Hi, everyone. This is Brian Zimmerman with Becker's HealthCare. For today's podcast, I'm excited to be joined by Nirne Patel, EVP and GM Benefits One, chief digital officer for Simplify Healthcare. Thank you so much for joining us today. Thank you, Brian. Thank you for having having having me here. Alright. Nunez, so let's get started with a simple introduction. Why don't you share a few details about your background and the work you're doing? Yeah. Of course.
So I get excited at the intersection of healthcare and technology. I've been in healthcare space for about fifteen years and then in in tech for pretty much all of my career. At Simplify, we are solving two problem areas, benefits the problem of benefits management from an end to end value proposition for payers and the problem of provider data management. So these are the two areas we focus on, and, we have an incredible set of capabilities and customers which,
solve these problems across different markets. So we specialize in how do we solve this for Medicare, Medicaid, commercial, and all the markets, involved. Yeah. And that that that data management challenge, I'm sure can create some silos Yeah. From from time to time. So I guess from your point of view, how are payers are doing this really well? How are they breaking down operational silos between the insure between insurance and and and care delivery?
Yeah. No. I think I think that's a that's a great question. You know, at at a at a very macro level, the way we see it is there are two aspects of of care. There is there is what I call it design of care, and then there is delivery of care. And I think, where most successful payers and even paywiders, right, are increasingly going towards is how can we
bridge that gap? Because at the end of the day, the continuum of care for a member, would require these two areas, right, to be highly integrated. So for example, when you're designing the care, you will be looking for what are some of the shared risk models from a delivery of care you would like to incentivize the member.
So designing of the care would mean what are your strategies with respect to your network, are there vertical integration option if you are taking shared risk and capitation models, what kind of member experience you wanna deliver before you onboard the member, and what kind of personalization, right, you want to deliver after you onboard the members, in particular, during their their care delivery process. So when we look at these silos, there
are common denominators. Right? Benefits is a common denominator. You would want to know when you're shopping for your insurance plan, how much it's gonna cost. And you would want to know the same question when you're actually in the middle of a care episode. So benefit is one kind of data layer, which we believe is a common denominator, which kinda threads the needle between designing the care
and delivery of the care. The last thing you want is to create a fragmented data source for such an important layer, which is where which is the problem we are trying to solve. We enable a source of truth for benefits so that all different stakeholders from actuary to product design development, to your customer service, to your claims team, to the to the care delivery providers who need access to those benefits, they all are essentially getting a consistent view of benefits because it's sourced
from the same source of truth. So those are some of the value propositions we bring to the table. And, essentially, you kind of break down the silos by building an integrated layer across the continuum of care. Yeah. And that that that tie in or that bridge, so to speak, is that the benefits information serve serving as, like, sort of that bridge, like you said, between design of care, delivery of care. And, of course, you know, we're we're talking about health care in 2025.
So I gotta ask you what role sort of when doing that work with with benefits, and shaping that member experience as you put it, what role is AI and analytics playing in helping make this a connected experience from, you know, benefit navigation to the proactive care that that I believe, you know, all of the the the idea here is to get to a place like that where there's more proactive care? Yeah. Yeah. Yeah. Well, you know, we are in this incredible wave of AI,
here at Becker's. Right? It's hard to even walk 10 steps without not hearing AI. True. Yep. So it's it's very exciting. We we have taken the mandate of applied AI at on two fronts. The first one is how can we make access to knowledge easier? And that becomes more along the lines of how can we personalize what's important on the benefits level. So we recently launched, an AI assistant feature to benefits one platform. We call it
Benny, which is Benefits Native Intelligence. And, essentially, the the mandate for Benny is how can we make sure that, you have access to all different kinds of benefits information we house within our platform almost in a natural language manner. So things like, hey. I'm gonna go and about to have a broken bone injury. What it might cost me? Now to answer that question, today, you may be on the phone with a customer service
rep. Right? And and and and and you will be dealing with calls or multiple, checkpoints where you would try to get that information. Benny would make it easier because we would source it directly from where the care was designed again. So this is a perfect example where the delivery of care and design of care are kinda eating from the same bucket. Mhmm. And that just allows, that removes the human error. It removes the
silos. It it takes the friction and the rate limiters away, and it gets you to the source of information and the knowledge as fast as possible, as natural as possible. So that's one use case of AI where we can deliver a lot more personalized experience on the frontline, by just limiting the distance from the source of truth. Yeah. The second one will be on more on the back office side where you would want to do a lot more automation.
So, for example, if you would want to match your member benefits, right, with incoming data sources, you would want to automate the end to end workflows using an agentic layer to to take care of your back office functions. As it comes to benefits and provider, those are the areas which we are also looking at. So you can you can you can talk to Benny in future, right, and say, hey. I would like to renew this plan for next plan year.
Show me, right, what are some of the plan recommendations I should be making as I look into design of care for next year. Now when you actually have that level of sophistication, you will be able to create and compile and design a plan. So your starting point of taking that process is incredibly sophisticated, and that would mean that you would save a lot of time, cost, and you can spend more time, right, designing the care versus dealing with, a lot more manual processes which exist today.
Yeah. When I when I come back to sort of sort of Benny and thinking about that that sort of, that sort of capability, I think it's come up being on-site at at Becker's Parachute's roundtable come up a lot. Like, the the demand for such a tool is high, and the need for it for members is high. When you think about how complex insurance can be to to the average member, being able to cut through the noise, not have to be on hold to have a
direct answer. I mean, are am I reading that correctly just from the rooms I've been in during the conference? Yeah. Absolutely. You know, we we have multiple solution options that simplify Benny. It essentially solves the problem of, exposing benefits information to all all of the product design, actuary, right, document management, compliance, a lot of the stakeholders which we have. We also have benefit inquiry solution, which empowers the day in the life of a customer service and the member.
So again, it's all the same source of truth information. The demand is high because, as we both know, Brian, it's a it's a team sport. The moment you are about to embark upon an episode of care, you are talking you're you're talking to at least interact with anywhere between 18 to 25 people, and that's the simplest form of care. Mhmm. And as you are interacting and as your as your care delivery needs gets more complicated, you will just have more stake Right? You not only have doctors, but you
have to you have to schedule appointments. You have to talk to insurance companies on how much you are going to pay for it. If you are prescribed, let's say, you know, pharmacy, now you have pharmacist. So now you will go back to your formularies and understand, hey. What what is this drug
type? Tier one, tier two, tier three. So, again, this pendulum kinda keeps swinging between who designed the care, which is more along the lines of payers and who is delivering the care, which is more on the providers and pharmacy. But as a member, I would be talking to both of these because I'm trying to take care of the episode of care, right, for myself.
So we see an incredible demand here of kind of bridging this gap because at the end of the day, one common goal across both of these entities is how can we improve the life of a member and how can we make sure that they are delivering and meeting the outcomes, right, the healthy outcomes we all intend for. Yeah. And and speaking about that, I think what you just, what you just shared kinda gets at this, but to zero and even closer, but maybe
a a a finer point on it. What are the most important moments that shape a member's perception of of the benefits they're getting of of the value from their plan? Yeah. I think, it's it's almost like the perception of the member is so intertwined with the market or the care access channel, which they're coming from. And what I meant for the moments that matter for a Medicare member will be different than a Medicaid member, which will be different
from a commercial member. If you look at Medicare member, for example, every year they have an opportunity to shop. Right. And that would mean that, every year there is just an extremely hyper focus on access to care, experience to care, because you would want, like, anywhere from onboarding and retaining a member all the way to making sure that, you know, their care needs are met. And a Medicare member in an urban Chicago versus Medicare member in a rural Chicago, rural Illinois. Right?
Could be very, very different need. Right? So, so I think moments that matter for a Medicare member would be how good is your broker network system, which can educate the member, how aware you are with their current care needs, and how accessible that care is. And the problem for Medicaid would be completely different. What are the social determinants? They are much more amplified, right, for Medicaid. Versus with commercial, you're talking about, hey, what
employer are we talking about? What kind of benefits is that employer subscribed to? So I think that the moments that matter for the member are onboarding and educating the member. I think that is a common theme there across all markets. Customer service becomes an important one, and then access to care and provider experience becomes an important one. So across all three markets, those are the common denominators. But there are so many nuances as you
can imagine. Onboarding a Medicare member would be very, very different than onboarding a commercial member. So the devil is really in the details. You know, one may think that, yes, these are the areas we want to improve and kinda get more sophisticated on. But the playbook for each one of these market is extremely nuanced and different. And I think those are the areas, right, which we essentially offer a lot more value for our customers.
In considering everything we've we've we've talked about so far, Nirneh, what do you believe should be on the top of the innovation agenda this year for payers? Yeah. I think, I think it's it's really enabling more integrated, connected journey for the members and and your internal stakeholders alike.
So, personalization of benefits, which allows to meet more competitive needs in the marketplace, much more member facing needs in the marketplace, partnerships with providers and different entities, especially on value based and other shared risk arrangement that kinda start shifting the the output to the outcomes conversation. So we're excited about that trend line. Mhmm.
But at a at a macro level, we believe that the more bridging the silos happen between design and the delivery of the care, I think that's kind of the shared space, right, where it's a win win win. And when I say win win win, and there are three stakeholders here, there's member, there is holders here, there's member, there's peer, and provider. So how can we get these three wins? And it's really founded in how well we can integrate the delivery of the care and design of the care.
AI is making a lot more lot more of these use cases much more easier, faster, and more accessible. We, we have use cases like how can we do how can we recommend plan for a particular member or a particular market. Right? So your your journey of onboarding a member becomes a lot more smarter knowing what was the delivery of care formula, right, which worked for that member. So with all the data available between peers and provider, some of these use cases on enabling a
connected journey becomes much more easier. And those are the value propositions we bring to the table at Simplify. Yeah. And can we talk about I think that's that's,
an important point. Maybe we can go even deeper for for our final question here, which is really about, you know, they're either payers are gonna have to partner, obviously, here or they're gonna have to to to build solutions of their own to sort of get to this future state, fill this need that members have, and, you know, the the payers that do this are gonna be the ones that thrive in the
future. So I guess the final question is, what should they be looking for in partners, or what kind of capability should be looking for as they go to build their own, so that they can get to this future state of a more connected future for for members? Yeah. No. I think that's a great that that's a great question. So it's almost like, you know, there are two constraints, which which which we see. The the first one is really invest and improve upon personalizing your experience for your members.
And on the other end, there is an incredible pressure of doing that at scale without adding a lot more cost. And if you look at these two constraints, right, it's inevitable for you to not leverage platforms. And what platforms bring to the table, what platform thinking brings to the table, the technology which comes into picture here is it can kinda allow you to kill both
birds with same stone. Right? So on the on the front line and on your digital front doors, it can enable a personalized experience for the member because it's using the data to have a much more integrated story, more accessible story for your members. And, for your back office teams, it brings
incredible automations. So your manual silos goes away, which is exactly where a lot more admin savings and cost and a lot more exhaustion, frankly speaking, because there are highly regulated environments, which has timelines, which are high pressure. And there's just a lot of customers try to kinda endure that. So having a platform which allows you to improve, on personalizing for your members at scale, at the same time not adding more cost.
Like, we have a story with, our customer where they improved their NPS score by 12 points without really adding, you know, any person on their employee staff. Now it cannot be possible because as you grow in, in geographically in more markets, as you add on more members, if you're not adding more admin cost, it it's a litmus test, right, on how the degree of automation and sophistication you have in your operating protocols. Those are the areas which we we think are going to be important for,
for journey onwards. Yeah. Appreciate that that sort of, it it's very easy to conceptualize the way you put it in terms of this becomes a litmus test in terms of how effective the technology is being. And, Nirne, it was a pleasure speaking with you today. Thank you so much for coming on the podcast. Yeah. Sounds good. Likewise, thank you so much, and, have a nice day. Yeah. Absolutely. I also wanna thank Simplify Healthcare for sponsoring today's podcast.
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