← Becker’s Healthcare Podcast
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- [00:00]
A
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 SCAN Group. Vinay, thank you so much for taking the time to be with me on the podcast today.
- [00:14]
B
Awesome. Great. Great to be here. Excited to talk about the things that we want to talk about.
- [00:19]
A
Yeah, likewise. 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 healthcare and what it is that you do today at scan?
- [00:29]
B
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 25 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.
- [01:08]
A
Fantastic. Well, Vinay, we're really excited to have you with us. I first want to get started by talking about the buzzword that everyone is consistently talking about nowadays within the health insurance industry 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?
- [01:35]
B
Yeah, you rightly called it out as a buzzword, but I see it as 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 want to 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 with more empathy. Our approach is human plus machine. And notice that I say humans first because that's what really is the core of our ethic, core of 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 @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.
- [03:20]
A
Absolutely. Vinay, what role do you think that emerging technologies like the ones we just mentioned, what role are they going to play in scaling your clinical models effectively across across your diverse member population? How are you addressing the unique healthcare needs of the Medicare beneficiaries that you serve?
- [03:39]
B
Yeah, until recently, you know, healthcare was delivered 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 somebody like diabetes or having other diseases that we always used to cohort. But healthcare is much more personal than that. We need to have an n of 1 which is basically addressing that everybody's healthcare 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 want to tailor care for the healthiest 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 ISNP 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 for example, for that population. We spent more than 1500 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 B2B use cases. We are also working on improving medical record summarization for hospital discharge for case management team patient summaries for APCs. All these improve coordination of healthcare patient panel sizes 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. That's the scale that we are trying to achieve. We also implemented some clinician copilot to improve care coordination by surfacing incomplete tasks. 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.
- [06:10]
A
Understood. So a lot of technology investments both internally and in things on the front end facing your members. Vinay, I also, as you know, I wanted to ask about the Medicare open enrollment period. It just started in the month mid October. And you know there's been a lot of changes this year with the Medicare Advantage market going into next year and what seniors are going to 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?
- [06:45]
B
Yeah, it's an exciting time for all the Medicare Advantage companies enrolling newer members and making sure that we retain our existing members. We are using technology, especially AI in multiple places. We have to serve these new members 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 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 are investing from a member services or a contact center environment purposes. I talked a little bit about embrace. This is where we have our clinicians seeing our patients. We want to have our clinicians have more face time with those patients, reduce screen time as part of this endure through ambient dictation and automated Care ops flow. This is new thing that we have introduced here which is Care Ops. 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 helping us to be able to have our clinicians have more face time and also summarization of the documentation. This allows a super important thing within healthcare which is building relationship between the patient and the clinicians. This also reduces some of the cost that we incur when you actually see a patient. So this is our way of introducing technology slowly that can help our clinicians and our member services to be able to give a better experience for our members.
- [09:02]
A
Well Vinay, we've covered a lot of ground. Any final thoughts or final bits of advice you want to offer the other health plan leaders listening in?
- [09:12]
B
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 been changing a lot this year. We are seeing a lot more changes in healthcare. Example of that is we are looking at 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 these interoperability. Second thing I would, I would say is keeping it very simple. Many are close to your business. You can predict a lot of problems that they're going to face. We need to be empathetic 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.
- [10:30]
A
Fantastic. I think that's some great last bits of advice to leave on. So, Vinay, I want to 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.
- [10:41]
B
Thank you. It was my pleasure too.
- [10:44]
A
And to our audience, if you'd like to listen to more podcasts from Becker's Healthcare, you can visit Beckershospitalreview.com.