experience through smarter 61 00:02:16,935 --> 00:02:17,754 service tools 62 00:02:18,135 --> 00:02:21,094 that help our teams respond faster and more 63 00:02:21,335 --> 00:02:22,555 and with more empathy. 64 00:02:23,860 --> 00:02:26,659 Our our approach is human plus machine and 65 00:02:26,659 --> 00:02:28,519 and notice that I say 66 00:02:28,900 --> 00:02:30,120 humans first 67 00:02:30,419 --> 00:02:30,919 because 68 00:02:31,459 --> 00:02:32,360 that's what really 69 00:02:32,739 --> 00:02:34,199 is the core of our 70 00:02:34,739 --> 00:02:35,239 ethic. 71 00:02:36,444 --> 00:02:38,864 Core of our our way of approaching, 72 00:02:39,324 --> 00:02:40,625 automation and AI. 73 00:02:41,084 --> 00:02:44,064 Automation handles the administrative work, so our clinicians 74 00:02:44,125 --> 00:02:46,525 and service teams can focus on what matters 75 00:02:46,525 --> 00:02:47,025 most, 76 00:02:47,564 --> 00:02:48,625 which is relationships, 77 00:02:49,245 --> 00:02:51,104 care quality, and member trust. 78 00:02:51,860 --> 00:02:54,659 We take a cautious and ethical approach and 79 00:02:54,659 --> 00:02:55,800 prioritize explainability, 80 00:02:56,419 --> 00:02:57,879 fairness and privacy. 81 00:02:58,740 --> 00:03:01,960 AI at SCAN is designed to support decisions, 82 00:03:03,219 --> 00:03:04,520 not to make decisions 83 00:03:05,219 --> 00:03:05,879 in isolation. 84 00:03:06,985 --> 00:03:08,365 As an industry evolves, 85 00:03:09,784 --> 00:03:12,045 AI and automation will separate 86 00:03:12,425 --> 00:03:15,085 the plans that deliver both quality and compassion, 87 00:03:15,705 --> 00:03:17,965 and we want to be on both quality 88 00:03:18,105 --> 00:03:18,844 and compassion. 89 00:03:19,840 --> 00:03:22,000 Absolutely. And and, Vinay, what role do you 90 00:03:22,000 --> 00:03:23,459 think that emerging technologies, 91 00:03:24,080 --> 00:03:26,000 like the ones we just mentioned, what role 92 00:03:26,000 --> 00:03:27,680 are they gonna play in scaling, you know, 93 00:03:27,680 --> 00:03:31,300 your your clinical models effectively across your diverse 94 00:03:31,360 --> 00:03:34,080 member population? How are you addressing the unique 95 00:03:34,080 --> 00:03:34,900 health care needs 96 00:03:35,574 --> 00:03:36,875 of the Medicare beneficiaries 97 00:03:37,175 --> 00:03:37,995 that you serve? 98 00:03:38,694 --> 00:03:39,194 Yeah. 99 00:03:40,135 --> 00:03:41,034 Until recently, 100 00:03:42,055 --> 00:03:42,715 you know, 101 00:03:43,014 --> 00:03:45,835 health care was delivered as as a cohort, 102 00:03:46,854 --> 00:03:49,574 you know, where you are you're actually bringing 103 00:03:49,574 --> 00:03:51,969 a cohort of or a persona kind of 104 00:03:51,969 --> 00:03:52,949 thing and saying 105 00:03:53,250 --> 00:03:56,449 this persona of having, you know, somebody like 106 00:03:56,449 --> 00:03:58,150 a diabetes or having, 107 00:03:58,849 --> 00:04:01,349 other diseases, then we always used to cohort. 108 00:04:01,650 --> 00:04:03,889 But health care is much more personal than 109 00:04:03,889 --> 00:04:04,389 that. 110 00:04:04,885 --> 00:04:07,305 We need to have an n of one, 111 00:04:08,085 --> 00:04:10,425 which is basically just saying that everybody's 112 00:04:10,805 --> 00:04:11,465 health care 113 00:04:12,085 --> 00:04:14,585 needs are very different from the other person. 114 00:04:14,965 --> 00:04:16,264 Yes. There is a general 115 00:04:16,725 --> 00:04:19,449 layer of, okay, for this kind of setup, 116 00:04:19,590 --> 00:04:20,490 we need something 117 00:04:20,870 --> 00:04:21,529 in common. 118 00:04:21,830 --> 00:04:24,550 But at a person level, it has to 119 00:04:24,550 --> 00:04:26,790 be unique. That's what we are striving to 120 00:04:26,790 --> 00:04:27,529 get to. 121 00:04:27,910 --> 00:04:29,830 We we want to tailor care for the 122 00:04:29,830 --> 00:04:32,569 healthier seniors as well as those managing multiple 123 00:04:33,044 --> 00:04:35,785 chronic conditions or living in complex care settings. 124 00:04:36,884 --> 00:04:38,824 Talking about the complex care settings, 125 00:04:39,365 --> 00:04:40,985 we have a plan called Embrace. 126 00:04:41,604 --> 00:04:44,164 It's an I SNP plan, which is a 127 00:04:44,164 --> 00:04:45,305 special needs plan, 128 00:04:46,430 --> 00:04:49,410 that serves patients requiring higher level of care 129 00:04:49,790 --> 00:04:52,270 as they reside in institutional settings, such as 130 00:04:52,270 --> 00:04:54,770 skilled nursing facilities or nursing homes. 131 00:04:55,310 --> 00:04:58,529 The needs of these patients are high touch. 132 00:04:58,904 --> 00:05:01,564 You know, for a for example, for that 133 00:05:02,665 --> 00:05:05,785 that population, we spent more than fifteen hundred 134 00:05:05,785 --> 00:05:06,285 hours 135 00:05:06,904 --> 00:05:08,764 getting medical records retrieved. 136 00:05:09,544 --> 00:05:11,564 We are pursuing an automated outbound 137 00:05:12,250 --> 00:05:15,209 way of doing this. That's one example of 138 00:05:15,209 --> 00:05:18,009 how we are using AI, especially around the 139 00:05:18,009 --> 00:05:19,470 b to b use cases. 140 00:05:19,930 --> 00:05:22,569 We are also working on improving medical records 141 00:05:22,569 --> 00:05:25,310 summarize summarization for hospital discharge, 142 00:05:25,689 --> 00:05:29,274 for case management team, patient summaries for APCs. 143 00:05:30,134 --> 00:05:32,714 All these improve coordination of health care, 144 00:05:33,654 --> 00:05:35,675 and patient panel sizes for 145 00:05:35,975 --> 00:05:38,314 for for our entire clinician population. 146 00:05:38,935 --> 00:05:41,550 This gives them a picture of what is 147 00:05:41,629 --> 00:05:43,310 that they are going to see for each 148 00:05:43,310 --> 00:05:44,209 of their patient. 149 00:05:45,149 --> 00:05:46,289 Control the population, 150 00:05:47,310 --> 00:05:49,789 health at a smaller level. So that's the 151 00:05:49,789 --> 00:05:51,490 scale that we are trying to achieve. 152 00:05:52,189 --> 00:05:55,149 We also implemented some clinician co pilot to 153 00:05:55,149 --> 00:05:56,289 improve care coordination 154 00:05:56,754 --> 00:05:57,495 by surfacing 155 00:05:58,355 --> 00:05:59,975 incomplete tasks, you know, 156 00:06:00,675 --> 00:06:03,634 where people forget to do things. So bringing 157 00:06:03,634 --> 00:06:05,415 up those things, small little things, 158 00:06:05,795 --> 00:06:07,894 that matters a lot for our members. 159 00:06:08,435 --> 00:06:10,055 That's where we are going with that. 160 00:06:10,569 --> 00:06:12,830 Understood. So a lot of technology investments, 161 00:06:13,370 --> 00:06:16,170 both internally and and in things on the 162 00:06:16,170 --> 00:06:19,069 front end, facing facing your members, Vinay. 163 00:06:19,529 --> 00:06:21,129 Also, as you know, I wanted to ask 164 00:06:21,129 --> 00:06:24,165 about, the Medicare open enrollment period. It just 165 00:06:24,404 --> 00:06:24,805 started, 166 00:06:25,205 --> 00:06:26,665 in in the month mid October. 167 00:06:27,205 --> 00:06:28,404 And, you know, there's been a lot of 168 00:06:28,404 --> 00:06:31,285 changes this year, with with the Medicare Advantage 169 00:06:31,285 --> 00:06:33,045 market going into next year and what seniors 170 00:06:33,045 --> 00:06:35,045 are gonna be seeing. So where is SCAN 171 00:06:35,045 --> 00:06:37,740 leveraging new technology to not only enhance, 172 00:06:38,139 --> 00:06:41,419 payer provider relationships, but also streamline the care 173 00:06:41,419 --> 00:06:44,240 delivery as you expand into more markets? 174 00:06:45,419 --> 00:06:45,819 Yeah. 175 00:06:46,220 --> 00:06:48,639 It's a exciting time for all the Medicare, 176 00:06:49,660 --> 00:06:50,160 Advantage 177 00:06:50,855 --> 00:06:51,355 companies, 178 00:06:52,134 --> 00:06:55,574 enrolling newer members and, making sure that we 179 00:06:55,574 --> 00:06:57,435 retain our existing members. 180 00:06:58,535 --> 00:07:00,154 You know, we are using technology, 181 00:07:00,535 --> 00:07:02,475 especially AI, in multiple places. 182 00:07:03,439 --> 00:07:05,039 You know, we we have to serve these 183 00:07:05,039 --> 00:07:05,699 new members. 184 00:07:06,079 --> 00:07:08,240 So in our contact center environment, we have 185 00:07:08,240 --> 00:07:10,899 deployed generative AI and automation tools, 186 00:07:11,759 --> 00:07:14,319 that allow our members to reduce after call 187 00:07:14,319 --> 00:07:14,819 work. 188 00:07:15,120 --> 00:07:16,099 We are not using 189 00:07:16,479 --> 00:07:17,300 the technology 190 00:07:17,759 --> 00:07:18,009 to, 191 00:07:19,055 --> 00:07:20,975 to talk to our members, but we are 192 00:07:20,975 --> 00:07:23,795 using technology and AI to be able to 193 00:07:24,175 --> 00:07:25,395 enhance our 194 00:07:25,774 --> 00:07:26,274 members' 195 00:07:26,654 --> 00:07:28,355 experience with our call centers 196 00:07:28,895 --> 00:07:32,290 and support more personalized conversation with members. That's 197 00:07:32,290 --> 00:07:35,090 where we're investing from a member services or 198 00:07:35,090 --> 00:07:37,110 a contact center environment purposes. 199 00:07:38,210 --> 00:07:40,230 I talked a little bit about embrace. 200 00:07:41,009 --> 00:07:42,530 You know, this is where we have our 201 00:07:42,530 --> 00:07:44,310 clinicians seeing our patients. 202 00:07:45,314 --> 00:07:46,935 We we want to have our clinicians 203 00:07:47,395 --> 00:07:49,574 have more face time with those patients, 204 00:07:50,035 --> 00:07:51,175 reduce screen time. 205 00:07:51,795 --> 00:07:53,335 As part of this, and you are 206 00:07:54,035 --> 00:07:57,235 through, ambient dictation and automated care ops flow, 207 00:07:57,235 --> 00:07:59,254 this is new thing that we have introduced 208 00:07:59,314 --> 00:08:01,449 here, which is care ops. We we have 209 00:08:01,449 --> 00:08:04,909 significantly reduced the administrative burden for our clinicians. 210 00:08:05,610 --> 00:08:09,069 For example, through an AI based risk stratification 211 00:08:09,289 --> 00:08:09,789 approach, 212 00:08:10,089 --> 00:08:12,349 we empower providers to visit patients 213 00:08:12,889 --> 00:08:15,389 based on their clinical needs and allow clinicians 214 00:08:15,449 --> 00:08:16,029 to have 215 00:08:16,334 --> 00:08:19,535 larger patient panels without actually sacrificing the quality 216 00:08:19,535 --> 00:08:20,194 of care. 217 00:08:20,654 --> 00:08:22,995 We also used ambient dictation alongside. 218 00:08:23,774 --> 00:08:25,795 This is this is helping us 219 00:08:26,254 --> 00:08:28,035 to be able to have 220 00:08:28,879 --> 00:08:32,080 our clinicians have more face time and also 221 00:08:32,080 --> 00:08:33,700 summarization of the documentation. 222 00:08:34,799 --> 00:08:38,559 This this allows a super important thing within 223 00:08:38,559 --> 00:08:40,960 health care, which is building a relationship between 224 00:08:40,960 --> 00:08:42,259 the patient and the clinicians. 225 00:08:43,534 --> 00:08:46,254 This also reduces some of the cost that 226 00:08:46,254 --> 00:08:46,914 that is 227 00:08:47,534 --> 00:08:50,014 that we incur when you actually see a 228 00:08:50,014 --> 00:08:52,254 patient. So this is this is our way 229 00:08:52,254 --> 00:08:55,554 of introducing technology slowly that can help our 230 00:08:55,889 --> 00:08:58,290 clinicians and our member services to be able 231 00:08:58,290 --> 00:09:00,769 to have give a better experience for our 232 00:09:00,769 --> 00:09:01,269 members. 233 00:09:01,889 --> 00:09:03,490 Well, Vinay, we've we've covered a lot of 234 00:09:03,490 --> 00:09:03,990 ground. 235 00:09:04,529 --> 00:09:06,930 Any any final thoughts or final bits of 236 00:09:06,930 --> 00:09:09,649 advice you wanna offer the other health plan 237 00:09:09,649 --> 00:09:11,110 leaders listening in? 238 00:09:11,894 --> 00:09:14,134 I think it is important to stay close 239 00:09:14,134 --> 00:09:14,954 to the business, 240 00:09:15,495 --> 00:09:17,274 and not just changes in technology. 241 00:09:17,815 --> 00:09:18,714 There are changes 242 00:09:19,174 --> 00:09:21,274 in regulatory too, but 243 00:09:21,654 --> 00:09:22,315 the landscape 244 00:09:22,934 --> 00:09:25,995 in technology has has been changing a lot. 245 00:09:26,214 --> 00:09:26,714 And 246 00:09:27,100 --> 00:09:28,860 this year, we are seeing a lot more 247 00:09:28,860 --> 00:09:30,240 changes in the health care. 248 00:09:31,259 --> 00:09:33,340 Example of that is, you know, we are 249 00:09:33,340 --> 00:09:34,240 looking at 250 00:09:34,620 --> 00:09:37,039 how how you can increase the 251 00:09:37,580 --> 00:09:39,679 better have better coverage through interoperability. 252 00:09:40,264 --> 00:09:42,424 There are some regulatory changes that are coming 253 00:09:42,424 --> 00:09:43,164 for that, 254 00:09:43,945 --> 00:09:45,404 and there are more, 255 00:09:45,865 --> 00:09:47,485 networks that are being established. 256 00:09:48,105 --> 00:09:50,044 How can we utilize those things, 257 00:09:51,065 --> 00:09:53,004 better in in our own health systems? 258 00:09:54,259 --> 00:09:56,100 We need to look at how how can 259 00:09:56,100 --> 00:09:58,259 we use the data that we already have 260 00:09:58,259 --> 00:10:00,019 and the new things that we are going 261 00:10:00,019 --> 00:10:01,559 to acquire through this interoperability. 262 00:10:03,059 --> 00:10:05,299 Second thing I would, I would say is 263 00:10:05,299 --> 00:10:06,600 keeping it very simple. 264 00:10:06,975 --> 00:10:08,815 When you are close to your business, you 265 00:10:08,815 --> 00:10:10,274 can predict a lot of problems 266 00:10:10,815 --> 00:10:12,355 that they're gonna face. 267 00:10:12,975 --> 00:10:15,214 We need to be empathetic to to our 268 00:10:15,214 --> 00:10:16,434 providers and members. 269 00:10:17,214 --> 00:10:19,615 Make it better for them. So these are 270 00:10:19,615 --> 00:10:22,339 some simple things that I would advise, 271 00:10:23,200 --> 00:10:24,419 anyone who's listening 272 00:10:25,039 --> 00:10:27,039 to make sure that we have a better 273 00:10:27,039 --> 00:10:28,980 experience for our members and providers. 274 00:10:29,839 --> 00:10:31,759 Fantastic. I think that's some great last bits 275 00:10:31,759 --> 00:10:33,925 of advice to leave on. So, Vinay, I 276 00:10:33,925 --> 00:10:35,925 wanna thank you for taking the time to 277 00:10:35,925 --> 00:10:37,764 sit down with us on the podcast today 278 00:10:37,764 --> 00:10:39,925 and for sharing your insights with our audience. 279 00:10:39,925 --> 00:10:42,565 We really appreciate it. Thank you. It was 280 00:10:42,565 --> 00:10:43,545 my pleasure too. 281 00:10:43,880 --> 00:10:45,320 And to our audience, if you'd like to 282 00:10:45,320 --> 00:10:47,800 listen to more podcasts from Becker's Healthcare, you 283 00:10:47,800 --> 00:10:50,460 can visit beckershospitalreview.com.