As part of my series “The Future of Healthcare” I’ve had the pleasure of interviewing Rushil Desai, Vice President of Provider Strategy and Performance Outcomes at IlliniCare Health
IlliniCare Health is a subsidiary of Centene Corporate, one of the major Medicaid and Medicare insurance payer groups across the US. And it’s interesting because, in my current role, I get to tackle some fun questions. Where are the opportunities for us to grow strategically? How do we work better with our providers? How do we use analytics and data and capabilities of our plan to help providers progress?
We are disrupting the previous payer-provider relationship dynamic. Rather than payers and providers acting from opposite ends of the table, we are identifying synergies to bridge that gap, and looking to find new dynamics and playing fields where we are looking at the goal as a team.
Data is the currency in our realm right now. As we grow as an industry and an organization, data will become essential in how we progress. I believe the transparency of data is key to how we have been successful in working with our providers. That free flow of information between providers and payers leads to building centers of excellence. We provide clear transparency from finances, to the regimen, to expense, to the predictive side of things. That trust is crucial.
Right now, we are focused heavily on predictive analytics and machine learning in population health. For example, out of a 400,000 member population, we know that roughly 5% of that population will drive 50% of the overall expenses. So, with that data, we focus on the most acute membership, the members that we are unable to reach and the ones that providers need to be aware of. Together, providers and payers goals are aligned, trust is built, and we build an integrated system. And a key to creating that system is a transparent sharing of data and analytics.
A potential drawback is that as an industry, we still do not have a complete picture. It’s very segmented. Payers work off of claims data, which has a lag. Providers work off of EMR access. Right now, we do not have the two sources of data integration, and because it is not cohesive, we do not yet have a complete grasp of the full picture of the member.
And although there is a lot of new technology coming out to help solve this problem, such as the Apple Watch, personalized health and digital health, the integration between payers, providers and patients is still a challenge.
I think it’s going to take a bit of time for us to get to that perfect integration, where the data cycle from patient to provider to the payer is collected in one place. We are just hitting the surface, and we’re not quite there yet.
What brought you to this career path?
My past is a little unconventional. I’ve wanted to be a physician all my life, and I went to the University of Miami for undergrad. At Miami, I majored in neuroscience and shortly obtained my master’s in Biomedical Science and Healthcare Administration at Rosalind Franklin University’s Chicago Medical School. A year after that, I attended medical school for three years.
In my third year, I became heavily involved with the leadership side of the school but started having a combination of burnout and reevaluation of my career path. I wasn’t sure if I wanted to continue to be a physician.
I ended up taking some time off, worked at the University of Chicago Hospital, then attended Duke University Fuqua School of Business. During my MBA, I was the Senior Principal and Healthcare Lead of the Improving Health & Outcomes Practice at Trexin Consulting, and gained exposure to a variety of payers and providers and challenges that healthcare is facing, such as managing the cost of care, large scale transformation, , moving towards value-based care, and clinical program redesign from strategy to execution
Looking back, it was essential to have that consulting experience and be able to focus on a lot of different techniques to manage cost of care and integrate the financial side with the clinical side of healthcare. We tackled questions such as how do providers and payers collaborate together? Where are the opportunities to address the social determinants of health to focus on the most acute patients through population health analytics?
What do you believe in?
As I think through the choices I’ve made in life, I keep going back to the idea of balance. I’m always struggling to find that balance. I think it’s imperative to continually reevaluate your life to figure out the balance between your personal and work life, the things that make you happen, and the things that are continually changing.
Another foundational philosophy I believe in is to hire people who are committed to changing the world through an entrepreneurial spirit . I like to hire people who may not have a healthcare education or background. People can learn the healthcare side, but bringing out the strength to move teams toward a common purpose leads to success. Managed care is new, and I’m learning things daily. But people who come from outside industries bring valuable diversity and thought. In my current team, I have folks with analytical knowledge, learning skills, and finance strategy background. Adapting to dynamic business
Outside of your team, it’s vital to surround yourself with people who constantly challenge and push you and help you grow. I think that solutions in healthcare are integrated. It’s not a siloed approach, and you have to learn from all different elements—from contracting to networking to quality to medical management to finance. You have to learn all of it and be able to fit the pieces together.
How do we future proof our career in healthcare?
We are experiencing a lot of merger and acquisitions in healthcare. You have big mergers like CVS and Aetna. We are mixing pharmacy benefit managers, and we see hospitals mixing with payers. We are trying to figure out what the best blend is, and I think the reason why the healthcare industry is changing so much daily is that we haven’t quite figured out the best mix yet.
So, going back to your question, the critical success is having an open mind, having the data competencies, and never losing sight of empathy for our members or patients. Strong interpersonal skills and diverse perspectives and problem solving is key. You have to be agile and find solutions quickly.
Everyone in this industry is trying to make a difference one way or another. We are trying to find the best solutions in the confines of our geopolitical climate and the guard rails of the models that currently exist.