HealthWorksAI: Enabling AI Driven Innovation in Healthcare Insurance

Spotlight on AI |

Focusing its efforts in the data analytics space, HealthWorksAI is driving a lot of innovation with the help of its unique offerings for the healthcare insurance segment. The company has been working on solving complex problems in the healthcare insurance business with the help of next generation AI innovations.

Arvind Nagpal, CEO HealthWorksAI speaks with Zia Askari from about the company’s current focus and its future plans.

As data has become a crucial part with the coming of new-age technologies like AI-ML, what are some ways HealthWorksAI is exploiting these technologies?

As a data analytics firm, we’ve been working on some complex problems in the healthcare insurance business that utilise the next generation of AI, known as xAI (Explainable Artificial Intelligence), which can explain the “Why” behind model outcomes. For example, if I predict that Patient X will be readmitted to the hospital within the next 10 days, the black-box models are fairly accurate in predicting the outcome but they are unable to explain why this patient will end up in the hospital. This is where xAI provides the solutions to pin point if it the care available at home, or it is the adherence to medication or something else. This allows the insurance companies and health care providers to provide interventions that reduce the chances of readmission.

As the industry is evolving, many new ways for the adoption of AI and other new-age tech will be explored and one needs to be decisive enough regarding the selection of data and quickly respond to the dynamic changes coming in the industry.

India has become a talent hub for the IT sector.  What are your future plans regarding hiring fresh talents from India?

As the businesses are expecting a sharp rise in the adoption of new-age technologies, we as a data analytics company too are expanding in terms of our talent base. In India, hundreds of students are passing out from engineering and science colleges. This talent will be the key differentiator and will play a crucial role in shaping up the company’s workforce and the digital economy of the country with emerging solutions based on AI and machine learning.

We are actively looking for fresh and experienced talent and looking to double our employee base in India in the next two years. With stronger HealthWorksAI offerings, we are building our team on the back of its unique developmental programs for employees like genie awards, open leave policy, multiple opportunities for promotions each year including self-nominations, weeklong work retreats like a portable office and more fostering entrepreneur spirit among its millennial work force.

What are the skills sets you are looking for, with the likings of engineering pass-outs?

Our products are built at the intersection of business, math, and technology. While it is understandable that we will teach the business side, we expect that candidates to have excellent command over applied maths, as that’s the foundational science for our solutions. We have bias towards high achievers in math Olympiad tests. In addition, strong logical thinking and programming skills complete the third key skill. We are tool agnostic so focus is on hacker mindset. We look for coders who write efficient code quickly without taking on technical debt

Be it the health sector or real estate, new-age tech is being adopted everywhere. How do you think the entire ecosystem would change with these future technologies?

The healthcare industry generates a lot of data but turning it into insights that improve patient outcomes and operational efficiency is a perpetual challenge. Artificial Intelligence (AI) and Machine language (ML) are being widely adopted to arrive at more meaningful insights that have the potential to drive better ROI and solutions to the age-old problems. With new technologies, the ability to deliver better health outcomes has gone up significantly. Only 35% of the health outcome of a patient is based on medical care and procedures. Rest 65% comes from everything else surrounding the patient which is popularly known as SDOH (Social Determinants of Health). SDOH interventions can create a significant uptick and AI/ML-based solutions are being deployed to get a 360-degree view of drivers of a patient’s health.

Since we have our customers based in the US and largely healthcare companies, we are seeing growing adoption of new-age technologies for not just clinical diagnostics but many other functions surrounding the clinical care such as care management, benefit design, and member engagement. Patient is no longer a receiver of diagnostic and prescription but an active participant in the care planning and management

Technology plays an important role in the upliftment of any sector, be it real estate or health. Data is present in abundance quantity; we need to find innovative and efficient ways to make the data useful. By leveraging cloud computing (CC), solution providers are creating new dimensions for healthcare innovations benefitting healthcare professionals to increase their output but also patients in availing services in a transparent manner. The beneficiary calling the shots is imminent….no pun intended.

What are your views regarding major technological advancements happening in the US Medicare Advantage market?

US Medicare Advantage(MA) is a unique healthcare program that is funded by the federal government and managed by private insurance companies also called Payers or Health Plans. MAHealth plans have always been big outsourcers of services and solutions to get the best of what’s available. A solution provider whose focus is inch wide and mile deep will always have an edge over providers that are “All things to All health plans”

Digital Technology adoption in every aspect of the business especially member engagement. Digital strategies to inform, acquire, and engage members have been a key focus area which accelerated with the pandemic. Mobile apps and tools and Telehealth which were on the back burner suddenly became the go to channel and has now become mainstream with rural population which always struggled with access to care.

MA data is public data and hence competitive intelligence and positioning is another area that is used by Health Plans to anticipate the changes in the market by competitors and position their products to gain unfair market share. These strategies are powered by new age technologies of AI/ML.

Benefit Designs is at the heart of what beneficiaries are buying as part of their health insurance. A poor design can lead to adverse selection and ultimately cause distress to the health plan and the beneficiaries, This complex balancing act of the richness of benefit design and the type of benefit design plays an important part in the downstream impact on beneficiaries health outcomes and profitability for health plans. AI/ML is the technology of choice as the data is huge and teasing out the ideal benefit design for a market is an art and science at its best.

Zia Askari
Zia Askari works as the Editor for and carries over 18 years of experience in technology writing, branding, communications and digital marketing. Over these years, Zia has worked with Cyber Media and Grey Head on the content side and RAD Data Communications, Huawei Telecommunications and Shyam Networks on the branding and marketing side.

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