Rajeev Ronanki, Anthem Inc

Rajeev Ronanki

The Digital Health Guy Gets The Expert Opinion: Rajeev Ronanki, SVP & Chief Digital Officer, Anthem Inc.

Rajeev Ronanki is Senior Vice President and Chief Digital Officer of Anthem Inc., a Blue Cross Blue Shield company that is dedicated to providing consumers with affordable, high-quality health care. Anthem currently provides more than 74 million people with health care, about 40 million of whom are enrolled through family health plans administered through Anthem’s affiliated companies.

Rajeev has spent more than two decades in health care. Prior to joining Anthem in 2018, he spent a decade at Deloitte Consulting, where he led Deloitte’s Cognitive Advantage (Markets and Technology) and Health Care Innovative practices. While there, he focused on implementing solutions for personalized consumer engagement, intelligent automation, and predictive analytics.

Kevin Pereau: I’m wondering what Anthem has been up to with developing new solutions for connecting with health care consumers. We hear a lot of buzzwords in health care today, words like seamless, consumer this, consumer that. If you will drill down into it with me, what do those terms mean? And what do they really mean for individuals who are Anthem clients, either individually or through employer and other plans?

Rajeev Ronanki: I’ll use the words technology, analytics, artificial intelligence and digital—probably all part of a spectrum. We’re going to be using a combination of those technologies for our stakeholders. But if you look at that packet of technologies, I think I’ll use those terms generically to be able to simplify our conversation.

The heart of it? At the end of the day, I think Anthem is a data, analytics and AI company. It just so happens that insurance is the business model that presents our value proposition to the market.

Let’s think about Google for a minute. Search is the core technology that Google has. But at the bottom of it all, Google is offering advertising and marketing and a matching set of services that are part of the overall value to consumers. So we think of insurance in sort of the same way, and we offer insurance products.

Apart from the individual market and Medicare and Medicaid, for the most part insurance is still largely a B2B business. And flowing from that, our focus and intent are to serve our employer groups. That’s who we’re contracting with. And the members are somewhat incidental to that, ultimately the consumers of the services we are creating in conjunction with our employer groups.

But the consumer experience needs to be much more than that, because no one is happy living in that model.  Consumers feel like they can’t really navigate the complex ecosystem between providers and life sciences companies, or paying for insurance, or a number of other processes. There’s no transparency for consumers about what the real costs are and who is really paying.

One significant change is that consumers are starting to take a more active interest and asking questions like, “Well, what am I paying for? What am I getting in return for it? And why is my experience in health care so poor, compared to, let’s say, Uber and Amazon or Apple, or other consumer-oriented companies that provide world-class service, at seemingly no cost to the consumer?”

And therefore to survive and thrive as a business, we have to orchestrate the entire suite of services around the consumer, even if there is an underlying B2B model. It has to be consumer first. And then the solutions come from there, instead of putting consumers somewhere toward the end of that spectrum.

Does that make sense as a frame to explain why we are orienting technology toward the consumer?

Kevin Pereau: It does indeed, and it gives us a great framework to discuss. We’re probably eight years into the investment explosion into health care. But when you put your thinking cap on, how do you decide whether to partner with a company like VIM, or with an Omada? And when do you decide, “Instead of working with one of those companies, we are going to build this functionality ourselves?”

Rajeev Ronanki : That’s a fair question. If you look at the Apples and the Amazons and the Googles, you see that like them, we are not ultimately building everything in-house. We are in a broader community and a broader ecosystem that connects a common data fabric. How each of those companies automates is different. But there are some very common patterns you can apply to a platform business. And then the economics that follow from that can be compelling.

So think of Anthem as being a data platform. Which means that we will certainly build things that are absolutely essential to the member experience. Anthem will obviously address other entities and stakeholders as well, but at the moment, the focus is on the consumer. We want to create an optimal experience for members by first asking, “Well, what would that experience consist of?” And then to ask, “Do we have the data to do it justice?”

If the answer to questions like that is yes, we will build it.  As an example, let’s look at scheduling, a core consumer activity. Improving it is going to require us to cooperate with all the other providers and their practice management systems and their scheduling systems. The question is, how can we simplify the task of making an appointment? Making an appointment online is easy. But it might not be something that we would want to build a system for ourselves. So we may say, yes, let’s partner with a certain company, rather than building a scheduling system ourselves.

But for other things like core engagement, we are asking, “How do I continually know the consumers better and start to create a more transparent and personalized experience for them?” And we might find that is something we’d want to build.

Think about what Amazon has, that kind of shopping experience. You log into Amazon, you discover something you want to buy, and you buy it. That’s pure Amazon IT. But for shipping and for other things, Amazon is working with a number of partners. What we are doing is very similar to that.

Kevin Pereau: That makes total sense. In my book, I’ve been writing about how we are hurtling toward a world of connected health and making data actionable. It sounds like Anthem is moving in that direction as well.

Rajeev Ronanki: Oh, absolutely. I think data is our primary asset. And we’re using it in a way that is very responsible. I don’t know if this has come up in any of your other interviews, but we are taking steps to make sure that we promise data privacy.

Responsible use of our algorithms is one of our core values and orientations. We eliminate biases in our algorithms—how we make decisions with data. It’s very transparent. As the systems that are built on them become more and more sophisticated, we are able to trace back and say, “Well, why is it that we’re making these recommendations?” And it is important to have that information available so the consumers, the members, the providers, all can peer into that and decide if that’s what they want to do. It’s aligned to the collective interest of all parties, not just Anthem’s.

Kevin: Pereau: I’m an ecosystem guy. I was a Cambridge Technology Partner, where we were all about ecosystem and leveraging the greater sum of our parts. But how do you get all the parties in the ecosystem to share your mission and participate in the value creation?

Rajeev Ronanki: That’s the curation part. In our case, we want to be very thoughtful about who we choose as partners. And we go through a significant amount of alignment from the perspectives of privacy, data rights, usage and more, to make sure values are in synch. And then, we obviously build our agreements with the goal in mind to make it financially viable, so all parties benefit from the relationship.

But let me stress, that doesn’t mean that we are not going to work with third parties. More and more, the companies we are working with are aligned around making sure that the data relationship resides with the consumers. We want to be able to very transparently and very openly communicate how we use their data. As long as that common Bill of Rights, so to speak, is in alignment with our ecosystem, we will absolutely work with them.

We are not going to work with companies that want to take that data and drop it into third party sources. That might be part of their business model, but in cases where we can’t control where the data ends up or how it gets used, we will not become involved. We need to assure our members that there will be no malicious use of their data by some party downstream. So we’re building in a lot of data governance, to be sure the partners that are coming into our system share the same goals.

Kevin Pereau: What is Anthem doing, and what is its activity on the investment and venture capital fronts?

Rajeev Ronanki: We do have an internal venture capital department. We are not scaled to be a traditional VC kind of company. But we are able to say, “We like these two or three bets here. So let’s go ahead and make an investment in them.”

We’ll continue to expand that. Because we see that as a critical shift. Again, building all the resources ourselves is unrealistic.

Kevin Pereau: I’m sensing that the industry can’t remain focused on the low-hanging fruit of finding solutions for diabetes and hypertension and similar ailments that affect broad segments of the population. It seems the industry is turning a corner on recognizing that there’s a whole untapped market segment they’re beginning to take a look at. Are there any populations that you particularly want to focus on?

Rajeev Ronanki: I’m not sure if it’s a segment of the population that we’re focusing on, as much as focusing on whole health, from physical to emotional wellbeing. And financial wellbeing.

We believe we have to deal with the whole person. Much of that will involve how we deal with incentives and rewards, get to the biometrics where appropriate, and create a feedback loop for the physical wellbeing and emotional wellbeing, which is getting more traction these days.

Financial wellbeing is another sort of thing that is closely tied into the social determinant. We had a case recently where a member was unfortunately diagnosed with cancer. That’s one big life event. But at the same time, the consumer is stuck with a huge medical bill as well. That starts to impact the family life. It is time to start thinking in new ways about kids and all. There’s an entire spectrum of issues that we need to piece together in order to serve the member well. That’s where we’re going.

The population of health care consumers is very diverse, and we’re not excluding anyone. We’ve got people who are gig economy workers, people who are aging into Medicare, people with chronic conditions, and others. But you’ve got to look at overall health to serve any segment well.

Kevin Pereau: Do you think we’re turning a corner so that larger healthcare insurers and other businesses will be better able to serve people from a variety of populations who have different health concerns?

Rajeev Ronanki: I certainly hope so. We’re still in the early stages. I’d say the major players in the ecosystem are all recognizing that is the end goal, just to get there.

Kevin Pereau: And where is Anthem heading next? What are the priorities?

Rajeev Ronanki: If you look at our net assets, the data assets, we’ve done a lot of work in the provider network optimization space. We’ve got a huge library of algorithms and we’re doubling down on creating even more. And there are some really innovative ways we may be able to match providers to their members, much like how Netflix matches movies to consumers. We want to get to that next generation of being able to match providers and consumers, focusing on cost and quality. That’s going to be a core piece of what we’re going to do.

Member engagement, as we’re calling it, is going to have a lot of personalization built into it. And what I mean by that is, we take a longitudinal view of our members’ health data that includes social determinants, that includes claims obviously, and that includes a lot of clinical data. And increasingly, a lot of biometric data from devices too. So if you put that all together, there’s a kind of rich view that gives us all kinds of insights.

That is going to get built into a very tailored data set that leads to proactive outreach that enables us to say to consumers, “Here’s what we think you ought to do next.” If in fact members want to be communicated to in that fashion. Not all people do. For those people, there will simply be a kind of digital breadcrumb that invites them to the next thing they ought to be able to do as they manage their care. And built into the system is what they can choose to do, and what happens afterwards—medications, specialists they need to see. Our vision is to be able to serve as a guide to seamlessly make all of that happen.

Kevin Pereau: That’s really exciting. It’s great to see you evolving a framework and a strategy around that. As you think about the vetting process and all that you just laid out, what’s the best way for technology partners to approach Anthem? How do they land on your radar?

Rajeev Ronanki: We have the capability to ingest a lot of data from VC firms, from our network, and elsewhere. As you would imagine, literally hundreds of ideas and solutions come our way.  We organize that information into what you could call a taxonomy of solutions. They could be anything from care coordination to virtual care, to telehealth, to condition-specific apps like VIM. We sort them into one or more of those categories. We’ve got a sensing algorithm that enables us to go through opportunities that other companies offer and say, “This looks like it fits a need that is open, should we look more into it?” And then we do. And if we find it interesting, we might reach out and have a discussion with the company.

An example of that is a recent filing that we’re doing with a company that wants to do personalized clinical trials. So clinical trials are one of the categories that we really didn’t have any near-term needs for, but this company approached us to say, “We’ve got this going on. Would it be of interest to Anthem?” One deeper interest of ours was the architecture and how they use AI and blockchain as a safe way to use consumer data to match them up to appropriate clinical trials.

So we decided to look more into it. And that led to a decision to move forward. So we’re piloting that with Anthem in-house, with our employees. And then based on the results of that, we might conclude that it works, and we’ll throw it out to a broader population. Or we might learn something from it. And based on all of that, they might become one of our ecosystem partners.

Kevin Pereau: Rajeev, where do you see the industry going in four or five years. Where does Anthem fit as a driver of disruption? If you’re successful, what will the world look like?

Rajeev Ronanki: I think where we’re headed is that Anthem will be a creator of an ecosystem that creates solutions for consumers. And in so doing, what we’ll do in five, maybe push it out to a seven-year horizon, I would envision us being able to dynamically create an ecosystem based on real consumer data and deeper needs.

That level of dynamic creation using the resources is technically possible today, but there’s no business model that requires it. If everything unfolds in the way that I think it will, that’s where we’re headed. It will perhaps be a world where you can essentially configure a set of assets on the fly, and people can either opt in or opt out. And that’s probably how health care is going to work.

Many thanks to Rajeev for contributing to The Digital Health Revolution! Follow him on Twitter: https://twitter.com/RajeevRonanki – @RajeevRonanki

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