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