A Conversation with Rajeev Ronanki, Senior Vice President, Chief Digital Officer Anthem, Inc.

If you spend any time at all with Rajeev Ronanki, you quickly realize that there is probably nobody else in healthcare who knows as much about the realities of how AI can be used to improve patient experiences and outcomes.

Rajeev Ronanki serves as Senior Vice President and Chief Digital Officer at Anthem, Inc., where he oversees the vision, strategy, and execution of Anthem’s digital, Artificial Intelligence (AI) and exponential technology portfolios to move Anthem to become a true AI-first enterprise. In addition, he oversees innovation and modernization, and with his team, drives enterprise data strategies. Before Anthem, Rajeev started and led Deloitte’s Life Sciences and Healthcare Advanced Analytics, AI, and Innovation practice. He was also instrumental in shaping Deloitte’s blockchain and cryptocurrency solutions and authored pieces on various exponential technology topics. Rajeev also led Deloitte’s partnership with Singularity University and start-ups that included doc.AI, OpenAI and MIT Media Lab’s MedRec.

Sydney is Anthem’s remarkable, AI-driven engagement app that Rajeev was instrumental in developing. Virtually every healthcare company has an app of some kind, but you don’t have to spend more than a minute or two on Sydney to see that it is different in the degree of friendliness and functionality that it brings to our smartphones.

Anthem’s website states that the Sydney app is simple, smart, and personal.  And after a minute or two, you see that is certainly true. I should know. I am not only a big fan, I am a big user.

What can Sydney do?

• Find care and check costs: It’s easy to search for doctors, dentists, hospitals, labs, and other providers in your plan. You can search by name, location, or the type of care you are seeking. You can even filter by gender or languages spoken, then check costs before you go. This helps you find what’s best for you, and you get a gain an advantage in knowing what to expect before you go in for your visit.
• See all your benefits: Sydney shows you essential information at a glance, whether that’s an overview of your plan, health reminders or suggestions for wellness programs. You also can find your deductible, copay and share of costs. It is all integrated so there is never any doubt about what is covered, how much is in your health savings account (HSA) and what your out-of-pocket expense will be.
• Sync with your fitness tracker: Sydney makes it easy to stay connected to your health. You can easily sync your devices to your fitness trackers and set custom reminders to help you reach your goals. This gives Anthem a more holistic and longitudinal view of who you are and what you do. Knowing your history is an important precursor to knowing how to best help you.
• Use the interactive chat feature to get answers quickly: Just type your questions in the app and get the info you need quickly. Plus, Sydney can suggest resources to help you understand your benefits, improve your health, and save money. In the COVID era, this has become an essential feature that addresses all of our needs.
• View and use digital ID cards: You can always have your most current ID card handy. And you can use it just like a paper one when you visit the doctor or dentist, pay for care and more. Soon, your HSA debit card will be integrated, meaning you shop for your healthcare needs, know what portions will be covered and pay from your HSA all from one application.
• View claims: Check medical, dental and vision claims in one click. That means you can spend more time focused on your health and less on managing your health benefits.
• Check My Family Health Records (myFHR): myFHR gives you easy access to your health data, including health history and electronic medical records, all in one place. Availability is based on your Anthem plan.

What makes Sydney different is that, thanks to seamless and invisible AI, it’s all simple and intuitive. I have come to think of it as a curated experience where best-of-breed solutions are at my fingertips. Sydney knows my history and what is important to me.

“Pre-pandemic, Sydney was essentially designed as a one-stop shop for all things service-related for Anthem.” Rajeev explains. “The idea was to create a simple easy-to-use experience that would allow users to resolve all the issues that would ordinarily be handled on a phone call to customer service. Initially, finding care was the function that it was used for most often. You could also follow up on a claim, make a payment, or do anything you would typically do on a call. Only instead of being placed on hold, you were driving the content with your inquiries at your own pace.

“And then the pandemic hit, and we were looking at ways in which we could bring care options to our members who otherwise would not have access to care. In a matter of a few weeks, we saw a wider range of digital and virtual care options that could be made available in Sydney.

“That was rolled out last April, and we had over 200,000 people that were able to triage symptoms and do preliminary research on symptoms they might be experiencing. Several million people used text, video, and virtual visits. The horse had left the barn so to speak and Sydney’s mission evolved overnight. A worldwide healthcare crisis can do that.

“So there was a transition. It started with customer service, but it was always on our roadmap to deliver actual care via Sydney. During the pandemic, we accelerated that and integrated digital and virtual primary care, and we’ve made that available to all of our members. They used Sydney to find vaccination sites, track when vaccinations were actually being administered, and schedule appointments. Those resulting patient records could be used by the appropriate vaccine passport providers, as a way of validating that people actually got their vaccinations. And the data can be used to analyze and understand trends and patterns in Covid care both at the micro and macro level.”

When I interviewed Rajeev two years ago for my first book The Digital Health Revolution, Sydney was really more of a vision. Now, Rajeev tells me that about 20 million Anthem members are using Sydney which certainly answers initial questions about scaling. During the pandemic, Sydney was used about 11 million times, on computers, tablets, and smartphones.

Goodbye to Live Care?

Clearly, Anthem is embracing digital technologies. But does that mean that live care experiences are about to go away?

I asked Rajeev.

“I think maybe we define telehealth too narrowly,” Rajeev told me, then he went on to explain, “there was definitely a spike in usage of specialized telehealth networks. I think that’s going to level off and return to pre-pandemic levels, maybe slightly higher than the pandemic level. We define digital care as care that does not require a human at the other end, whether that is a nurse, a doctor, a caregiver or care manager. There are things that we could do that are automated, based on our data. One goal is for users to be able to understand what is best for them to do next, based on our insights. Let’s say that our data indicates that the best next step for a member is to see a doctor. We want to be able to provide multiple options for doing just that. The user, for example, can either text or email a doctor, which can lead to an in-person appointment, or a video consultation. But the user would be able to seamlessly bridge into that. There are times when a physical service is needed. Maybe the patient needs to have blood drawn. So, how do we get that done for Anthem members? Do we have our member go to a local lab somewhere? Do we send someone to his or her home? We want to integrate that on Sydney. We have both ways of doing it.”

“If an in-person service is required, we want to keep that continuum flowing seamlessly; we can schedule an appointment, get the procedure taken care of, and then follow up with digital virtual remote monitoring care so that that loop continues to be seamless and continuous between digital, virtual and physical. And then, from a member’s perspective, it’s all seamless. If that care needs to be rendered at home, so be it. If it can be done virtually—terrific. If it requires an in person visit because lab work is required—not a problem.

“That seamless experience is something that’s hard to find on many services, where experiences are siloed. You can download an app and track your symptoms, but that really doesn’t go anywhere or connect to all that you need to really be a seamless experience. You can have a telehealth consultation, or you could get a discount pharmacy card somewhere and get your prescriptions mailed to your home by connecting to your prescriber. But there is no larger awareness of what is happening with your health, no context or medical history. Do you have allergies? Have you experienced side effects after using a medication? That information might not be captured. If none of that is integrated, then everyone’s operating sort of in the blind. But we’re connecting all the dots, so that on our platforms, the data breadcrumbs carry forward seamlessly and we’re able to provide insights at each interaction.” For homecare to ever be an accepted norm, this is essential.”

AI and Individuation

Rajeev and his team have worked hard to have AI provide an experience in which each member’s search for care solutions is different – highly individuated.

“My search could be different from yours,” Rajeev says, “Each search should be tailored to our unique set of fingerprints, our health history. And that results in a very curated sort of presentation of network options or doctors choices, which is no different than how Netflix matches up users with content. We match up our users with appropriate providers, based on hundreds of attributes that have been uniquely curated. So that’s a far richer experience then what people will discover on popular Internet apps that provide information on health. The information those internet apps give is not always connected – it’s purely informational. Again, nothing is connected to a user’s individual data. If you need an appointment, that online page is not going to schedule one for you. Your health history will not be there. If you have an in-person appointment with a care provider you have never seen before, you are going to have to provide information on your medical history and your medications all over again. When we talk about reducing the friction associated with getting the care we need, this is always at the top of everyone’s list of pet peeves. How many times do I have to provide my doctors with the same information? What the heck are they doing with my data if they have to ask me for it every time I step through their front door? For Anthem members who use Sydney, all those assets are available at their fingertips now. Let me say, Sydney is not available in every market for every provider, because we’re still in the process of connecting all the providers into our platform. We are making that universally available, but it’s very much a work in process.”

AI and the Democratization of Healthcare

Over the years, I have often heard it said that your Zip Code can serve as a better predictor of your long-term health than your genetics. And we now know just how true that is. Who suffered the poorest health outcomes during Covid-19, for example? The people who lived in the least wealthy locales in America. They had the poorest access to good food and often, the poorest access to hospitals and other healthcare providers.

AI, which most people think of as a way of making computers more communicative and smarter, can really level the playing field in that situation. The reach and availability of AI-enhanced apps is growing day by day, with the increasing numbers of smartphones in use in inner cities, in America’s rural regions – everywhere. 

“AI is here to stay,” says Rajeev. “It’s already part and parcel of every industry, or it will be in the near future. It’s something that every industry is going to have to learn to adapt and apply to optimize their businesses. Healthcare is no different. In fact, healthcare is the top industry where AI has the greatest potential and benefit.”

Ethical Considerations

“There absolutely is a risk in the expanded ability of our models and algorithms,” Rajeev says. “I think there’s bias, there are ethics to consider. And all these things have to be very carefully thought through while implementing and scaling IT programs, because the fact of the matter is that bias and inequities exist in the healthcare system today. We need to make sure that we are not furthering those biases. As we touched upon earlier, your Zip Code can greatly influence your health outcomes, perhaps even more than your genetics. So if that’s the case, there is a danger of turning what is perhaps a non-scalable bias in humans into something that’s infinitely scalable. There is a risk of perpetuating the normal checks and balances of decision-making and making them more dangerous when applied at a machine scale. So to mitigate that, we have to be very consciously designing for governance and testing for data quality. We need to be building checks and balances into the algorithms to account for all the things you referenced, Kevin. At Anthem we have a robust program around responsibility, which includes governance, ethics, bias.”

“We routinely check our work from an independent lens to ask,  `While we are solving one problem, are we doing something that will create or perpetuate another problem?’ We look for data quality issues, we look for holes in the way most algorithms are developed and take every practical step we can to mitigate any bias. We also need solutions around the completeness of data sets, because if only certain kinds of data are considered, or considered incompletely – demographics, for example, or certain geographies – then inherently the knowledge base is not accurate. It might not be representative of the entire population. But then, if that’s the case, how do we get the healthcare data for the rest of the population if they’re never in the system? So I think there have to be more collective industry efforts to create a broader dataset and have a lot of rigor in making sure that that data is complete, has integrity, and represents the entirety of population to make sure that we’re using complete data to build the ground floor of a scaling area, if you will.”

Earning Trust

 I have noticed that trust or lack thereof can be the greatest enabler of any new technology. In healthcare, if end-users do not trust a provider or an app to protect their data, for example, then that solutions provider will simply not succeed. I am not surprised that Rajeev, who with his team is introducing a new way of interacting with consumers and their data, also views trust as a prerequisite for success.

“Trust is absolutely foundational to all of this” Rajeev says. “So Anthem is presenting options and engaging our users and members in highly considered and careful ways. We can’t reach the entire spectrum of our population if they don’t trust what we’re serving up. And if they don’t believe we’re acting in their best interests, we’re not going to get the adoption that we need to get. Said a different way, we need to be solving real world healthcare problems and adding value in a near real time environment.

“Trust starts with the premise that consumers should own their own healthcare data. From a practical perspective, that means that everyone in the system should make it as easy as possible to let consumers have access to their data in a way that’s easy and affordable and simple to navigate.

“If we start there and say to consumers, `You’re in charge of your own data, you tell us how you want to use it. We, of course, would like the privilege of using that data to improve our algorithm and insights. But if you’d rather have us not use it, we’ll find other ways to find a solution.’ That is easier said than done, and I think every industry struggles with it.

“I think big tech has not done us any favors with the way that they’ve approached the problem and we’ve got to overcome that. You think along the lines of Facebook and Google during the election process, and it sends a chill up your spine. But unless we overcome that, I believe our future, where our health care experiences are very much like a retail experience, is going to be hard to pull off at scale.”

Rajeev Sums Up

“At the end of the day, it’s all about simplifying. So between your life and your watch and your phone and all the other sensors and all the data that you’re probably inundated with, how do you simplify it and engage just with the minimal amount of information that’s necessary to create the optimal outcome?

“For Anthem, that is what it comes down to, how do you create that human-centered, design-led approach to presenting all of this information in a way that’s meaningful and actionable? And how do we address the needs of a family of four that’s worried about homework, jobs, and commutes and not only health maintenance and care? We need a really simple, simplified way to engage. We need to profoundly simplify the experience. Then we can serve up the things at the right moment to create the right outcome and intervention.”

Sounds a lot like meeting people where they are. They live in the real world, not the healthcare world and increasingly, that means being able to coordinate their care needs from home.

Follow Rajeev on Linkedin and on Twitter.

You can read the full interview with Rajeev, in Kevin’s book, It Takes a Village – Click here to get it on Amazon.