Building health plans for the new consumer

This is the 1st blog of a 3-part series “The CIO’s Role in Digital Transformation”

An interview with John Santelli, Chief Information Officer, UnitedHealth Group and Executive Vice President, Optum Technology

John Santelli HeadshotAs costs shift to consumers, the demand for retail-like convenience, price transparency and digital tools grows. Today’s health care CIOs have a powerful opportunity to move the health system forward by guiding the modernization of the digital ecosystem.

In the first of a three-part series “The CIO’s Role in Digital Transformation,” Optum CIO John Santelli brings experience and perspective to the challenges of shifting from a B-to-B to a consumer-centric business model.  In a world where consumers want quality and convenience, payers need to use data differently and deliver information the way consumers like it.

Q. What does the payer need to do to get closer to consumers?

Santelli: The gap between payers and consumers is greater than many payers realize. To be truly consumer-centric, payers who are going to cross the chasm will need to:

– Design for consumers rather than plan sponsors

– Proactively use and connect data to give consumers a holistic view

– Improve consumer engagement with digital technology

Let’s take the last one first: In the current payer-to-employer world, so much of the experience of health insurance products is controlled by plan sponsors, rather than consumers. The employer selects plans for its employees based on cost management, plan quality and effectiveness. This makes them another gatekeeper of plan benefits — despite the fact that the product is consumed (and largely paid for) by employees.  The logistics the member must navigate between employer, plan and network providers are complicated, confusing and often disconnected.

Meanwhile, in the real world — which grows more digital by the minute — consumers define quality in terms of convenience. Yet, even the simplest things, like access to their own health records (regardless of employer or payer) and certainty of their financial obligation are extremely limited with legacy payer systems. And if they leave their company or the plan, consumers will have to re-establish a new “member identity.” None of these demonstrate that payers have prioritized consumers.

Q. How can the CIO use technology to connect to consumers?

Santelli: Payers have a lot of data about their customers that could be used to understand issue management and common service issues. New technologies such as recommendation engines, machine learning, analytics and artificial intelligence (AI)  have the potential of delivering strong, relevant insights about consumers that can be used proactively to build better relationships.

There’s gold in that data that will help payers see patterns in the administrative interactions with members — and find ways to build stronger engagement directly and digitally with consumers. Are there HSA questions we can address before members call? Are there clinical insights that would help the payer address treatment protocols or affect better health habits? The answer is yes.

Q. Is the CIO’s role to enable business strategy or drive it?

Santelli: I think CIOs are playing a new converged leadership role in the payer organization. Payers are waking up to the value of their data and looking for solutions to help them mine it. It’s up to the CIO to bridge the knowledge gaps and educate the leadership team on what’s possible — particularly with cloud technology. The shift from legacy systems, where data is held captive, to the modern compute of big data platforms is dramatic. The CIO has to build the confidence of stakeholders in both the benefits of a scalable, single platform and its ability to meet strategic goals.

Q. What’s the modern CIO’s biggest opportunity?

Santelli: Forward-thinking CIOs are freeing their data from isolated back-end systems to next-generation platforms — much like successful retail organizations. They’re taking a page out of the “search engine” mentality where billions and billions of rows of data can be searched in milliseconds. Open source systems have broken the barrier on being horizontally scalable — meaning they span compute to many, many blades, reduce the result set and return it in a ridiculously short time frame.

These big-data platforms can process unstructured data like open text, voice recordings, images, information streaming from consumer devices — even faxes. Application programming interfaces (APIs) enable many applications to consume data. It’s a very modern, very powerful and ultimately a cost-savings approach to reuse data and create consistency of data across all apps as data is externalized.

Q. Where are the pitfalls in a CIO-driven transformation?

Santelli: The kind of change payer organizations are undergoing is more difficult than combining disparate systems. When I came to UnitedHealthcare in 2004, we had 48 claims systems. It was just a complete disaster. Today, many mid-sized payers have advanced to one system — an ERP that runs their whole business. And it scares them to death to think they can sweep it out in lieu of a “modern” platform.

But as market dynamics change, products get to the market faster, and auto adjudication reaches incredibly high rates, plans will not be able to afford outages of legacy platforms. It’s up to the CIO to articulate the map to modernization: its value against the competition, and its value to consumers, who are hungry for a consumer-centric, digital orientation.

The second blog in this series offers a practical approach to aligning stakeholders in the payer organization by beginning with a use case.

Learn more about the trends and technologies shaping the health care industry

Catch up on all the blogs in “The CIO’s Role in Digital Transformation” series


More about John Santelli: 
Chief Information Officer, UnitedHealth Group
Executive Vice President, Optum Technology

John leads Optum Technology, which serves the broad customer base of Optum and UnitedHealthcare. John also serves as UnitedHealth Group’s chief information officer where he is responsible for technology strategy and delivery across the enterprise. John joined UnitedHealth Group in 1986 and has extensive experience in software engineering and application development. He has served as CIO since 2007 and is credited for leading enterprise architecture and foundational technology capabilities within UnitedHealth Group.

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