In this episode of Health Biz Talk, host Tony Trenkle, former CMS CIO, interviews Ilanko Kumaresan, CEO of Genzeon and veteran healthcare technology leader with 30 years of experience spanning McKinsey, Cognizant, and global transformation initiatives.
Their discussion explores how Kumaresan’s early experiences in retail data analytics shaped his approach to healthcare innovation, emphasizing the power of actionable insights over raw data. He reflects on lessons from his time leading billion-dollar payer and provider businesses at Cognizant and highlights the importance of humility and incremental improvement when tackling healthcare’s complexity.
Transcript of the Podcast
00:00:00 Intro
Welcome to Health Biz Talk, the industry’s leading podcast that brings you today’s top innovators and leading voices in healthcare technology, business and policy. And here’s your host, Tony Trenkle, former CMS CIO and health IT industry leader.
00:00:16 Tony
Good morning and welcome to our latest podcast from Health Biz Talk. I’m pleased to welcome this morning to the podcast Ilanko Kumaresan, who’s the CEO of Genzeon, Ilanko is a seasoned business health transformation leader with over 30 years of leadership experience in healthcare and technology at McKinsey Cognizant and other organizations. Before his current experience at Genzeon, he was a senior advisor at McKinsey where he guided executives across healthcare and tech services on strategy and execution.
At Cognizant, he spent many years building and driving Multiple Very large 1 billion plus businesses in healthcare spanning payers providers in the public sector. Three of my favorite areas Ilanko and I’m sure we’ll have a great discussion today and I always like to start off the discussion with asking you to kind of give us a little bit more about your background in terms of how you got to where you are today. And one of the things I’m very interested in is it looks like you spent some of your early years in the retail sector and it’d be interesting to hear how you kind of applied some of those lessons as you moved into the healthcare space.
00:01:46 Kumaresan
Yeah, wonderful. First of all, thank you for having me Tony. It’s wonderful to talk to you. I grew up in India and early years of my technology chops were in learning especially as a developer and learning technology was all in early days, early 90s and I think I was one of those fortunate to come of age at a time when I think the Internet revolution was beginning and network revolution was happening as well. Right. So I think all of that has powered the last 30 years and it’s all timing as they say to your question on retail.
I spent the first few years working in retail in late 90s and I remember I don’t know whether you know, Cognizant that I was part of used to be a sister company of AC Nielsen and AC Nielsen is where I spent a lot of time doing retail IT and at the time they had some of the largest databases in the world and they were doing retail trends that were looking at predicting shoppers habits and here I was working in Germany mid-90s where looking at trying to get insights from the data they were collecting that oh men go to shop on Thursday evenings and let Rearrange the store to appeal to men’s products and stuff. Right. I mean they were doing things like that in mid-90s. So that tells me a lot about how to use data, how to use the insights to get information from data. Right. I think that is something that has remained with me all through and I think you being in healthcare will know we drown in data in healthcare. Right. There is data, data everywhere but information is hard to get. Right. And that I think is a good insight too. I try keep in mind as we, as we do products and solutions in healthcare.
00:03:57 Tony
Great. Yeah. And you know as someone who also spent time in the, in the electro electronic commerce side and then the electronic services to the, to the public or to the citizens as we called it, I understand how valuable that background can be. So I want to turn next to an area that’s near and dear to my heart which is the payer community. Obviously I spent a lot of time at CMS which is the largest payer around but also spent a lot of time working with payers both during my time at CMS and after I left CMS and I followed them through the years. And one thing I’ve noticed with payers is they’re not generally leaders in customer experience and a lot of their challenges deal with the fact that customers as they see them are not necessarily how customers see themselves.
So they call members for example, we call them beneficiaries at cms. So you’re coming in as a, as a, you know, building technology platforms, trying to understand that community. What, what. And I, and I know there’s a balance between what they want you to do and where you think they should go. So can you kind of spend a couple minutes to talk about how you got to understand the payer community and what are some of your thoughts in terms of getting them to continue to modernize and improve their experiences?
00:05:38 Kumaresan
Yeah, it’s a quite an interesting topic and I think quite complex. So I’ll try and I think when you, when you approach healthcare I think humility is important and a lot of people treat healthcare I think similar to some other industries. But though, but I think healthcare is what I’ve learned is, is much more complex and it’s for a variety of reasons. Right. Nobody would have designed the U S healthcare system I think the way it is today if they were starting fresh. I, I don’t think anybody would design it this way. Right. So I think that I’ll start with that. Right. So having an appreciation for the complexity and humility is I think Number one important and secondly, I think it’s important also that you talk about, let’s identify areas that we can improve incremental improvements that we can make that makes patient lives, member lives, provider lives better I think are very important ways to chip away at the problem, if you may.
So, so I start with, in my mind, start with the business processes when you look at a payer, right. And break it down to the sub process level in each of the areas whether it is member and enrollment claims or even sales and underwriting. I mean these are very big major processes with a lot of sub processes. Right. And at Cognizant I was fortunate enough that we recognized this very early on that domain knowledge and business understanding is core to be a good technology provider to payers and doing that exercise of breaking the business process and look sub processes level and then seeing, okay, what can we do with technology to improve one sub process at a time. Right. And that approach I think has been quite valuable, quite successful and then you build on it. Right. And once you do multiple sub processes, suddenly you realize you have made the whole process much better and think of technology as a tool to do that. Right. I think that approach I think has been helpful. People who have tried to say I’m going to come top down trying to make the whole thing better, I think that approach tends to fail. Right. It’s more understanding the nuances and building on incremental improvements I think is very important. And, and that is the approach that I think has been more successful.
00:08:25 Tony
What’s an example of how you did that? And, and with a payer you don’t have to mention their name obviously, but yeah, absolutely.
00:08:33 Kumaresan
Right. So for example, this whole HIDIS reporting is a, is a, is a, is a critical area when it comes to people, Medicare Advantage star rating. It’s at the core of IT in, in many ways. And we were working with many payers and we saw that every year they got to submit lot of data to get their HE scores evaluated. And, and those measures do change every year. I think Last I count, 52 different measures were there and we used to spend, I don’t know, six months in a year trying to collect all that information, report on it and provide. And we could see that we are doing it with every pair.
It’s like this doesn’t seem a vision way to do this. There should be a better way to do this. And it’s an idea born out of the fact that we were working with many payers doing the same thing. So we built a solution that can automate many aspects of it. It was a, I mean it’s not a hundreds of millions of dollars solution by any means. It’s a small solution, but it took off every client when we went and approached. You know what, last year you guys paid me to do this somewhat manually with some point technology. Would you mind trying out the solution we have built and at no additional cost for you? Right. And payers were like go have at it. Right. And that’s a way we try to automate a lot of that he disreporting. And in three years, I would say there were 25 different payers that we were doing it at probably a fraction of the cost that we were doing three years ago.
That’s one way of using technology to improve this entire process and like that. I mean there are many, many examples you can look at in every aspect of healthcare. You can go talk about value based care. I’m sure you and I are old enough to know about meaningful use and what we did at that point and so on. So every time some new area comes in, understanding the business process and how the change that is happening in the industry fits into that process is a key to make sure you build it the right way. Right. Everything doesn’t need kind of a rip and replace or this wholesale way of trying to replace things. That approach is way too expensive and industry can’t afford it either.
00:11:01 Tony
Right, right. So just pivoting a little bit from that. One of the, one of the challenges is you’ve got a lot of players in the healthcare ecosystem both on the payer side. Of course you got, then you have the providers and you have others and you have a lot of other technology companies playing in this field as well. So you rarely have the opportunity as one company to control everything. And then of course there’s the customer side as well. So how did you, and how do you work with other players to make them all kind of work at the same, have the same goals and work the same way?
00:11:47 Kumaresan
Yeah, yeah. So at the end of the day, right, I am a big believer that services companies, service providers like us, exist for one on one reason only. And that’s to make our clients successful. Right. So and once you put the client as the North Star, I think it actually it aligns the goal of everybody in the program. Right. We are all trying to do what’s right for the client. And then once you do that, then you look at, okay, what’s my role and what am I bringing to the table. Right. And, and this holds True. For whether you are working on a program management or in a support engagement or building something, testing something, you can be doing various functions.
You may be doing one function, but you must know it’s in service of what. Right. And once we understand what’s the client trying to do and what’s, how can I best serve the client’s need and everybody operating with that same playbook I think is the recipe for successful programs. Right. And companies or service providers that don’t operate with that mindset will tend to find themselves at the crosshairs of the client as well as others. And I don’t think it’s a long term way to build a partnership with a client that is sustainable. Right. And that’s at least the way I’ve seen. We have been in, I’ve been part of many, many programs where we have had a role to, along with multiple partners. Right. And that’s just the nature of the industry. The complexity of the programs and different players bring different strengths to solving a problem. And it’s very important that we all work together to solve the customer problem. And I think if we do that, generally good things happen.
00:13:39 Tony
So here’s a question tied to that. I worked at IBM, as you know, for several years and in some cases IBM was very, that did a very good job of working with the client and then overnight some of that evaporated. So how did you keep that trust with the client over the years? Because it’s one of these things where we used to say one screw up gets rid of 10 attaboys.
00:14:09 Kumaresan
Yeah. I think there are two things that are important. I think we have touched on both in this conversation. First one I think is, is the domain and client understanding. I think you got to have people that understand not just technology, but the, what it does for the client’s business problem. And that needs to be deep. Right. It’s not enough if just your leaders understand it or your senior people understand it. I think this is the mistake a lot of service providers make is you cannot be skin deep here. You have got to drive that down. Right. And think that’s one. Right. And once you have that, that will help you with the second one, which is, as I said, putting the client’s interest as the North Star. If you don’t understand, it’s very difficult for you to even understand what that is. Right. So what is the client trying to do? And if you understand that, that’s the second part. It’s a decision that each company needs to make that we are going to put the client interest at the North Star. And we are going to do everything to be part of the solution and not become part of the problem. Right. In achieving success for that goal. And if you do these two things consistently, I think you can retain the client trust for very, very long time. I mean I’ve been associated with clients 10, 20 years. I mean I still have some CIOs that I have done work for, I don’t know, almost 30 years ago that I still talk to and they reach out for some discuss and I reach out for advice. And that kind of relationship that’s built on a foundation of mutual trust and invest in each other’s success, I think kind of thing, it’s what builds long term relationships.
00:15:54 Tony
Yeah, I think one of the things I saw and you probably see the same thing, so they have a client lead or a partner like yourself who comes in and spends years and then you move on to a different responsibility. Another partner comes in, doesn’t have the same relationships, the same background, the same knowledge that you have. So sustaining that over time, not tying it to one personality or one individual. To me is challenge that I see a lot of these companies face.
00:16:30 Kumaresan
Definitely I think that’s a very valid observation. But I think it’s the culture of the company. Right. We have got to insist that everybody in the company learns the customer domain. If you are working in, I mean Genzeon is a healthcare solutions company. Right. And we try to hammer this home every time I get a chance with my team that you may be working in java.net, aI whatever. Right. But always remember it’s towards technologies in service of a business problem. You got to understand the client’s business, whether it is a payer provider or something, or life sciences, even all of them. If you don’t understand that, then invest the time to understand it. And we try to do a lot of programs within the company to educate people on the domain aspects of things. And that investment and that continuous push from the entire leadership is very important to reduce, mitigate that there will always be some gap and difference between people. I’m not saying it doesn’t exist, but you can mitigate that so that clients get a consistent experience when they engage with you.
00:17:39 Tony
I think one of the things that is important for technology companies is not only understanding the, the business that they’re trying to sell into, but also educating the client on what we used to call at IBM the art of the possible. Because if they don’t understand where technology can take them and how that ties into their business and of course, on your side it requires a deep understanding of the client’s business needs and business requirements. But on their side they need to understand enough about technology to understand what you’re trying to lead them towards is something that’s good for them and not just a sale for your company. So what are your thoughts on that?
00:18:25 Kumaresan
No, 100%, I agree. But I think clients have become quite sophisticated.
00:18:30 Tony
Much better.
00:18:31 Kumaresan
Yes, I think I, and I think it is also a part of the evolution in which there has been a lot of movement of people, but from services industry to many of them are clients today. Right. They have been at the maturity of the industry as such. Right. IT services is in this middle age at this point. Right. So as an industry, and I think that maturity has percolated to the client side as well, they’re quite sophisticated, they understand. And I think I remember this, I’m sure you do as well. Ten to 15 years ago, I think it’s Jamie Dimon, I think, who said, right, JP Morgan Chase is not a bank anymore, it’s a technology company. And I think taking that concept seriously and the fear that Silicon Valley put in everybody, that every industry needs to, for technology to be a CEO agenda, not a CIO agenda, I think has, has had a lot to do with it. Right. And I think that has made this, that, this issue much lesser of an issue than it probably was 20 years ago.
00:19:40 Tony
Yeah, yeah, I would agree with you there. I think we’ll talk about AI in a few minutes, but that’s certainly one area where we’re starting to see some of that manifest. But I wanted to get your thoughts just for a moment on the larger picture. I mean we, we’re talking about incremental business improvements that lead to larger business improvements. We’ve seen a lot of changes in the health space move towards value based payments and, and other changes, but we have not seen the quality improved to the point we thought it would. We haven’t, as we used to call, bent the cost curve the way we thought it would be bent or hoped it would be bent, I guess, or strived to bend it.
So here we are almost in 2026, many years after the Affordable Care act was, was passed, years after, a number of other changes have been made to the health space. So now we’re moving into a new era in the health space. What do you think? Why do you think we haven’t been able to achieve, at least in the US what we thought we would achieve? Do you feel like it’s a lack of, well, let’s put it this way. Is it because the system is too fragmented? Is it because there’s not the national will and leadership? Is it because companies are in different stages of evolution? I mean, what do you, what do you, what do you think? You’ve been around this space a lot of times. You’ve probably dealt with every player in the industry.
00:21:21 Kumaresan
Yeah, I think it’s a very important question, Tony. Right. I think there are two. This will be kind of a multi part answer. Right?
00:21:31 Tony
Right.
00:21:32 Kumaresan
One from a political dimension perspective, I think there has been a lot focus on increasing access to health care. Right. Coverage.
00:21:43 Tony
Correct.
00:21:44 Kumaresan
And there’s been a lot of talk about it. There is a lot more emphasis on it and then. Rightly so. Right. Getting more people. Healthcare is a critical, critical element of any civilized society. Right. So I think that has consumed a lot of the oxygen.
00:22:00 Tony
Right.
00:22:01 Kumaresan
And while there has been some steps towards the bending the cost curve angle that you talked about, not enough focus and attention has been paid to it. That’s the first part of it. Now there are many reasons for that. Because I think it’s a harder problem to attack, simply speaking, politically. Right. Because there are entrenched interests and players. If you are bending the cost, it impacts somebody. What looks to cost to one person is income to somebody else and that is that element of it. Right. So that is a. It’s a harder problem to solve. But I also want to say everybody is interested in. That can be, that can unite everybody is reducing inefficiency, removing waste, fraud and abuse and so on. Right. That I think everybody is kind of aligned on that. Right. So.
00:22:52 Tony
Right.
00:22:52 Kumaresan
That that can be more technology can be used to do. And I’m beginning to see, and this is where I’m quite excited about what AI can do in this space. Right. In terms of doing more to reduce base fraud and abuse. That’s one part of it. And the third to me is there are supply side things that can be done as well in terms of whether it is. I mean, I see, I mean you have seen this as well last couple of years, the amount of burnout with clinicians that has happened after the pandemic and the number of how do you increase the supply of physicians, nurses and what can we do on that? How do we increase care locations? Right. You touched on health care being fragmented, but to some extent it’s unavoidable in a continental country like United States. Right. I mean care has to be where people are. Right. I mean otherwise. And in a continental country you gotta, if you’re in a rural county, you gotta have a hospital that you gotta have a doctor there. You can’t make, right. Everything cannot be dense like a big cd, right.
So, so there will be efficiencies of scale will be missing in some of those cases and some of that cost will. It may not be the most efficient, but you’ve got to have care where it is needed, right. You don’t want make people travel hundreds of miles, right? So, and that has, that has got to be acknowledgement of that. And that costs money, right? Everything people like to compare with Singapore or something else. US is not Singapore, right. So it’s much, much bigger. And there are all types of. There is New York City and there is towns that have only a few hundred people, right. I mean what do they do for healthcare? Right. So that’s the other aspect of acknowledgment and understanding of that is important.
And last but not the least I think is. And that gives me hope is the increased use of technology that for example, remote health. How do you get some of the best doctors to provide consultation for somebody in a rural county? Now it’s possible. Technology makes it possible, right. And, and post pandemic, the level of adoption and acceptance of whether it is telehealth, home health, mobility, there are all of these that I can see a lot more acceptance on the provider side and on the patient side, which I think gives me hope that we are maybe finally reaching a point where the technology is available. The acceptance of these technologies among the provider community, patient community is becoming available and the political environment is also becoming little bit more focused on cost of care, not just coverage. Because I think we have made significant strides in improving coverage over the last 15 years thanks to ACA. This hopefully we are at a point that we may finally may have a step jump in improving that. That’s my hope.
00:26:03 Tony
I think you made some good points. I’m just going to kind of recap a few of them and just kind of maybe just dig a little bit deeper on each of them. But the first one you talked about. Yeah, I was in the meetings with the Obama administration when they made the choice to go more for access than cost containment. And the idea was that as you get more people into the healthcare system over time, then you can really focus on containing the costs. The downside of that is you bring more people into the healthcare system, they want to consume more healthcare.
So that’s been kind of an open question there. The second thing you mentioned about. Well, one of the, one of the things you mentioned about was the whole fraud, waste and abuse. There’s been a lot of work done many years in fraud, waste and abuse. And a lot of technology has been applied to it. Both, you know, the upfront, weeding out the bad actors, looking at stuff, certain anomalies and stuff, and then at the back end, obviously catching bad behavior before it becomes too widespread. We still have, you know, a substantial amount of fraud, well, what we call fraud, waste, abuse and errors that occur in the system. And technology certainly can help with some of that. Some of it relates back to behavior. If people are upcoding or doing other things to more or less game the system, that can be solved to some extent. But technology works both ways with that. It helps one side evade the system, it helps the other side catch some of the people that are trying to evade or exploit the system. So we always have that constant push and pull. And I agree with your technology. The third thing you talked about was the number of providers. And that’s been another area that’s been a big problem because there was a lot of talk, there’s continues to be talk over, you know, empowering the general practitioners, you know, the primary care docs or even the primary care practitioners, whether they be doctors or others in the medical field who do more and more of the, some of the primary care work.
And you know, that was always a raid against this increasing need for specialists as you improve technology and as you move towards more personalized medicine. A lot of that involves specialists that get engaged, which have tended to have much higher incomes than the people in the primary care practices. So that was always a constant tension. And like you mentioned about the rural areas, that’s another issue that if you’re looking at it from a cost benefit perspective, if government became, I mean, if medicine became all privatized, why would you focus in the rural areas? Because there’s no, there’s not the, the benefit because you don’t have the, the numbers.
And I think the final thing you mentioned was, was the increasing role of technology and as it gets into, you know, how can it help people manage their own health? I think that’s been one of the challenges that we face. You can empower the clinician side with all kinds of tools, but if you can’t get people on the patient side to begin taking care of themselves, turning medicine from a. Treating the, the patient as opposed to making sure the patient doesn’t get the condition in the first. So which. Some of that is cultural, but some of it is the way we’ve driven Technology and we’ve driven the cost benefits of the system. So I was just wondering what your thoughts are about that.
00:30:02 Kumaresan
No, 100%, I think, I think you summarized it really, really well. The only additional point I will make to that is the. I was talking to somebody in. I used to live in Pennsylvania at some point and my wife’s OBGYN quit the practice and she was leaving and we were like, she really liked the doctor. Why? She said look, my malpractice insurance premium is like more than $150,000. It’s just crazy. I can’t afford this and, and I don’t want to just keep increasing costs. So my wife nearest obgyn was like 50 miles away. Right. It’s like. And so, so total form is a key element as well. Coming back to some waste in the system. Right.
I think California, I think addressed this problem long ago and I wish ACA had adopted that as part of its regulation. Right. So there are areas that we can do more and to your point on using technology and improving both prevention and care for people. An exciting project that we are working on with the hospital is we implemented physician co pilot for that hospital which is focused on in AI that actually understands everything about the patient, all the lab results and so on. And the doctor can just enter the symptoms and it already the AI can be an assistant to the doctor in being able to suggest not only diagnosis, treatment options, if he suggests a drug, it can find out what are the drug the patient is taking and finding out interactions reduce errors. There is a lot of things I think AI can do in improving clinical care, but I actually think there is a point in time with of course the right guardrails, some of it patients can actually access as well. I know even today people are just using ChatGPT, but I worry about guardrails on, on what recommendations are being given and that’s something, we need to do something sooner rather than later.
But I think if we do, I think it will collectively improve awareness on what are the things that people can do for themselves without always needing somebody in insurance or provider calling and saying do this, do that. I think people knowledge of how to live healthier and better can be significantly improved because they fully understand the connection between that and their health. Right. And that’s a gap I continue to see quite heavily. All of us can do better on.
00:32:42 Tony
That front, I think, I think you raise a good point and you know, we can turn a bit to AI. I think it has a lot of promise. It also. Well, I guess I Guess I’ll throw this at you. You know, we’re awashing information today, good information, bad information, and we’re negligent in, in being able to take that information and put it through a lens that tells us what we really need to know, as opposed to a lot of information that we don’t need to know. So you look at AI as maybe something that can help with that. But on the other hand, AI has its biases and has other limitations. Any of us who’ve used AI can see that. So where do you see that going in the coming years? How can we get beyond this kind of stage of too much information, half of which is poor, and AI not helping as much as potentially it could do?
00:33:51 Kumaresan
Yeah, at this point, it is a bit of a wild west, no doubt about it. Right. So. But I think it happens Right. In early days of most, I think, technology trends, it’s a bit all over the place. And I think a is in that, that stage of its development. But I, I do think that as various players work on this and develop this, it will shake itself out. And government has a role to play, I think. Right. In terms of stepping in. I think not just government, AMA and AHA and many of the other associations have a role to play. All the industry players have a role to play. And I think we have a role to play. When we are building AI, we’re trying to make sure that we develop guardrails to do as much as we can to be able to eliminate some of the biases so that we come up, even as technology providers come up with test cases that tease out those biases, so that before you implement it, you deal with these things up front. Right. So. But it should not be. At some point, it cannot be left to just individual players to police themselves. There is going to have to be some regulation. Right.
I think the only debate is, do you do it today? Do you wait for this to shake out a little bit longer and then do it in a few years later? I think that’s where I can see a lot of the debate, and I can understand that. Right. And I don’t know where you fall on that side of the debate, but I also, I do think that you don’t want to. Europe has been trying to regulate it, maybe sooner rather than us, but I think that it will shake itself out over the next three to five years and I think we’ll be in a better place. We got to make sure that in that process, we don’t hurt a lot of people in that process because this can do real damage to people if not handled well. So I like to just caution people you can use AI, but don’t just rely on that one source. I think you need to make sure you still. Even the physician co pilot that we implemented at the hospital, it always a recommendation to the doctor, not directly to the patient. It’s up to the doctor to decide what to take and what to ignore. Because this is still pretty early in the process. But I think the long term potential I think is pretty high in elevating how care is done in primary care, to hospital care, to home care and others.
00:36:34 Tony
I think you’re absolutely right. Turning to another topic that you spent a lot of time with is hospitals. What do you see today as their biggest challenges and where do you see where technology could be used in a more effective way to help with them?
00:36:49 Kumaresan
Yeah, most of the hospitals that I talk to, I mean are always cash constrained. Right. I think majority of the hospitals, I think somebody was telling me runs with about 100, 150 days or less than 120 days of cash flow. Right. So and, and it makes capital investments always difficult for, for hospitals. Right. I don’t know, many people may not realize, I mean out of 6,000 hospitals in this country, 70% are community nonprofit. So it’s easy for somebody in technology industry to complain, hey, why are you not adopting technology? But it is much harder to come up with the capital to do it.
So what I see a lot of hospitals doing though is I think finding ways to leverage end to end solutions rather than point solutions so that they can get an ROI relatively quickly. It’s not like I got to make million dollar investment today, wait for a year or two to get the rewards. I need to be able to get the rewards very quickly so that I can actually manage within my operating expense. So you implement something that reduces my operating expense, then I’m interested in that. For example, we are working with a hospital that doing a lot of three year referral management work today. And we are looking at it, they’re spending, we are looking at going back to the business process, sub process steps is exactly what we have approached that problem.
And we identified quite a bit of inefficiency in how they are doing it today. And with our partner UiPath, we are implementing and automation of that entire process in referral management where it’s going to deliver results in three to four months. The hospital will start seeing savings within that period. Yes, you may spend a few hundred K, but you know what, within the same year it will more than pay for itself. Right. And it’s ideas like that that show immediate value. That’s what a lot of hospital CIOs are interested in. And secondly, they are also interested in making sure service providers have some skin in the game. Right. Okay. You are saying we can save money. Okay, show me. Right. Put some skin in the game, then share in the savings rather than asking me to invest everything up front. And can you do some gain? Share models. Right.
So those kind of models in terms of how contracting is done is also where I think there is interesting ways to adopt technologies going on as well. Right. So, I mean, I’ve been in the industry now for a long time and I used to sometimes be challenged as to how you can get providers to adopt more technology. I mean, 20 years ago it was a much more difficult challenge than it is today. I think the pandemic changed a lot of things. And I think provider CIOs and providers have realized that they have to have technology as their friend and drive efficiency, reduce cost, improve patient satisfaction and care. And technology can be a big help. And I see a lot less resistance today across hospitals. And that’s, I think, a significant change. I would not have said that 15 years ago. Right. And today I can see definitely that to be the case.
00:40:20 Tony
Right, right. I guess another thing to kind of run by you about hospitals, and it was kind of a unintended consequence maybe in a way of the meaningful use and the promotion of electronic health record systems. We now have seen over the past 15 years a big consolidation of hospitals, more venture capitalists getting into the game, large systems like the epics and the Cerners increasingly taking over. So we’ve seen this kind of consolidation and this bringing together of a lot of different organizations where we used to have a lot smaller community hospitals and others in the play. And I get, I’m assuming that will continue. Or do you see that as this maybe something that AI can change to some extent. But if I put a billion dollars into an EPIC system, I’m obviously not going to throw that out for something else, at least not in the short term.
00:41:31 Kumaresan
Yeah. I think this trend towards consolidation, I think of it as it’s a wave that, that, that happens and then it crests at some point and then it stabilizes. Right. And I, I do see that there are some benefits for that as well. Right. In terms of, I mean, you know, this scale helps create efficiencies and, and sometimes the consolidation creates a scale and that scale produces efficiencies.
I know People get a big concern or probably dominate the industry from a technology standpoint and a lot of hospitals, and I think it has allowed, I think quite a bit of adoption of technology as well. Now to your point, I do still believe there will always be, there will be some of these big hospital chains, but there will always be, I think think the hospital side of things I think will remain fragmented for a variety of reasons. To your, I think, as you said, I think somewhere earlier, if profit is the only motive, it’s very difficult to be able to give access to health care in, in some of the rural areas and smaller towns and so on. And I don’t know that those will ever be of big interest to APE or others to, to come in and do and they will remain.
So I do think that there is a role for big hospitals, regional chains, nonprofits, community hospitals. I think this ecosystem I think will remain somewhat diverse and I don’t know that that’s necessarily bad. I think each of them have a role to play and a contribution to make. And some of the things that you are learning in doing in a large hospital, you can actually do it in a smaller scale in a regional or a rural hospital as well. In fact, we do that today. I was talking about the referral management idea that we are doing for a mid sized hospital and the same idea that can be done at a smaller scale in a smaller hospital. And there are benefits for them as well. I think maybe the adoption of technology may not be as much as some of these bigger players, but there is a trickle down effect of the learnings that happen in some of those bigger engagement, bigger projects. The benefits do flow to the smaller and regional and rural hospitals as well. That’s what I see.
00:44:12 Tony
Right, right. Yeah. No, I don’t disagree with you. I think in a lot of cases that’s been true. In other cases, unfortunately, some of these smaller hospitals have suffered and especially in rural areas. Now one of the programs that the government has run over many years that’s helped the rural areas has been Medicaid. And I know you were heavily involved in the Medicaid. Some of the Medicaid modernization work that CMS was promoting in the last 10 years, I guess would probably be an apt way of putting it. So now we’ve got a new piece of legislation that’s passed that’s going to change some of that because it’s going to put new requirements and other things on the program. So I’m not talking about it from a political standpoint here, but from a technology Standpoint, what do you think will be some of the challenges of that as it gets rolled out over the next couple years?
00:45:13 Kumaresan
Yeah, it’s obviously a pretty large change and significant impact it will have on the coverage requirements, the work requirements and so on. And it definitely can result in the concern that everybody is worried about is the loss of coverage for some millions of people. But at the same time, I don’t know how many people are aware. I was just reading a recent stat that 10% of people eligible for Medicaid are not enrolled. And we. So while we can talk about what the law has done and how many people may end up losing because of work requirements, we need to do better on the people that are eligible to cover them first. Right.
And I think the eligibility vendors can definitely take a bigger focus on how do, how do I cover if I make sure that the these people are aware that they’re eligible and they are covered and how can states do more in outreach and education and make sure that we cover that? Right. I think there is this definitely, I think a lot of work, I think especially technology vendors that are focused on eligibility side of things can do in reducing the impact of the new law from a loss of coverage standpoint. Right now beyond that, I also think that there are some. The fund that has been set up to support rural hospitals, because I think that’s another big concern, right. That how that impacts people in rural areas and if we do, hopefully that gets implemented well, that can address some of the funding challenges a lot of rural hospitals face.
Even before this law. Right. Forget about after this law and that fund that has been set up, I don’t know whether that’s enough. There is a lot of opinions around how much fund is set up and how much is needed. But whatever is there, I think it’s very important to make sure that’s used to implement some of the technology related improvements in care, both access and a care that can be provided in rural areas, which has been kind of neglected for quite a long time.
00:47:34 Tony
And I think, I don’t know whether they’re intended to use it for this purpose. But one of the challenges has always been with the rural community is the broadband access and the access to technology that can help provide them with better care. And of course as we move to these larger AI models and how do you begin to use them to support rural health care? I mean, it will be interesting to see how much of this money is applied to that. Of course I wouldn’t like to see it applied all to technology because Then you’re just going to lose some of the other aspects that are needed to keep the lights on and the doors open.
00:48:13 Kumaresan
Absolutely.
00:48:14 Tony
Yeah.
00:48:15 Kumaresan
I couldn’t agree more.
00:48:17 Tony
But another area with that, and I don’t know what your thoughts are on that, it could also, this change may also help in terms of Medicaid fraud prevention because there’s always been an eligibility issue with Medicaid and if it’s used in the right way, it could help improve some of the areas around Medicaid eligibility issues and things of that sort, with hopefully not creating a impact that hurts rural health care or health care of any area that’s covered by Medicaid, whether it be in the urban areas or the rural areas.
00:48:55 Kumaresan
No, I definitely think so. And I think that’s an opportunity for all the Medicaid vendors that are focused in that space to make sure that we are able to improve, reduce the loss of coverage to people, but also improve the care that’s provided.
00:49:15 Tony
Okay. Yeah, I agree. So I think we’re getting closer to the end of the podcast. I just have a couple more questions to ask you. We spent some time talking about AI and how it’s, you know, beginning to change both on the clinical side and the business side. How are you beginning to use AI with your company? What have you been doing to kind of bring it into some of your services and products that you offer?
00:49:44 Kumaresan
Yeah, there are three ways we use AI in Genzeon, right. So number one is eat your own dog food. Right. So I’ve mandate that every single person in the company is understands AI. It’s good what it is not good, what to use it for, what not to use it for, has a good understanding. So we have a very aggressive program for everybody to train, learn everybody. And we also took all the policy documents and internal our knowledge systems and everything and, and we have put a, we call it Ask Jedi in in front of it and, and, and people can query it and get the information they need whether it is okay for HR policy or a finance policy, travel policy, whatever, all kinds of information you can just query and get the information. So I think all of that is in place. So that’s first is internal use. Right. So and get everybody aware and trained.
00:50:43 Tony
Right.
00:50:44 Kumaresan
Second is the services work that we do for our clients. Right. I mean Genzeon we take to market three platforms and three services and the three services are a Automation, data and digital. Right. Engineering services. That’s what we do. And we are using a. Across the board, right. Within that. Right. So for example, for a client recently there was a production outage and normally it might have taken three, four hours for somebody to analyze what happened and why it happened and where the issue is. Now we use AI to analyze production support problem, an outage and we can solve it in minutes, not hours. And that’s something that clients are appreciating.
And across the board we are seeing 20 to 30% productivity improvement of our software engineers and how software engineering is done across. So we call it A in engineering and that’s a big benefit to our clients and the same thing in data and testing, QA and so on across the board. So that’s on services. And the last is the three platforms I mentioned. We do take three platforms to market. A privacy automation platform, prior AUTH automation platform, as well as a patient engagement solution. Right. The three platforms we take to market and we are trying to infuse A in all of this and especially the prior AUTH automation with AI we are able to reduce the time that a nurse spends dealing with the prior auth by more than 30 to 40% in approving it. And that improves the clean.
I mean, as you know. No. None of the nurses went to college to sit and go through documents to prior author for claim review. Right. So anything that can improve their lives and speed up their work is something they are thankful for. Right. So we are infusing A in all of our platforms. Right. So those are the ways we are using A and we’ll continue to. We also, I mean the key thing that I constantly emphasize is the guardrails. Right. Using A is one thing, but it’s very important to have the right guardrails governance model to make sure it’s done the right way and has the right controls. That’s the part that keeps me up, if you may, to make sure that we don’t inadvertently use it in ways that are not productive. I think that’s the way you use AI.
00:53:11 Tony
Great. Yeah. We could spend a whole nother hour talking about that whole area. Maybe we’ll bring you back for another discussion on that because that is topic that’s near and dear to my heart as well. So just finishing off Alenko, when you’re not focused on trying to fix the healthcare system, what. What are some of the other interests and hobbies and things that you have?
00:53:35 Kumaresan
Yeah, so I, I’m a. I’m a bit of a history buff. I, I spent quite a bit of time learning history both. I do read a wide variety, whether it is Indian, Middle East, Europe, US and so on. To spend A lot of time I do that. I also like to watch streaming. I do stream quite a few shows, doc dramas to TV shows and others. And then occasionally I catch some sports. Especially tennis and cricket are two of my favorite sports that I do try to watch as often as I can. I know a lot of people in US may not be familiar with cricket, but cricket obviously, having grown up in India, is near and dear to my heart. And the World cup is coming next year to, to. To us.
00:54:23 Tony
Well, actually, cricket is becoming much more particularly, I think, because of a lot of Indian Americans and others who have interest in it and people who have financial backing. So we are starting to see that. I know here in my area they’re starting to see a lot more picking up cricket. So I think it may become one of the next, next major sports here in the US over the next number of years.
00:54:50 Kumaresan
That’d be cool.
00:54:51 Tony
Yeah, I think it’d be. I think it’d be great as well. Of course, baseball was supposedly descended from cricket in the first place.
00:55:00 Kumaresan
That’s right. That’s right.
00:55:03 Tony
So what if people want to find out more? We’ve talked about a lot, it’s been a great conversation. And are there any kind of newsletters or podcasts or other things that you go to, to kind of get up to speed and stay up to speed that we can offer the listeners?
00:55:23 Kumaresan
Yeah, I think there is actually a plethora of sources available for. I think today it’s a great number. I mean, first of all, I think CMS and the government themselves put out a lot of information, right. There’s so much available about what new regulation, why, how its impact. So there’s so much data that’s collected, reported and so on. I think that’s a, that’s a great place that I use. There are a lot of publications that like yours, right. Biztoc and many others. Right. That also available and whether it is modern healthcare, health, IT news talk, there is quite a few that is available. I think that people can use that to track key developments in healthcare. Third, I would say the associations, right. Whether it is Blue Cross, Blue Sheet association, ahip, aha, ama, I think all of them and I should be. And Kaiser, Kaiser Foundation.
KFF is quite insightful and they put out a tremendous amount of data that I think there’s probably not a week that goes by that I don’t come across something from kff. Right. So I think that’s a third source especially I think for people to use and then for macro trends and technology trends. In healthcare. I think it’s also good to follow some of the analysts. Right. Whether it is Gartner or Everest especially. And I also, sometimes I also think the strategy consultants. Right. I think like McKinsey and Deloitte put out a lot of macro trends and technology and how it impacts the industry, especially if you want to understand big picture, I think that’s quite helpful as well. So I think these are some of the things that I would say are available that. And of course, last but not the least is podcasts like this. That is, there is a lot of podcasts.
00:57:27 Tony
Yes.
00:57:28 Kumaresan
I listen to podcasts from some of the CIOs, especially a lot of hospital CIOs and payer CIOs and others. I recently listened to a podcast about EPIC and its history and I learned so much I, I didn’t know and I think so those are another great way and fun way to, to, to learn it, both about healthcare and health, history of healthcare in the U.S. right. I think it’s, it’s very fascinating and, and you learn a lot doing that as well, right? You are running or walking. Yeah. Listen to a podcast as you do.
00:58:02 Tony
Right? Right, I do. I, I do the same thing. No, I, I think you, you’re probably the first person I’ve interviewed who’s hit some of the major ones that I subscribe to. The KFF stuff. The, you know, Kaiser Family foundation has amazing amounts and as you mentioned, some of the other major groups like the cmss and, and I do, I listen to, I do the same thing. I listen to podcasts more than I listened to anything else at this point. But there’s so many of them and the richness of what they provide is fascinating. How you can get all this great information as well as the major consultant, the KPMG, McKinsey, Deloitte and others, they publish a lot of great macro trends information that’s very invaluable. I, I agree with you. It’s, it’s, it’s not a matter of enough information. It’s a matter of curating through all that and, and being able to have the time to do it.
00:59:05 Kumaresan
Absolutely.
00:59:06 Tony
Okay, we’re going to close here with just a couple real quick things. These are like one minute answers. So Alenka, what do you, what is your, what’s the best thing you think that’s happened to healthcare in the last 10 years?
00:59:22 Kumaresan
I think access to healthcare has significantly improved. I think, I think it’s one of the best things that have happened in the last 10 years. I’m quite glad about that. I think, I mean we all can do more, but I think I’ve been in the US now for more than 25 years and I have seen that change and that I think is very gratifying and I think that’s something we got to continue on. I would say is the best thing that has happened. Adoption of technology has contributed to it, but I think that also is another gratifying thing. I know you only asked for one thing, but I’ll throw in that adoption of technology as well.
01:00:03 Tony
So what’s your biggest disappointment over the last 10 years that you’ve with health in the healthcare space?
01:00:11 Kumaresan
More than. I don’t want to call it a disappointment, Tony. I think I would say it’s an area of opportunity. I’ll just put it that way. That we can do more is the area we spent some time early in this conversation on bending the cost curve and the effectiveness of how we deliver healthcare in the U.S. i think if we can focus on that in some of the points that we talked about, lower the regulatory burden in terms of how care is accessed and I know there is concern about people hurting themselves but at the same time you can overdo the defensive nature of it and, and I think so improving the, focusing on the overall cost, supply side and demand side with the ideas that we talked about and doing more of that I think because at the end of the day I think it becomes a very big political issue because of the cost involved. That’s why it becomes a big political issue. If you can, if, if you make it less expensive there can be plenty and everybody can have healthcare.
I mean give an example. My sister in law in Australia and, and people think that your public sector healthcare is a, is a, is a, is a silver bullet and this example will teach. It’s not. She spent three months trying to, she dislocated her shoulder. It took three months to get, get the right care to the surgeon and waiting and other things and finally she got sick of it and she traveled to India and diagnosis, the treatment, it was all done in two weeks and, and she could recover from there and I, I was shocked. Right. And, and for less than 1/10 of the cost. I mean so I, it’s so other countries are, are finding solutions and, and progressing and we need to do the same and, and I think if we can do something more on the cost of care and the effectiveness of care, access to care, I think this problem can be solved. And I’m hoping all the ingredients, all the forces are aligning to move the ball in that direction.
01:02:28 Tony
Great. Great. Well, thank you, Alenka, for a great conversation and look forward to talking to you again.
01:02:37 Kumaresan
Thank you, Tony. I appreciate your time and I enjoyed this. Thank you very much.
