Breaking Health

As a former Partner at Deloitte, Rajeev Ronanki established and led Deloitte's Life Sciences and Healthcare Advanced Analytics, Artificial Intelligence, and Innovation practices. He then was offered a chance to join Anthem and lead their transformation to becoming a digital-first enterprise. Rajeev viewed this a great opportunity to help transform healthcare, so he accepted the position. How did he start to tackle this challenge and develop a vision for this insurance giant? First, by simply defining what “digital” meant within Anthem. Once aligned on that, he was able to start implementing automation of core business practices and developing an application to engage consumers in a more personalized manner. Then, the real value came. Leveraging over 10 million users on their digital platform, Anthem was able to improve their app based on user feedback collected on the platform (they tested an average of 180 user experiences per day!). More impactfully though, the group could start deriving real healthcare insights. Tune into this episode to learn more about Anthem’s new digital-first approach, as host Steve Krupa chats with Rajeev on the company’s digital revolution, its partnerships with startups and investors, the opportunity for more upfront diagnosis, and even Rajeev’s thoughts on blockchain’s utility in healthcare.Rajeev Ronanki serves as Chief Digital Officer at Anthem, Inc. He is leading the transformation of Anthem to become a digital/AI-first enterprise through driving the vision, strategy, and execution of Anthem’s Digital, Artificial Intelligence (AI), Exponential Technology, Service Experience, and Innovation portfolios. Through these efforts, Mr. Ronanki is enabling Anthem to harness the power of AI and data to better understand healthcare consumers and provide tailored, personalized care. His experience spans over 20 years of innovation-driven industry and social change across healthcare and technology.  

Having been both an operator and an investor in the healthcare industry, Fay Rotenberg knows the challenges and silos all too well. She was encouraged when she first met the co-founders of Firefly Health though. Initially, she had agreed to meet with them 1 day per week, then that grew to 2 days per week, then 3, and before she knew it, she joined the company as President and CEO about 3 years ago. Firefly is striving to shift healthcare from episodic to continuous care. They are a virtual-first clinical network consisting of primary care, behavioral health, and specialty care, all accessible via a world-class navigation platform. Think of Firefly as a mini and virtual Kaiser, as they are now also expanding into full benefit models for employers. By reducing costs and improving outcomes, they have begun to achieve concierge medicine at scale. Patients interact with their platform an average of 41 times per year and receive a response within 5 minutes, while doctors also love being part of their team-based care approach, as it allows them to focus on tasks that are most value added for them. Tune into this episode to learn more about Firefly Health, as host Steve Krupa chats with Fay on the company’s mission to provide half priced health care that is twice as good, its start with insurers as original customers (now somewhat competitors), its growth to over 50 employees, and its future including developing a health plan replacement for employers.

In his final rotation at Harvard Medical School, Andrew was baffled by how many patients were googling their symptoms to make decisions about whether to seek care. Things became personal though when his own father hesitated and waited too long to seek medical attention while experiencing a mini stroke (thankfully he survived). Andrew became convinced that there had to be a way to reduce the effort and hesitancy deterring potential patients from engaging with healthcare professionals. So, he took three years off from medical school and co-founded Buoy Health. The goal was to develop an AI chatbot that could help people answer the simple question: “When do I need to go to the doctor?” Built upon manual review of thousands of medical articles and incorporated user feedback, Buoy quickly became a truly machine-learned algorithm that could not only account for medical best practices but also user demographics. Today, buoy.com services over 30 million people, including being the official COVID-19 screening tool for both Massachusetts and Virginia. The company has also developed a “Back with Care” feature to help employees return to work and is about to release a vaccination module as well. Tune into this episode to learn more about Buoy Health, plus hear host Steve Krupa chat with Andrew on his transition from medical student to entrepreneur, what he wished he knew before starting the business, and Andrew’s vision for the company’s future.

Having started working in the healthcare space directly after graduating, Bryan quickly learned the ins and outs of health insurers, broker distribution, and self-insurers. After a decade in the industry, Bryan decided to pivot to a much smaller company and became both the CEO and just the 3rd employee at RxBenefits in 2005. He then realized the opportunity to help smaller, self-insured companies handle their pharmacy benefits by carving those out. RxBenefits developed a platform connected directly to the major Pharmacy Benefit Manager systems, which enabled them to directly and cost-effectively ingest claims and operate as an apparent larger entity. This approach helped them deliver mid-market employers an average direct pharmacy savings of 27% and an indirect clinical savings of 10% per year. Hear host Steve Krupa chat with Bryan on his transition to a much smaller company, how RxBenefits has leveraged their niche in pharmacy benefits for mid-sized companies, and Bryan’s vision for the company’s future

While working as a graduate student intern for a clinical documentation company, Jeff discovered his passion for the healthcare industry. He stayed there for 10 years and benefited from strong mentoring and development opportunities before seeing the company through its exit. Fast-forward 6 years- after another successful exit as a senior manager at a different business- Jeff was introduced to the concept of payment integrity and started ClarisHealth to help solve challenges in this area. Having grown from 3 to over 140 employees, Jeff sees ClarisHealth’s focus as helping plans tackle their entire payment integrity continuum (post-pay to pre-pay) with a longer-term vision of increasing payer-to-provider transparency. ClarisHealth’s Pareo platform is a multi-module SaS solution that helps health plans and payers grow recoveries from 1% to 7% or more. Hear host Steve Krupa chat with Jeff on his decision to start the business and how it has benefited both payers and providers.

Starting out as a minor league baseball broadcaster, Ben Albert realized he was better at the business side of his role than the on-air aspect. He then landed at a healthcare consulting company and became hooked on healthcare- so many silos and opportunities for automation! After a successful exit at the helm of Care Team Connect, Ben decided to start and lead Upfront Healthcare to help patients navigate the unending waters of their medical journeys. By applying analytics to scheduling, billing, and operational data to develop each patients’ profile, the company can direct patients through an app-less experience to their next right service, which can be booked right then. Not only do patients enjoy this much easier experience, but providers benefit from the improved revenue profile for each patient and reduced administrative overhead. Listen to host Steve Krupa chat with Ben on how he progressed from deciding if he should start the business to now running a company servicing over 1 million patients in less than five years.

Host Steve Krupa chats with Aver CEO Bill Nordmark about Bill’s career in the healthcare payer and reimbursement space, including his decision to take over the reins at Aver. Hear Bill share helpful insights on retrospective vs. prospective payment systems and how he is leading Aver on the quest to increase quality of care while reducing costs by helping payers expand and bundle payment programs.

Steve sits down with Zipari Founder and CEO, Mark Nathan to discuss how his career set him up for entrepreneurship, as well as the motivation and inspiration for starting a health insurance consumer experience platform. Mark shares the challenges associated with taking a homegrown business technology and creating generally available software and gives his best advice for entrepreneurs starting a company. 

Greg discusses his early days as a professional musician and shows how creativity and problem-solving helped transition his career into software development, and led him to working in healthcare, helping providers and patients by innovating payment data. He discusses developing new, data-enabled products and using advancements in tech to expand a company footprint.  

No fan of traditional PBMs, Steve Krupa talks with Jake Frenz, founder and CEO of SmithRx, creator of a new tech-based PBM player.