AI Is Not Replacing Jobs, But Enhancing Them with Rajeev Ronanki, CEO of Lyric AI

[00:00:08] [SPEAKER_00]: Hey everybody, welcome back to the beat podcast recorded live here at Vive in Los Angeles

[00:00:14] [SPEAKER_00]: Today I have the privilege of hosting Rajeev Ronanki on the podcast. He's the chief executive officer at Lyric AI

[00:00:23] [SPEAKER_00]: He's got over 25 years experience in innovation driven work and the healthcare industry and also social change in the industry and

[00:00:32] [SPEAKER_00]: Really as his vision is to invigorate Lyric's technology and utilize AI

[00:00:38] [SPEAKER_00]: Blockchain and machine learning while building best in market strategic partnerships to make healthcare better before joining Lyric Raj led the

[00:00:46] [SPEAKER_00]: transformation at

[00:00:47] [SPEAKER_00]: Elevance

[00:00:48] [SPEAKER_00]: formerly Anthem from a traditional insurance company to a digital platform as a president of Carolyn

[00:00:55] [SPEAKER_00]: So Raj such a pleasure to have you here again and be with you

[00:00:59] [SPEAKER_00]: It's all good to see you in person and thanks for having me. It's such a pleasure

[00:01:03] [SPEAKER_01]: It's always a pleasure to chat with you. How's the meeting going for you? You enjoying it?

[00:01:06] [SPEAKER_01]: Enjoying it. Yeah, it's it's a lot of steps my Apple watch and phone have been tracking all that so very happy with the step counts

[00:01:13] [SPEAKER_01]: But beyond the health outcomes meeting a lot of good partners a good solutions

[00:01:18] [SPEAKER_01]: And it was a pleasure to host our clients here and just have a meaningful in-depth a couple days with them

[00:01:22] [SPEAKER_00]: That's great. Yeah, it's always great to get together live and before we dive into the questions Raj

[00:01:28] [SPEAKER_00]: Give us your high level on Lyric AI what you guys do and why you do it?

[00:01:33] [SPEAKER_01]: Yeah, Lyric AI our purpose all is to to simplify the the business of care and

[00:01:38] [SPEAKER_01]: Every consumer in the country that's undergone any health procedure would say that even if the health outcomes were great

[00:01:45] [SPEAKER_01]: All of the insurance processes and the confusing paperwork that ensues from that visit is anything but simple

[00:01:52] [SPEAKER_01]: And so we want to go after that problem and and simplify that entire ecosystem of why

[00:01:59] [SPEAKER_01]: Care gets delivered the way it is and the implications of that to consumers and help them understand

[00:02:05] [SPEAKER_01]: What happened in that care setting and then codify those transactions accurately so that health insurance companies help lends

[00:02:13] [SPEAKER_01]: Can pay those claims accurately and ultimately improve the access and affordability of care through paying for things that need to get

[00:02:20] [SPEAKER_01]: Paid and then cleaning up all the noise that exists in the system and ultimately get up this

[00:02:25] [SPEAKER_01]: Cliche trillion dollars of waste and that we keep talking about that. We haven't made much progress on so that's what we want to

[00:02:31] [SPEAKER_00]: Get after and solve love it big problem with some big solutions that you guys are after so definitely excited

[00:02:37] [SPEAKER_00]: Digital transformation, it's reshaping health care delivery in

[00:02:41] [SPEAKER_00]: 2024 how do you see that happening and what are the main challenges and opportunities this presents?

[00:02:47] [SPEAKER_01]: Yeah, so health care

[00:02:48] [SPEAKER_01]: I think in general lags other industries and the adoption of digital technologies and

[00:02:54] [SPEAKER_01]: Primarily, so if you not that you would consider the internet digital technology per se given that it's been around for a while

[00:03:01] [SPEAKER_01]: But it's the foundation of the modern economy

[00:03:03] [SPEAKER_01]: And then your most other industries have taken advantage of the the components of web-based technologies to really modernize their infrastructures

[00:03:10] [SPEAKER_01]: Healthcare ending is largely ignored it and bypassed it

[00:03:14] [SPEAKER_01]: What next so similar to all the countries that bypass the landlines and jump straight to mobile and perhaps leapfrog in using that strategy?

[00:03:23] [SPEAKER_01]: I think healthcare probably is in the same position which is with AI with Jenny I with with advancement in blockchain

[00:03:30] [SPEAKER_01]: I think health care can leapfrog the internet foundation and move to an AI based foundation for constructing its future

[00:03:39] [SPEAKER_01]: Now does it doesn't mean that it's going to happen automatically?

[00:03:43] [SPEAKER_01]: I think there's a lot of work ahead to actually

[00:03:46] [SPEAKER_01]: Reshape the thinking of key leaders in health care to for that to come to life

[00:03:49] [SPEAKER_01]: And I see that as a collaboration between the established big players that have such a dominant position in our health care ecosystem

[00:03:56] [SPEAKER_01]: Players like epic or Surner that are on the provider side on the EMR back office

[00:04:01] [SPEAKER_01]: and and all the payers that are the natural aggregation points for a

[00:04:06] [SPEAKER_01]: Convening care delivery and making care available in an accessible to all their consumers

[00:04:10] [SPEAKER_01]: So if you think of those big players as the platforms the conveners of supply and demand if you will

[00:04:16] [SPEAKER_01]: Then there's in the this conference being an example

[00:04:19] [SPEAKER_01]: hundreds of millions of

[00:04:21] [SPEAKER_01]: Innovations that are happening with new technology new capabilities and new solutions are super interesting

[00:04:26] [SPEAKER_01]: But they lack a distribution mechanism to get the scale

[00:04:30] [SPEAKER_01]: So I think a collaboration where the platform players like the big health plans and the EMR is in the health systems of the world

[00:04:37] [SPEAKER_01]: If they think of themselves in that mold

[00:04:40] [SPEAKER_01]: I don't chase after the next point solution or the next prior off AI or the next underwriting

[00:04:47] [SPEAKER_01]: AI whatever it is that the solution that are out there interesting and innovative out there

[00:04:51] [SPEAKER_01]: But systematically think about how do you engage consumers digitally through apps portals and search and other digital means of engagement?

[00:04:58] [SPEAKER_01]: and then connecting and providers through

[00:05:00] [SPEAKER_01]: Equally digitally enabled solutions so connect EMRs into administrative systems connect clinical workflows to administrative workflows and

[00:05:09] [SPEAKER_01]: Focus on relentlessly improving the connectivity and the access to both providers and consumers so that health care could ultimately

[00:05:15] [SPEAKER_01]: Be thought of as a supply and demand problem and that in connecting supply and demand digitally

[00:05:20] [SPEAKER_01]: You can have a lot of instrumentation into what happened. What could happen next?

[00:05:25] [SPEAKER_01]: How do you anticipate that and how do you fulfill that demand?

[00:05:28] [SPEAKER_01]: That's where I think companies like Lyric could be a good partner to the platform players by providing the payment intelligence

[00:05:34] [SPEAKER_01]: The predictive sort of cost of care models to understand care journeys care pathways

[00:05:39] [SPEAKER_01]: Given the patterns of data and the volume of data that we see and then together the

[00:05:44] [SPEAKER_01]: Ecosystem plus the platform can ultimately transform health care

[00:05:48] [SPEAKER_01]: The digital transformation sort of term is used to describe that in short

[00:05:52] [SPEAKER_01]: It's mistaken to think of just point solutions and applications as being the the primary sort of ends means to that end

[00:05:59] [SPEAKER_01]: To me

[00:06:00] [SPEAKER_01]: I think what's missing is this platform level thinking across the health care system to really impact a transformative change

[00:06:06] [SPEAKER_00]: Yeah

[00:06:06] [SPEAKER_00]: well a big opportunity to tackle and taking a look at it from that broad perspective is I think the

[00:06:12] [SPEAKER_00]: Need that we have today

[00:06:14] [SPEAKER_00]: It's not the point solutions that are going to get us to eliminate that one trillion that you mentioned

[00:06:20] [SPEAKER_01]: Absolutely imagine if instead of shopping on Amazon you had to shop at 50 different retail sites, right?

[00:06:27] [SPEAKER_01]: Could you do the same thing? Yeah, is it efficient?

[00:06:31] [SPEAKER_01]: Absolutely. No

[00:06:32] [SPEAKER_01]: Is the price is going to be as cheap as you would get on a Mars mass aggregated platform? Absolutely not

[00:06:38] [SPEAKER_01]: So you know healthcare is no different

[00:06:40] [SPEAKER_01]: It's just that there's all these point-to-point connections that exist and where eventually

[00:06:44] [SPEAKER_01]: Whatever needs to get done get does get done. It's very costly. It's very efficient at low quality and it's very reactive

[00:06:52] [SPEAKER_00]: Yeah, so can you share some of the most exciting technological innovations?

[00:06:57] [SPEAKER_00]: You believe will significantly improve patient care and outcomes

[00:07:01] [SPEAKER_01]: I think the biggest thing is is our ability to predict

[00:07:04] [SPEAKER_01]: Yeah, I think I was reading the other day a stat that healthcare data doubles every 73 to 80 days

[00:07:10] [SPEAKER_01]: so that already on top of the hundreds of

[00:07:13] [SPEAKER_01]: Petabytes of data that already exists in healthcare. So that doubling effect of data

[00:07:18] [SPEAKER_01]: I think if left untapped would be a great disservice

[00:07:22] [SPEAKER_01]: Yeah, so to me tapping into that data and understanding really all the care pathways and all the ways in which we can predict

[00:07:29] [SPEAKER_01]: What might happen next in a person's healthcare journey?

[00:07:32] [SPEAKER_01]: I think it would be the most significant

[00:07:35] [SPEAKER_01]: Transformer thing that happens in the next a few years

[00:07:37] [SPEAKER_01]: But that's alone is not enough right to predict some means that that's great

[00:07:41] [SPEAKER_01]: But unless you can act on it then puts to no end so then

[00:07:46] [SPEAKER_01]: Combine predictive with proactive and then proactive with interventions

[00:07:50] [SPEAKER_01]: So then you can start to move away from reactive sick care system that we have today to much more

[00:07:56] [SPEAKER_01]: personalized proactive and predictive health system which means that we can

[00:08:01] [SPEAKER_01]: anticipate and prevent disease and

[00:08:03] [SPEAKER_01]: Ultimately expand healthy lifespans and healthy aging and all the other goals that we have as a country love that

[00:08:10] [SPEAKER_00]: Thank you for that response

[00:08:11] [SPEAKER_00]: You're outspoken on the importance of ethical and responsible use of AI

[00:08:17] [SPEAKER_00]: We hear the use of guardrails quite a bit

[00:08:20] [SPEAKER_00]: Can you perhaps more be more specific on what as the top two or three most important focus areas for AI?

[00:08:26] [SPEAKER_00]: Specific to driving responsibility and ethical use. Yeah, I think with any tool. I think there could be

[00:08:34] [SPEAKER_01]: Positive users as well as unintended consequences with a tech like AI

[00:08:39] [SPEAKER_01]: I think the unintended consequences could be essentially scaled

[00:08:44] [SPEAKER_01]: with the power of the internet and AI coming together and

[00:08:48] [SPEAKER_01]: Perhaps perpetuating something that shouldn't be so number one to me is that all AI programs need to have

[00:08:56] [SPEAKER_01]: transparency and

[00:08:57] [SPEAKER_01]: explainability so that you understand exactly what's in the black box why the AI is reaching the decisions that it is and

[00:09:04] [SPEAKER_01]: There's no illusion hallucinations. What have you that perhaps could have an unintended consequence, right?

[00:09:10] [SPEAKER_01]: So one that's super important to I think before we embark on AI

[00:09:14] [SPEAKER_01]: I think the foundation of any AI initiative is going to be in the data

[00:09:18] [SPEAKER_01]: So examining the quality of data the completeness of that data the representation of population in that data and

[00:09:25] [SPEAKER_01]: Understanding all that is is super critical before we even jump into developing algorithms and AI solutions

[00:09:31] [SPEAKER_01]: third is just ongoing checks and balances once deployed a

[00:09:35] [SPEAKER_01]: descriptive

[00:09:36] [SPEAKER_01]: Conventional system doesn't change

[00:09:38] [SPEAKER_01]: Whereas an AI system is going to continue to learn and change and evolve based on new inputs in your data and your learnings

[00:09:44] [SPEAKER_01]: So then even if everything was done right you're going up for a system going into production three months in a year in

[00:09:51] [SPEAKER_01]: It still could change and evolve into something different

[00:09:53] [SPEAKER_01]: So we need to have ongoing sort of introspection of model performance things like model drifts new inputs data

[00:10:00] [SPEAKER_01]: And make sure that the original intent that was expressed is still carried through in the solution into production

[00:10:06] [SPEAKER_01]: and then finally think of AI not as a

[00:10:10] [SPEAKER_01]: replacement for humans necessarily but an augmentation of human intelligence so to me

[00:10:15] [SPEAKER_01]: Humans should always be in the loop and the most critical

[00:10:18] [SPEAKER_01]: Decisioning processes that involve care and care delivery and denying care and then use AI for

[00:10:25] [SPEAKER_01]: Automation of the more routine things where they're well established patterns

[00:10:28] [SPEAKER_01]: So to me if we did all those things I think it would constitute a good way to implement AI

[00:10:34] [SPEAKER_01]: responsibly and not have to blow back from you know regulators and consumers and allow

[00:10:39] [SPEAKER_01]: Healthcare the industry to use AI is that it so desperately needs in order to ultimately improve this for all of our stakeholders

[00:10:46] [SPEAKER_00]: I love the framework that you laid out for us there

[00:10:49] [SPEAKER_00]: And it's certainly promising to think about how we could use it to as you said earlier in our interview leapfrog

[00:10:55] [SPEAKER_00]: Yeah, where we've been in the innovation cycle here at Vive

[00:11:00] [SPEAKER_00]: You spoke on the future of payment innovation

[00:11:03] [SPEAKER_00]: Could you elaborate on how AI technologies are specifically enhancing payment accuracy and

[00:11:09] [SPEAKER_00]: Efficiency in the face of evolving compliance landscapes. Yeah, it's compliance its regulation

[00:11:15] [SPEAKER_01]: It's new innovations that happen for instance

[00:11:17] [SPEAKER_01]: There's roughly 800 new genetic testing products that come into market every every few weeks

[00:11:23] [SPEAKER_01]: So all of that how to you know, how do we decide what to pay for what's medically necessary?

[00:11:28] [SPEAKER_01]: What's discretionary and all the associated complexity around that think of Lyric as a company that's focused on

[00:11:34] [SPEAKER_01]: Examining all of that and being a neutral arbiter of what needs to get paid and reimbursed because there's good sound medical rationale

[00:11:41] [SPEAKER_01]: for it and all the stuff that is perhaps not as medically necessary and it's more discretionary and in some cases just waste and

[00:11:50] [SPEAKER_01]: So forking that and for the mass majority of the providers

[00:11:54] [SPEAKER_01]: I think they do the right thing and they intend to do the right thing

[00:11:57] [SPEAKER_01]: They just sometimes are not as educated on how to codify a service how to bill for something and therefore errors happen

[00:12:03] [SPEAKER_01]: And they get corrected over time

[00:12:05] [SPEAKER_01]: So Lyric's purpose really is to to make sure that all the good actors all the providers that are doing the right thing

[00:12:10] [SPEAKER_01]: But perhaps are not as educated on how to get it right

[00:12:13] [SPEAKER_01]: Give them the tools necessary to get it right the first time to eliminate the back and forth between pairs and providers reduce

[00:12:18] [SPEAKER_01]: the friction reduce the noise and then enable both parties consumers all parties

[00:12:23] [SPEAKER_01]: I'd say consumers providers and payers to focus on the things that perhaps are more subjective

[00:12:29] [SPEAKER_01]: Provider might disagree with a help plan might disagree with provider a consumer stuck in the middle right now

[00:12:33] [SPEAKER_01]: There's not enough a good enough collaboration platform to

[00:12:36] [SPEAKER_01]: Mediate and figure out how to get to an adequate resolution to that the issue is the reason it doesn't exist is because every

[00:12:43] [SPEAKER_01]: Transaction is looked at through some let's just say some level of suspicion

[00:12:47] [SPEAKER_01]: So it takes a long time to settle transactions and and there's not enough resource that could be dedicated towards just the exceptions

[00:12:54] [SPEAKER_01]: So I think what Lyric can do for our customers in the healthcare ecosystem is take care of all the noise

[00:12:59] [SPEAKER_01]: eliminate the friction simplify the transactions and

[00:13:02] [SPEAKER_01]: Enable all the stakeholders provide on the on the things that are truly exceptions and truly subjective

[00:13:08] [SPEAKER_01]: Where deeper research is net is necessary around patient history the patient medical condition

[00:13:13] [SPEAKER_01]: The effectiveness of a procedure relative to that condition personalized decision and then keep everyone informed as to why and how

[00:13:21] [SPEAKER_01]: And the transparency around that which ultimately will help in building trust between the stakeholders

[00:13:25] [SPEAKER_01]: Which is sorely missing in the current landscape. Yeah, that's really great

[00:13:29] [SPEAKER_00]: And it is it looking at all the transactions coming through recognizing

[00:13:33] [SPEAKER_00]: characteristics qualities of ones that don't really necessarily need

[00:13:36] [SPEAKER_00]: The time and attention so that people can focus on the ones that do that's exactly right, okay

[00:13:42] [SPEAKER_01]: So if a doc in Nebraska a doc in California doc in New York

[00:13:46] [SPEAKER_01]: Looking at similar patients or all doing the same thing and there's good medical policy and regulations and other

[00:13:53] [SPEAKER_01]: CMS rules that support it. There's no reason to

[00:13:57] [SPEAKER_01]: Double-think that right and just pay it just settle it

[00:14:00] [SPEAKER_01]: And then there may be others that are somewhat very bad providers very by region very by various other factors

[00:14:06] [SPEAKER_01]: That require a closer inspection and a close collaboration with providers to get it right until there's sufficient volume of pattern to

[00:14:13] [SPEAKER_01]: To do it automatically

[00:14:14] [SPEAKER_01]: So those are the ones that I think our health care

[00:14:17] [SPEAKER_01]: Practitioner subject matter experts should be focused on versus all the other stuff. That's fairly routine. That's great

[00:14:23] [SPEAKER_00]: I love the idea of being able to add structure that is reliable

[00:14:28] [SPEAKER_00]: Repeatable and creates additional trust that helps move faster. It's just very promising exactly right now

[00:14:34] [SPEAKER_00]: Very promising so what steps should health plans take today to to prepare the future

[00:14:40] [SPEAKER_00]: Innovation and ensure they remain at the forefront of payment accuracy and efficiency

[00:14:44] [SPEAKER_01]: It's a summary of many of the things we already talked about which is that one thing health plan should be thinking of themselves as a

[00:14:50] [SPEAKER_01]: Digital platform their conveners of care and care delivery

[00:14:54] [SPEAKER_01]: They know they have all the data to figure out provider performance who is doing well

[00:14:58] [SPEAKER_01]: Who's not who's average and you know where the traffic should be directed to and at what point at what time?

[00:15:04] [SPEAKER_01]: Hypercare should be delivered whether it's digital or virtual or in person

[00:15:07] [SPEAKER_01]: So rather than I think focusing on the next shiny object or the next innovative

[00:15:13] [SPEAKER_01]: Solution vendor what have you and attempt to churn the ocean

[00:15:18] [SPEAKER_01]: Fronting solutions would be better to focus on a systematic enablement of

[00:15:23] [SPEAKER_01]: consumers accessing care and starting to access care digitally and then

[00:15:27] [SPEAKER_01]: Providers being connected into a digital platform so that clinical and administrative workflows could be truly integrate for example

[00:15:34] [SPEAKER_01]: We still can't do a scheduling at scale or we can easily cancel and shift appointments

[00:15:40] [SPEAKER_01]: That all has to they requires a phone call and whatnot

[00:15:44] [SPEAKER_01]: Specialists it's hard to understand what the referral patterns are and why that's happening

[00:15:49] [SPEAKER_01]: So all that could be handled very differently and so health plan started realize alright

[00:15:55] [SPEAKER_01]: Let's focus on those bookends connect providers connect consumers to some digital enablement mechanisms

[00:16:01] [SPEAKER_01]: And then that intersection of supply and demand of care and care being delivered by providers and the care being received by consumers

[00:16:07] [SPEAKER_01]: Really then digitize all the processes that sit at the intersection of that prior

[00:16:12] [SPEAKER_01]: Do you do I need the service or not claims? How do I get paid for the services that were rendered?

[00:16:17] [SPEAKER_01]: Risk adjustment how do I account for the health risk of a patient and adjust that appropriately all the

[00:16:22] [SPEAKER_01]: Heedest quality measures that need to be collected

[00:16:25] [SPEAKER_01]: All the charts that need to be documented as a part of the process if you think about all these

[00:16:29] [SPEAKER_01]: Anisolid processes there's no reason for them to exist as silos they can all be

[00:16:34] [SPEAKER_01]: Swim lanes that are integrated into a digital platform claims prior odds underwriting health

[00:16:39] [SPEAKER_01]: You know risk adjustments key to quality measures stars measures all that could be done within so the context of one

[00:16:46] [SPEAKER_01]: Transaction and kind of rethink how everything happens what health plans typically tend to do is say oh I've got a problem with risk adjustment

[00:16:53] [SPEAKER_01]: So let me go digitize that tackle that thing right?

[00:16:56] [SPEAKER_01]: I've got a problem with prior odds. Let me go fix that we got a problem with benefits

[00:17:00] [SPEAKER_01]: I'm gonna it's one thing at a time without thinking about the larger

[00:17:04] [SPEAKER_01]: Patterns of platforms and how to think at scale so if that

[00:17:08] [SPEAKER_01]: Mindship a change happens and if let's say I was advising a health plan as to what to do

[00:17:14] [SPEAKER_01]: I'd say a focus on the platform think about the operating structure of the company to reflect the platform business not a

[00:17:22] [SPEAKER_01]: Traditional bricks-and-mortar business from the 60s which is what most health plans operate as and then create a corporate venture fund

[00:17:30] [SPEAKER_01]: That would invest in companies that could become part of that platform ecosystem

[00:17:34] [SPEAKER_01]: So if there's a company out there does risk adjustment really the company out there does real-time claims or a company that does payment accuracy lyric

[00:17:41] [SPEAKER_01]: Go curate that ecosystem to work on the platform

[00:17:44] [SPEAKER_01]: so you can plug in those solutions and then

[00:17:46] [SPEAKER_01]: Ecosystem then grows from there and becomes a vibrant sort of platform that thrives much like what Apple created with

[00:17:52] [SPEAKER_01]: And then there's an app store Google with their you know app stores once you create that mechanism for

[00:17:58] [SPEAKER_01]: Developers to reach consumers or providers then many good things can happen

[00:18:03] [SPEAKER_01]: But a structure has to be created to facilitate that so that can happen effectively. That's fantastic

[00:18:08] [SPEAKER_00]: I love the the playbook that you just laid out there

[00:18:11] [SPEAKER_00]: I think one that that many listening can follow

[00:18:15] [SPEAKER_00]: Fantastic, I really appreciate the approach the simplicity of the approach that you take Rajiv

[00:18:19] [SPEAKER_00]: This has been excellent to get back together with you and have this discussion here at Vive

[00:18:24] [SPEAKER_01]: What closing thought would you leave our listeners with first of all? It's been a pleasure. It's great to see you and see you person

[00:18:32] [SPEAKER_01]: Appreciate the opportunity to be here and I'd say Lyric's purpose has been to to simplify the business of care

[00:18:37] [SPEAKER_01]: I think purpose-driven companies. I think have a

[00:18:40] [SPEAKER_01]: Very research shows that purpose driven companies always have a better shot at dressing something because the entire sort of

[00:18:45] [SPEAKER_01]: Employee base of the company can rally around a singular

[00:18:47] [SPEAKER_01]: Purpose wake up everyone think about what am I doing to advance this purpose in our case AI is a tool to

[00:18:53] [SPEAKER_01]: Essentially enable us to achieve our purpose of simplifying the business care and so doing I think we can offer a service to the broader

[00:19:00] [SPEAKER_01]: Healthcare ecosystem continue to serve our clients with distinction and hopefully in that collaboration

[00:19:05] [SPEAKER_01]: We can ultimately get after this trillion dollar waste problem in the country and expand access to care and make care more sort

[00:19:12] [SPEAKER_00]: Equitable to everyone in the country. Well, it's a great vision a great call to action and Rajiv

[00:19:18] [SPEAKER_00]: Just want to say thanks again. Appreciate having you here. Thanks for having me. What's the pleasure?