Becker's Hospital Review caught up with Shashi Yadiki, President of health plans for NTT DATA, about innovation, technology and business transformation for health plans.
Editor's note: Responses have been lightly edited for length and clarity.
Question: Where do you see an opportunity especially ripe for innovation in the health insurance market?
Shashi Yadiki: I see maximum innovation opportunity around the two following areas:
1. Business transformation of health plans from traditional fee-for-service into value-based care that is also driving the convergence between health plans and health systems. There is increased opportunity to reduce the cost of healthcare by collaboration between health plans and health systems beyond the Bundled Payment for Care Improvement initiative driven by CMS and other bundled payment arrangements. Integration of business processes and data and adoption of advanced analytics capabilities such, as machine learning and artificial intelligence, can transform healthcare costs. These innovative technologies can facilitate more effective medical cost management that will be critical to the success of both health plans and health systems.
2. Consumer-centric solutions driving transparency. Consumer expectations are changing and so is the explosion of digital technologies. Health plans would like to engage their customers in a total lifecycle at the point of engagement. They also would like to enable the recommendation of the right physician with the right incentive structures and outcomes. This creates a massive opportunity in digital technology adoption to enable consumer engagement.
Also, health plans are becoming aware of the need to improve the customer experience and reduce the friction in transactions. NTT DATA is pioneering a forward-looking tool, called the Customer Friction Factor Assessment, that can help pinpoint the friction in customer interactions and transactions and predict consumer response to company interactions. We provide a numerical score and root-cause analysis to help companies identify and correct issues that can interfere with a good customer experience. We've used it extensively in other industries and are now using it with health plans.
Q: What do you consider your greatest achievement at NTT DATA?
SY: NTT DATA's greatest achievements in the health plan space are:
- Enabling digital transformation for our customer to enable better engagement with their members and providers and grow their membership.
- Helping regional health plans to be profitable by improving their operations using automation and artificial intelligence and delivering an end-to-end digital transformation so they can compete.
- Enabling our Medicare health plan customers to improve Star ratings from 3.5 to 4.5.
- Driving medical cost reduction for our customers using big data and analytics.
- Reducing operational costs for customers and enabling them to make investments in solutions mapped to their strategy.
Q: What is NTT DATA doing in the realm of collaborative care?
SY: We are seeing large health plans investing in the end-to-end management of healthcare for members and developing capabilities to support this direction. NTT DATA is continually evolving consumerism solutions that facilitate the engagement of members, providers and health plans through a joint platform. In addition, we have invested in analytics solutions that help health plans target the right members for the right programs at the right time. For example, using our cognitive engine (which utilizes machine learning), we have created a predictive model that integrates both structured and unstructured data from multiple data sources, including socioeconomic and behavioral data. For one health plan customer, this model resulted in a more accurate look at member risk, increasing by 30 percent the number of members that are predicted to move from medium to high risk within the next 12 months. It should therefore be considered for inclusion in one or more collaborative care programs that the plan offers.
Q: Have there been any developments in healthcare in the past one to two years that surprised you or changed your way thinking?
SY: Surprises have been the number of vertical integrations between the health insurer, pharmacy benefit manager and provider in the past year. The expectation about engaging the member at PBM and continuing through the lifecycle and the expectation of savings expected. This can drive massive change in the technology and process required for an end-to-end view.