Finding the Pulse – Rethinking Healthcare and How it is delivered

Pari: The role of technology in healthcare was very evident during the last two years. Technology is not only playing a key role in reducing the cost of healthcare, but also in improving patient experience and outcomes. Today’s podcast will focus on the future of healthcare digitization and its impact.

I’m Pari Natarajan, CEO of Zinnov. I’m your host today. It’s my pleasure to introduce Girish Venkatachaliah, Chief Technology Officer at Agilon Health as our guest for this episode.

He just spent over two decades in Data and AI in a variety of leadership roles. He has led many 500-plus person organizations, crafted data and AI strategies, transformed traditional software to cloud native SaaS offerings, incubated new products, changed processes from Waterfall to Agile, to name a few. Welcome to the podcast Business Resilience Series, Girish. It’s great to have you with us today.

Girish: Thank you, Pari. Looking forward to this conversation here. Super excited about it.

Pari: So let’s dive into the episode and hear more from him. US Healthcare spends over $4 trillion dollars. That is almost 20% of the country GDP. Even after spending that much money, US Healthcare seems to be lagging behind many of the other OPEC nations in healthcare delivery. What are some of the key challenges faced in the Healthcare industry?

Girish: Wow. That’s a loaded question. I think one of the introduction points you made is about patient experience. So, I think probably the biggest challenge about US healthcare is really in the title. It didn’t focus on health care or caring for health. So, probably the biggest is that patients, and consumers of healthcare feel like they’re somewhat underserved. So that’s probably the number one thing is that, we spend a lot and yet in terms of the overall wellness of a population it seems to still be lagging behind, as you rightly pointed out. Probably the second biggest challenges that the fixes that people have tried to make this to where the patient experience is better, the wellness is better have largely caused a lot of administrative overhead and that is putting an incredible burden on physicians who are then getting crushed under that load. So, the manifestation of that is actually making things worse. Third, technology as you rightly said, can be a real answer to these challenges.

US Healthcare has been notoriously slow in adopting technology. It shocks me on how many physician offices I go to where the center crown jewel of the office is actually a fax machine. I have a 17-year-old son who cannot recognize a fax machine if it bit him on the nose! And yet that is the centerpiece of what you will see in a physician’s office even today. There are many, many challenges, but certainly those are probably the few that I would call out.

Pari: And there has been enormous progress on digitization across the industry the last two years. What are some of the top innovations at Healthcare now, apart from the well-known innovations in vaccine development over the last few years, tele-health, and some of the challenges you spoke about…are there efforts to address the challenges?

Girish: Yeah. Certainly, there has been numerous, numerous attempts. And if anything, Healthcare startups is now a thriving ecosystem. Probably the largest set of VC investment is going in the Healthcare space. Now we’re starting to see AI really take off.

So there has been a lot of talk around technology not being impactful in Healthcare. But over the last, I’ll say three years, you’ve seen a lot of AI driven medical interventions actually bearing fruit where FDA is approving things that are AI driven and 100% AI driven, whether it’s detecting something from an ophthalmology standpoint or all the way to mental health issues, or any number of those you’re seeing actually where the entire protocol is technology-based, which has never existed ever before in our history. And FDA approving it is a non-trivial thing.

So as much as technology is being impactful in just about everything in like, speeding up drug development as you rightly pointed out, or analyzing a patient genome much faster, or any number of things, technology has been impactful, but purely having a technology driven medical intervention, I think is a new frontier that I’m supremely jazzed about.

Pari: AI is starting to play a significant role in driving that. And then one of the areas that Agilon has been focusing on is around optimizing Medicare. So, it will be great to tell the audience a little bit. We have global audience. Let’s talk a little bit about Medicare. US spends close to a billion dollars in Medicare. Can you explain how Medicare works and what key challenges face the Medicare?

Girish: I think it’s close to a trillion dollars plus, so it’s probably one of the largest spends that the U S government has outside of the pure military spending.

Medicare, the way it works is that any US citizen or permanent resident over 65, is eligible for healthcare that is largely covered by the US government.

So, in general think of it as a 65+ healthcare plan. Nearly everything is subsidized by the government or entirely free by the government. So, Medicare in general was traditionally what was considered a fee for service.

Where people come in for a particular procedure or a treatment or an episode, and they get treated for that. They get reimbursed or the claim would get paid out for it. And the physician would get compensated, or any number of providers would get compensated based on the volume that they drove.

And consequently, what happened in Medicare was that there was almost an increased user and an abuse of the system even. Where, because it was completely transaction-based, there was more drivers for driving more transactions. If I was having like diabetes, the doctor made more money the more complications I had and the more times they came.

So, it was a bit of a perverse system. So, Medicare advantage or what was called as value-based care was born out of the notion that what really matters is making sure that the diabetic patient stays well throughout the year. Not so much how many times that the person comes in. So, the notion of value-based care is that there is a calibration of the person’s wellness at the start of the year. And by the end of the year, their wellness along those 85 plus measures has to improve. And equally important is that the patient satisfaction has to also improve or be at a certain threshold for the physician to get paid. It then changes the contour of how medicine is practiced in that the physician now entirely focuses on keeping the person healthy and keeping the person out of the hospital and avoiding unnecessary spend. So that’s really where Medicare advantage comes in. And it’s a new program where more and more the government is pushing people to adopt that because it’s truly coming back to the point of caring for the health. That is really that thesis.

Pari: And moving from a transactional Medicare system to medical advantage, which is more value-based care, which means the whole system has to change. It’s just the business model of how the physicians work and how they get paid. All of that has to completely change, their internal systems have to change. How easy or difficult is this transition?

Girish: In just about every way it is both difficult and like with any transition, it is nontrivial. Probably also why Agilon Health is a sweet spot here is that we are able to help flip that switch if you will for physicians. The first thing one has to do is compute what is a called as a burden of illness.

For example, Pari as a patient longitudinally all of the chronic conditions you have, what times you’ve been to the hospital, and so on and so forth. It seems simple. But actually, I urge every reader to reflect on their own medical history and whether they have a complete dossier of all the things that they’ve experienced with healthcare. Imagine the physician has to build that. It’s a non-trivial problem because the systems are so non-integrated and so diverse that this compiling what is the entire health posture of Pari is actually a non-trivially very hard problem.

And then the physician has to take risk on that patient saying that, ‘Hey, Pari will stay well for the entire year,’ and if we end up costing more, then the physician has to pay out of pocket in the value-based care system. Because you’re actually taking risk on that patient. So, in just about every way it is non-trivial for a physician, and this is where a company like Agilon can help really bring in the processes, bring in fantastic information and really, we take all the downside risks. So, if a physician were to lose money on any patient, we cover the downside of it, because we believe so much in our models.

Pari: Very, very interesting. So, you are able to take the risk on behalf of the physician, so the physician is able to sign up more Medicare advantage patients into that program.

So this requires, like you said, you’ve got to integrate a lot of different systems, you’ve got to also predict. wWhat is the role of technology in doing all of this to make Agilon business model successful?

Girish: Just what every aspect of our company is run through technology. I’ll start with the very simple thing. So what we call as a member information profile which is really about stitching together the information of the patient from across any number of cities that they’ve stayed in, any number of hospitals they’re visited, any number of specialists they’ve seen. So we actually compile a good longitudinal view of that patient. Firstly compiling that is a non-trivial Data and AI problem, because it is really about assimilating that information, it is not easy even for the best technology companies out there. Many have tried and even failed. So it is a non-trivially hard problem.

And the second is delivering that information to the physician in the point of care, which means that we have to integrate with several EMR across different markets and so on. Also a non-trivially complex problem, because you want to get it to the physician.

The third is then you want the physician to act on that information and be able to calibrate those actions and understand what is actually working, what interventions are driving the best outcome and so on.

So just about every aspect of it seems on the surface very simple, but has a lot of complexity to it, and technology and AI is the only solve for it, because to triangulate that massive amount of information is non-trivial.

Pari: Got it. So the AI plays a big role in terms of creating massive amount of data integrating with so many different systems to drive it. It’s sounds pretty exciting. You need a great product and technology team to make it happen. And we are in the midst of this major talent-supply constraint, and it’s a global phenomenon, the great resignation. How do you compete with some of the big Tech companies for talent?

You have the hyper-scalers like Microsoft, Google, then you have the upcoming digital native startups. You have the large company which are transforming into a technology company. How are you able to attract and retain high quality talent? /p>

Girish: Yeah. So we hired over 100 people last year in my team alone.

I think, we are doing way better than industry average in terms of retention. And so in every sense we seem to be able to do that successfully in probably the toughest market any of us have experienced. Probably the biggest is our sense of purpose.

We have this deep enduring purpose to fix healthcare and to do it to where it is truly about bringing costs of healthcare down, which when people really understand what we do, they’re supremely excited about it. This is the stuff you can talk to your children, your grandchildren, and so on and there are very, very few companies on earth that are so focused and so consequential to our long long-term success and long-term future. So that sense of purpose, I think, is one of the most attractive things. The second is, we have amazing leaders, amazing people already on the team. And when they look at the folks on the team and they interact with them, I think that also is supremely energizing and that also is the next point of attraction. The third one is that when people do come in is that we make that a delightful onboarding experience and the way they get going. We’ve seen an increased uptake in reference and people referring their own friends to come join and so on.

All of that is indicative that we probably have our culture right. We probably have the experience of onboarding daily really right. And finally, the fact that we are having less than industry average attrition shows that we are able to convert all that to actually driving outcome which ultimately is the job satisfaction that keeps speaking.

Pari: Amazin! So, frictionless experience, onboarding experience, great peer group to work with and more importantly a purpose driven culture which is allowing you to drive this at this time. And you also have a global technology team and to drive a purpose driven culture across different location, that’s hard. And you are an expert, Girish, in building global teams over the last 25 years. How has your approach evolved in building global teams?

Girish: When I started in the US and I built out the team in India, at that time, this was probably what, 15-20 years ago, actually India and China and Brazil too, the thinking was really staff augmentation at that point… quite a few years ago. You augmented, you kind of still continue to operate as US. Then I actually ended up having the opportunity of growing and relocating to India and building out the team there.

And at that point, the perspective is ‘Man, we want a full ownership, more responsibility to move to India and that was certainly the phase where people were trying to demonstrate. I think today and especially more post COVID or through the COVID experience, you realize that talent is everywhere and really in the way our technology is in how we are all set up is anybody can be a leader from any place and it’s truly a global team. And that it is more of just viewing it in a boundary-less fashion and operating in a boundary-less manner, which I think is the evolution that I have myself gone through.

To me now it doesn’t even matter where the person’s physical presence is. Even though we have a large team in India, don’t even ever think of it as an India team or a US team or any such thing. I just think of it as the team that is doing DevOps or the team that is doing AI or the team that is doing X.

And it truly is a global team. And that mindset is really important in that agnostic of the boundary or the region that we operate in a truly global manner. It’s taken a bit of an evolution for me to get to that point, to be honest, but I have come to appreciate it that much more now.

Pari: Interesting! A boundary-less tech organization. And how do you define success for your global team?

Girish: So the global team‘s success is no different than the company’s success, Pari, because there isn’t specifically a globally the team per se, in that my team is global. So ultimately for us, it is really the team and the company is successful and they’re delivering the business outcomes we set out to and we invested to, to get it right. Almost completely and intrinsically tied to our company success.

Just to give you some context, we are about a 650 person organization and the tech team of about 250-300 people. So that’s a substantial part of the company and there’s really nothing that is unique about my team that is distinct from the company. You sink or swim with the company and our business does well or doesn’t do well as a consequence of all of us working in the same way.

Pari: Great. Great. Completely aligned to the organization’s goals wherever the team is in a boundary-less tech organization. Thanks for taking the time to spend with us.

You gave a very good bird’s-eye view on the challenges faced in the Healthcare industry, specifically around Medicare and how Agilon and your team is using technology to enable Agilon’s business model and your culture being a very purpose-driven organization will allow you attract and retain high quality talent. If some of your listeners are technology talent looking to work in the Healthcare domain, I’m pretty sure they can reach out to you, Girish. Thanks for taking the time.

Girish: Thank you, Pari. This was a fun chat. Really loved this. Thank you so much.