AIM podcast: Reimagining healthcare with AI

Introduction

0:00

I have with me Harish Guri, CIO of Optum

0:03

India. According to you, what do you

0:05

think is happening in the whole health.

0:07

tech sector?

0:08

There is better care, there is better.

0:10

procedures available today but more

0:12

expensive

0:14

as a technologist with the kind of

0:16

innovations that's happening. Which one

0:18

Are you most excited about that can

0:21

bring a big shift in the whole

0:22

healthcare industry? I think there are

0:25

three things that are really exciting me

0:28

and are going to make a difference to

0:30

affordability, access and outcome.

0:33

Number one,

0:34

so Harish, there's a lot of discussion

0:36

on value based.

0:37

Yeah.

0:38

Uh can you first tell us what that is

0:40

and what is the shift from episodic

0:42

care to value based care?

0:44

It's a big shift that is happening in

0:45

the industry. Like we talked earlier, if

0:48

you look at healthcare costs as a

0:50

percentage of GDP in the country, I

0:52

think it's rapidly rising. You know the

0:55

question is how we manage that better

0:59

with better outcomes?

1:01

Tell me how you think AI is

1:03

transforming healthcare industry?

1:05

If there is a job that AI should

1:08

do and will do, healthcare is probably

1:11

the most consequential job that AI will

1:14

do.

The state of healthcare & key challenges

1:15

[Music]

1:22

Welcome to a fresh episode of simulated

1:24

reality podcast by AIM leaders council.

1:27

I'm Vanda Naya and I have with me Harish

1:30

Guri CIO of Optum India. Thank you

1:33

Harish for taking the time to speak to

1:35

us.

1:35

Vana it's a pleasure to be here with

1:37

you. So Harish let's begin with uh I

1:40

want to understand the whole market now

1:42

with the healthcare industry rapidly

1:44

changing you have a lot of market

1:46

dynamics which is changing uh customer

1:48

perceptions which are changing so

1:51

according to you what do you think is

1:53

happening in the whole health tech

1:55

sector

1:56

look from a shift perspective there is a

2:00

rapid change in the ecosystem in

2:02

healthcare that is happening and uh I

2:06

would say there are three main

2:08

challenges in the industry as we see in

2:10

the United States u also in many places

2:14

and many other countries the challenges

2:16

tend to be similar in the US here is

2:18

what we're seeing we are seeing

2:20

challenges in and around how we make

2:23

cost of healthcare lower which is all

2:26

about affordability

2:28

number two how do we make access to

2:31

health care easier so we call that

2:34

access and last but the not the least

2:37

How do we focus on quality of outcome of

2:40

healthcare?

2:42

The challenge is not just about meeting

2:44

these demands or needs individually.

2:48

It's about how do we do all three of

2:50

them together. Right? That's the

2:52

difficult part. Now, if you look at uh

2:55

affordability, what's really happening

2:57

is the cost of healthcare in the US

3:00

is u rising at a pace that is faster

3:04

than inflation. Number one. Number two,

3:07

there are better more modern medicines

3:11

available today but more expensive.

3:14

There is better care. There is better

3:16

procedures available today but also more

3:19

expensive.

3:21

If we do not manage the situation well,

3:23

the cost of healthcare is to shoot up is

3:26

going to shoot up beyond being

3:27

affordable to all the people who

3:30

actually need the care. So that is

3:32

challenge number one.

3:33

Let's talk about accessibility.

3:37

No matter which part of the world you

3:38

go, US included access to care in the

3:42

most remote part of the country or

3:45

locations,

3:47

when needed continues to be the big

3:50

challenge and how do we solve for that,

3:52

right? That's a big one. Last but not

3:56

the least, how do we shift from

4:00

care being about sporadic

4:04

treatment when an event or an episode

4:06

happens versus ensuring that we take

4:11

care of health in such a way that the

4:13

outcome the overall outcome is better

4:16

and it not just about episodic

4:17

intervention

4:19

like I said it's about getting all these

4:21

three together and solving for them

4:22

together

4:24

in the In the middle of all these two

4:25

more things to remember. One

4:28

lots of administrative procedural

4:32

process overheads in the system. How do

4:35

we reduce administrative burden? So if

4:37

I'm burdened with administrative

4:40

overheads, my focus on you as a

4:44

consumer, as a patient goes down, right?

4:46

And I think this is what has to come

4:48

together

4:51

in an overarching theme where it

4:55

continues to be human centric

4:58

and human making the decisions. That's

5:01

the name of the game.

5:03

All right. That that sounds interesting.

5:05

And as a technologist with the kind of

5:08

innovations that's happening, which one

5:10

are you most excited about like that can

5:12

bring a big shift in the whole

5:14

healthcare industry? But then as a

5:16

technologist I'm excited about

5:18

everything. But if I were to look at u

5:22

healthcare in particular I think there

5:24

are three things that are really

5:27

exciting me and are going to make a

5:29

difference to affordability, access and

5:32

outcome. Number one, I think there is a

5:36

sea shift happening in the mind frame

5:40

and mindset

5:41

of this person not being a patient but a

5:45

consumer. What that means is when you

5:48

start thinking of your patient, your

5:52

provider also and put them in the center

5:55

of the universe as a consumer.

5:56

Yeah. and you uh implement technology

6:00

surround with technology surround with

6:03

innovation surround with care and

6:04

surround with outcome it changes the

6:07

game. So I'm very excited about

6:10

consumer experience centric

6:12

solutions right uh whether it is uh find

6:16

enterprise care whether it is apartment

6:18

scheduling whether it is providing the

6:21

right level

6:23

and uh you know verified information

6:25

about conditions looking up nutrition

6:28

looking up diet and all of these become

6:31

very important from a consumer

6:33

experience perspective. Number two, I

6:37

think along with consumer as a center,

What is value-based care?

6:41

there is a shift towards focus on

6:44

wellness, right? With all the

6:47

information that is available today with

6:49

focus on nutrition, diet, well-being,

6:53

exercise, let's talk technology, IoT,

6:58

devices that can tell you how, you know,

7:00

your health is progressing. Bringing all

7:03

that together to be able to predict a

7:06

need before it arises really

7:10

excites me. Right now last but not the

7:13

least a lot of these are built on a

7:16

foundation of a digital platform. So

7:20

what excites me is

7:22

the journey of building a core digital

7:25

platform that enables

7:28

data interoperability

7:31

with consent of course to be able to

7:34

create those innovations that we are

7:35

talking about at the edges innovation

7:38

happens at the edges of data at the

7:40

edges of system and that's why

7:42

interoperability is very big these three

7:45

things

7:46

I think are going to make the change

7:48

happen in the industry So Har there's a

7:50

lot of discussion on value based care.

7:51

Yeah.

7:52

Uh can you first tell us what that is

7:54

and what is the shift from episodic

7:57

sorry episodic care to value based care?

7:59

Okay. So let me um say this in like

8:02

simple terms.

8:04

Sure.

8:04

What is value based care about? It is

8:06

about shifting from

8:09

volume to value. Number one, it is

8:13

shifting from fee for service model,

8:16

right? To a quality of outcome based

8:20

model, right? Let me explain

8:23

this from the patient consumer

8:25

perspective. Let me give you an insight

8:27

from a you know caregiver provider

8:30

perspective and also from the insurance

8:33

provider payer perspective. Right? From

8:35

a uh patient consumer perspective,

8:39

what value based care does is that it

8:43

focuses on your outcome, your well-being

8:46

and able to put together all the

8:48

information that you need to be able to

8:51

create better affordability and better

8:53

accessibility and better outcome for you

8:56

as a consumer, as a patient. From a care

9:00

provider perspective,

9:02

physician provider, nurse, it makes sure

9:06

that it puts together the data and makes

9:09

it easily available. reduces

9:11

administrative overhead and ensures that

9:15

resources,

9:17

staff, amenities, hospital beds,

9:20

everything that is available is

9:22

optimized and used in such a way that

9:25

care can be better and more people can

9:28

be taken care of in a more timely

9:29

manner.

9:30

More importantly,

9:32

the shift from

9:35

what you said

9:36

from you know just treating that

9:38

situation or condition that happened to

9:40

be a to be able to prompt

9:43

about keeping the patient well or

9:47

healthier

9:48

and what are those things that we can do

9:51

right it gives and empowers the

9:53

physician nurses with that ammunition

9:55

and information to be able to make the

9:57

right decision from a payer perspective

10:00

it's all about that that dollar the

10:02

every dollar how far can I take that

10:05

dollar and make every dollar count in

10:08

terms of access to care and in terms of

10:10

affordability. When you solve these

10:13

three things, what happens is the entire

10:15

health care system which is VBC moves

10:18

from an episode based

10:21

treatment paradigm

10:24

to a wellness-based prevention based

10:27

paradigm which changes overall quality

10:31

and outcome of health.

10:32

And this shift is what is happening

10:34

now, right? If the focus is more on

10:36

that,

10:36

it's a big shift that is happening in

10:38

industry. Like we talked earlier, if you

10:40

look at healthcare costs as a percentage

10:42

of GDP in the country, I think it's

10:45

rapidly rising.

10:46

U now the question is how do we manage

10:50

that better with better outcomes.

10:54

So Harish uh let's talk about the most

10:56

important thing AI. Uh now we're seeing

10:58

how AI is transforming a lot of

11:00

industries and healthcare is no

11:02

exception. uh from say diagnostic

11:04

accuracy streamlining administrative

11:06

process and a lot of things. So can you

11:09

throw some light on how this is

11:11

happening in healthcare and also if

11:13

possible where are the AI use cases that

11:15

are there in United Health Group and

11:17

Optimum?

11:18

Look uh AI is making

11:22

access to data analytics

11:26

predictive analytics predictive modeling

11:30

everything more seamless. NLP is

11:32

creating wonders, right? Because of all

11:35

this, we are able to bring together vast

11:38

amounts of data and be able to analyze

11:41

them like whether it is uh EHR data,

11:45

wellness data, variable data, social

11:48

determinants of health. How do we bring

11:50

it all together to be able to do like a

11:54

predictive

11:55

kind of modeling in scenarios? I think

11:57

that's what uh AI is doing to the

12:00

industry.

12:02

From a use cases perspective, um there

12:05

is uh more than 100 use cases that we

12:07

have at Optum.

12:09

But more importantly,

12:11

what we have first is a well defined

12:15

and clear structure

12:17

on

12:18

use of data, which is responsible use of

12:21

data and responsible use of AI. In

12:24

healthcare, everything has to be

AI use cases in healthcare

12:26

explainable, right? So AI doesn't make

12:29

the decision for you. It gives you

12:31

enough information so that the care

12:34

provider human in the middle right can

12:38

make the decision. I think that's very

12:40

important. Now let's uh look at uh use

12:43

cases right if you look at uh the

12:46

customer centricity right from a

12:48

customer's perspective many use

12:51

cases that help you find care price care

12:56

u make appointments automate follow-ups

13:01

and all kinds of use cases that are

13:03

available from a consumer perspective

13:06

from a provider perspective we're able

13:09

to bring together all the data that

13:10

I talked about which is EHR, social

13:13

determinants of health and put it all

13:14

together

13:16

to be able to give a care plan which is

13:20

a best practice so this AI can learn

13:23

from best practices create a best

13:25

practice plan and make that available a

13:27

predictive plan available to the care

13:30

provider who are able to make well

13:32

informed decisions so that's on the care

13:35

side there is also a lot of work

13:38

happening on the administrative side uh

13:41

removing administrative steps,

13:43

procedural steps using AI. There's a lot

13:46

of uh communication that goes out,

13:48

right? Communications uh AI is able to

13:51

automate. Uh many times they are in

13:53

dozens and dozens of languages, right?

13:56

So there's a bunch of um you know

13:58

clinical help use cases and a large

14:01

bunch of administrative operational

14:04

efficiency use cases that are available

14:06

in AI that we are working on also. know

14:09

uh public health trends right AI can

14:13

predict monitor public health trends it

14:16

can uh be watchful and predict outbreaks

14:20

that are happening it can predict uh and

14:23

give us signals on vaccines that will be

14:26

required

14:27

that helps optimize the entire system

14:30

right vaccine is not just about it being

14:32

there when you go it's about you know

14:34

the manufacturing process the shipping

14:36

process and everything that goes behind

14:39

the scenes to get that vaccine there on

14:41

time.

14:42

So the earlier you can predict these

14:44

kind of things the better you can

14:46

service the consumer and AI is helping

14:48

with all of that today. Harish coming to

14:50

the end of this I have a question for

14:53

the future like so now technologists to

14:56

adapt to the evolving healthcare

14:58

ecosystem that's happening what kind of

15:00

skills and qualities do you think they

15:02

should be having to kind of match the

15:04

scale of evolution that's happening

15:06

so if they're technologists they're

15:09

already great at technology

15:12

the one thing that they now bring need

15:14

to bring to the table in this healthcare

15:16

e ecosystem is to bring

15:19

people process technology together with

15:23

like I said consumer in the center. When

15:26

you bring all of this together that is

15:28

when magic can happen by bringing the

15:30

power of AI, bringing the power of

15:32

digital and bringing the power of zero

15:35

distance. What do I mean by that? I mean

15:39

don't sit in some cubicle somewhere and

15:41

think of some new healthcare app that is

15:44

going to make a difference. It's not

15:45

going to happen like that. You have to

15:47

be able to bring all these elements

15:49

together which means you have to be zero

15:51

distance from the consumer. Develop your

15:54

solution zero distance from the

15:55

consumer,

15:57

zero distance from the care provider,

16:00

zero distance from the advocate who is

16:02

also helping the consumers. If you

16:05

develop your AI, your digital

16:08

interventions, your platform with this

16:10

in mind, following all the clear

16:12

structured methods and guidelines that

16:14

the organization provides for you, I

16:17

think you can make a hell of a

16:18

difference. I think we are at the cusp

16:21

of making magic to be able to make the

16:24

healthcare system work better for

16:26

everyone.

16:28

All right. Great. Yeah. So, thank you so

16:30

much, Harish. Uh, this was truly

16:31

insightful. Thank you for your time.

16:33

Thank you Vina. It was a pleasure and

16:35

hope to see you see you sometime

16:36

again soon. Thanks.

All

Watched