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Cognizanti
Part III
Navigating
the
digital
age
Navigating the Digital Age
What senior leaders worldwide
have learned from pushing the
boundaries of change.
Vol 12 • 2019
Vol 12 • 2019
About Cognizant
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Cognizanti is an annual journal published by Cognizant.
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An annual journal produced by Cognizant
VOLUME 12 • 2019
The Cognizanti Team
Publisher:
Malcolm Frank, President, Cognizant Digital Business
Editor-in-Chief:
Alan Alper, Vice President, Corporate Marketing/
Thought Leadership Programs
Editor:
Rajeshwer Chigullapalli, Associate Director, Corporate Marketing
Thought Leadership Program Management:
April Vadnais, Associate Director, Corporate Marketing
Art Director:
Jason Feuilly, Director, Corporate Brand/Design
Design/Print Production:
Diana Fitter, Contributing Art Director
Editing:
Mary Brandel, Contributing Editor
Columnist:
Bruce J. Rogow, Independent Advisor
Digital Distribution:
Nikhil Narayanan, Associate Director,
Social Media Marketing
Editorial Advisory Board
Irene Sandler, Vice President, Marketing, Cognizant
Mats Johard, Cognizant Consulting Head, Nordics
Ramkumar Ramamoorthy,
Chairman & Managing Director, India
Ben Pring, Vice President,
Cognizant Center for the Future of Work
Gary Beach, Publisher Emeritus, CIO magazine
Table of
contents
4
Editor’s Note
With Digital, the More We Live …
the More We Learn
Alan Alper, Cognizant
6
The First Word
Get Ready: AI Is Grown Up and
Ready for Business
Rajeshwer Chigullapalli, Cognizant
16
Health Insurance
From Vision to Reality: How MetLife Applied
Blockchain to Solve a Difficult Health
Insurance Challenge
Zia Zaman, MetLife
26
Healthcare
Digital Helps Geisinger Redesign
Primary Care Services
Jaewon Ryu, M.D., Karena Weikel, Juliann Molecavage,
Rebecca A. Stametz & David Riviello
38
Commentary
A Radical Rethink to Replenishing
the Talent Pool
Gary Beach, CIO magazine
46
Property & Casualty Insurance
Attrition Expedition: Using AI to Chart a
Course to Retain Call Center Employees
Michelle Deitchman, The Hartford
52
Banking & Financial Services
Tapping Blockchain to Slash Costs, Enhance
Trust and Speed B2B Transactions
Micah Kerr, Discover Financial Services &
George Throckmorton, Nacha
62
The Last Word
On the Road to Digital: Practical Encounters
Bruce J. Rogow, IT Odyssey
With Digital, the More We Live … the More We Learn When it comes to digital technology, business or thinking, established organizations have a different set of challenges from those of digitally native pioneers. They have hardwired business conventions, and are often constrained by regulatory mandates, customer/industry requirements and inflexible legacy systems and processes that just can’t turn on a dime – despite all the talk about human-centered design, Agile development methodologies and DevOps automation. Compared with those that grew up in the “all things digital” era, it isn’t as simple for these organizations to be digital across key business functions and tasks or in most interactions and transactions with employees, partners and customers. So, what’s a 20th century or older company in need of a modern digital overhaul to do? Pilot, perfect and, over time, provide business results that demonstrate the art of the possible. This issue of Cognizanti is dedicated to heritage companies experimenting with artificial intelligence (AI), blockchain and tailored platforms to more effectively serve their employees, customers and partners. Their efforts illustrate how companies must master the fundamentals that surround new technology adoption and business process change before dramatically over-reaching. Take insurance giant MetLife, which is piloting blockchain and smart contract technology to enable women in Singapore with gestational diabetes to be compensated for the cost of treatment over their cellphones – without having to file a claim. Or The Hartford, which is employing innovative AI-powered tools to reveal surprising truths about employee turnover to enhance its workplace culture. Then there’s Discover and Nacha, which are exploring how distributed ledger technology can make online business purchases safer. Or Geisinger, which is improving patient and population health and wellness while streamlining physician workflows via a platform-centric approach.
Editor’s Note
We open with a fact-based look at AI and how to ensure its effective
and ethical deployment. Veteran IT industry commentator Gary
Beach then explores novel ways organizations can restock the digital
talent pool. Bruce Rogow concludes the issue with practical advice,
gleaned from interactions with top senior business and IT leaders, on
proven ways to cut through digital headwinds.
We hope you enjoy and benefit from the views shared by your
colleagues and our commentators. If you’d like your own digital
journey featured in an upcoming issue of Cognizanti, or in our
Digital Perspectives app (available both at the Apple App Store
and Google Play on smartphones and tablets), contact me at
Alan.Alper@cognizant.com. You can also share your point of view
on our Cognizant Connections e-community (ask your client
partner for an invite).
Scan the below image
for a welcome from
Editor-In-Chief Alan Alper.
See inside cover for instructions to download
the Cognizant AR app.
Cognizanti • 5The First Word
Get Ready:
AI Is Grown Up and
Ready for Business
By Rajeshwer Chigullapalli
Despite great enthusiasm for AI, full-blown
deployments remain the exception rather than the rule
across businesses in the U.S. and Europe, according
to our recent research. Businesses can turn the tide
by honing their AI strategies, maintaining a human-
centric approach, developing governance structures
and ensuring AI applications are built on an ethical
foundation.
Germinating in R&D labs since the offering an intelligent foundation
1940s, artificial intelligence (AI) is for creating products and services
slowly but surely moving into the that drive topline growth.
mainstream across the consumer
Given the hype, it’s no wonder that
world. But in the enterprise space,
the AI market is expected to grow
AI remains bound by concerns
at a strong 36% CAGR to reach $191
about balancing its responsible
billion by 2025.1 And according
development, deployment and
to Gartner, global business value
usage with its ability to deliver
created from AI is projected to total
business value. And while there’s
$3.9 trillion in 2022.2
widespread recognition of
AI’s immense potential, many To gauge executive perceptions
organizations are still working to of and achievement with AI, we
determine how AI can move the recently surveyed 975 business
needle where it makes the most leaders from organizations in
sense: controlling costs, unleashing the U.S. and Europe. While our
new customer experiences and study uncovered widespread
Cognizanti 7enthusiasm and optimism about Moreover, most respondents
AI, it also revealed AI’s nascent expect major or significant
stage of adoption. For instance, the benefits in terms of revenue
vast majority of AI projects (78%) growth from their use of AI. In
remain in experimental stages (i.e., fact, almost all expect value
proofs of concept and prototypes). to increase significantly within
three years, with financial
The state of the state services and technology industry
of AI in business companies leading the pack (see
Figures 1 and 2).
The following are the key
takeaways gleaned from our study: ❙❙ AI is infiltrating multiple
business functions. Among
❙❙ Most respondents consider all business functions,
AI to be vital to business customer service appears
success. The vast majority of to be a prime target for AI
respondents across industries use across industries. This is
view AI as extremely or very understandable, since customer
important to their business. Not satisfaction, engagement and
surprisingly, respondents were buy-in is critical to ensuring
also optimistic about AI’s ability business success and justification
to generate benefits, including of an AI-led transformation
cost efficiency, revenues and agenda (see Figure 3, next page).
new products and services.
Importance of AI to company success
TECHNOLOGY 40% 53%
FINANCIAL SERVICES 32% 53%
MANUFACTURING 38% 47%
HEALTHCARE 42% 41%
INSURANCE 46% 36%
RETAIL 28% 50%
MEDIA 31% 24%
0% 20% 40% 60% 80% 100%
Very important Extremely important
Base: 975 senior leaders in the U.S. & Europe
Source: Cognizant
Figure 1
8Expected revenue boost from AI
TECHNOLOGY 42% 39%
FINANCIAL SERVICES 38% 39%
RETAIL 37% 39%
HEALTHCARE 39% 32%
MANUFACTURING 38% 32%
INSURANCE 43% 27%
MEDIA 41% 10%
0% 20% 40% 60% 80% 100%
Significant benefit Major benefit
Base: 975 senior leaders in the U.S. & Europe
Source: Cognizant
Figure 2
Top business functions for AI use
CUSTOMER SERVICE 30%
MANUFACTURING PROCESS 26%
OPERATIONS 20%
RESEARCH & DEVELOPMENT 18%
FINANCE 13%
SALES & MARKETING 13%
SUPPLY CHAIN/PROCUREMENT 9%
HUMAN RESOURCES 7%
RISK & COMPLIANCE 6%
0% 5% 10% 15% 20% 25% 30%
(Percent of respondents naming each function)
Base: 975 senior leaders in the U.S. & Europe
Source: Cognizant
Figure 3
Cognizanti • 9Organizations are also focusing ❙❙ Choice of AI technology is
their AI efforts on areas that influenced by functional area
are core to the business, such and associated processes.
as operations in the healthcare Respondents reported using
industry, production in manufac- all five of the AI technologies
turing and R&D in technology. included in our study at a fairly
similar rate (see Figure 4).
Many AI technologies currently in use
58%
49%
SMART ROBOTICS/ 47%
AUTONOMOUS VEHICLES 60%
46%
35 %
40%
33%
45%
ANALYSIS OF 54%
NATURAL LANGUAGE 42%
40%
44%
56%
42%
58%
ADVICE ENGINES/ 53%
MACHINE LEARNING 53%
44%
35%
41%
50%
55%
52%
COMPUTER VISION
56%
35%
44%
51%
42%
49%
58%
VIRTUAL AGENTS 44%
52%
41%
72%
0% 10% 20% 30% 40% 50% 60% 70% 80%
Media Retail Technology Manufacturing
Healthcare Insurance Financial Services
Base: 975 senior leaders in the U.S. & Europe
Note: Multiple responses allowed
Source: Cognizant
Figure 4
10Organizations seem to attach ❙❙ Faster-growing organizations
equal importance to the various appear to be more optimistic
technologies that can power about AI and more aggressive
an AI strategy. However, virtual in their AI adoption. Roughly
agents (conversational AI) 85% of respondents at faster-
and computer vision (machine growing organizations expect
intelligence algorithms that AI to provide a major or
recognize patterns, among significant impact on revenues,
other things) led other AI compared with 71% of slower-
technologies by a small growing businesses (see Figure
margin. Respondents said 5). A higher percentage of
their companies are selectively faster-growth organization
deploying technologies tailored respondents (89%) also
to specific functional areas, such expect AI to provide a major or
as virtual agents for customer significant benefit in terms of
service and bots in production. efficiencies that translate into
Expected revenue increase
SLOWER-GROWTH BUSINESSES 29% 42%
FASTER-GROWTH BUSINESSES
55% 30%
0% 20% 40% 60% 80% 100%
Significant impact Major impact
Base: 975 senior leaders in the U.S. & Europe
Source: Cognizant
Figure 5
Expected cost reduction
SLOWER-GROWTH BUSINESSES 32% 45%
FASTER-GROWTH BUSINESSES 56% 33%
0% 20% 40% 60% 80% 100%
Significant impact Major impact
Base: 975 senior leaders in the U.S. & Europe
Source: Cognizant
Figure 6
Cognizanti • 11cost reduction vs. slower growth organization, it becomes clear
businesses (77%) (see Figure that most organizations have yet
6). While a significant majority to hone a clear-cut AI strategy.
of faster-growth companies Further, given that top
(66%) said AI will increase jobs, challenges related to senior
only 38% of respondents at management commitment,
businesses with slower growth business buy-in, adequate
rates said they believed this to budget and lack of
be true. preparedness, it’s apparent
❙❙ AI adoption challenges span that many companies are still
talent acquisition, business struggling to define AI’s central
cases and ethics. Respondents role in advancing business
expressed a similar level of objectives.
concern regarding challenges Interestingly, technology industry
on the path to AI, with 40% of respondents were more apt than
executives considering each of respondents in other industries to
the 13 challenges listed to be be aware of ethical considerations
extremely or very challenging. playing a role in AI deployments
When that data is combined (see Figure 7). This could be the
with the finding that only 15% of result of increased scrutiny of
respondents were aware of a fully the FAANG (Facebook, Apple,
implemented AI project at their Amazon, Netflix and Google)
Concerns over ethical AI vary across industries
TECHNOLOGY 55%
FINANCIAL SERVICES 45%
HEALTHCARE 43%
RETAIL 41%
MANUFACTURING 41%
INSURANCE 41%
MEDIA 29%
0% 10% 20% 30% 40% 50% 60%
(Percent of respondents rating high or
significantly high concern)
Base: 975 senior leaders in the U.S. & Europe
Source: Cognizant
Figure 7
12companies relative to their use of be geared around solving a
data- and algorithmic-enabled human problem and factor in the
analytical decision making, as right combination of machines
well as the issues they’ve had and human talent – from devel-
to contend with regarding user opment and deployment,
privacy. Sustainable and successful through usage.
AI deployments will need to be
❙❙ Enact an effective governance
built on a foundation that ensures
structure: Businesses need
ethical and responsible outcomes.
to engage teams in defining
standards, best practices and
The road ahead: investment strategies to get
strategy, governance the most value from AI. The
and ethics imperatives governance model should
ensure that AI-led decisions are
To successfully move from the
reached in a transparent and
nascent stages of AI into full
auditable way while obviating the
business value realization, we
influence of biases (unintended
believe organizations should
or otherwise) that may creep into
focus on three key areas: AI
the fabric of AI designs.
strategy, governance and ethics.
Addressing gaps in these areas ❙❙ Build an ethical foundation
can place AI on a sustainable path – and continually maintain it:
to delivering desired results. We For AI to take hold, businesses
recommend businesses take the need to embed processes
following actions when planning that ensure integration of
their path to AI: ethical considerations into the
development, deployment and
❙❙ Embrace a human-centric
ongoing usage of AI, both inside
strategy: In addition to focusing
the organization’s four walls and
on measurable business value,
with customers and partners.
an effective AI strategy should
This article was adapted from our primary research-based report “Making
AI Responsible – and Effective.” To learn more, visit https://www.cognizant.
com/artificial-intelligence-adoption-for-business.
Cognizanti • 13Endnotes
1 “Artificial Intelligence Market,” Markets and Markets, February 2018, https://www.marketsandmar-
kets.com/Market-Reports/artificial-intelligence-market-74851580.html.
2 Alex Knapp, “Gartner Estimates AI Business Value to Reach Nearly $4 Trillion by 2022,” Forbes, April
25, 2018, https://www.forbes.com/sites/alexknapp/2018/04/25/gartner-estimates-ai-business-
value-to-reach-nearly-4-trillion-by-2022/#47bf0f433f9b.
Author
Rajeshwer Chigullapalli is an Associate Director within Cognizant’s thought
leadership program. He has over 25 years of experience in the areas of
business research and publishing. Previously, he was the Head of ICFAI
University Press and Chief Editor, SPG Media, India. He can be reached at
Rajeshwer.Chigullapalli@cognizant.com.
Acknowledgments
The author would like to thank Cognizant Digital Business’s AI and Analytics Practice for their
contributions to this article, including Poornima Ramaswamy, Vice President, James Jeude,
Vice President and Practice Leader, Jerry A. Smith, Vice President, Data Sciences, and Bret
Greenstein, Global Vice President and Head of the AI Practice.
14Scan the above image to hear about MetLife’s use of blockchain as told by Zia Zaman. See inside cover for instructions to download the Cognizant AR app.
Health Insurance
From Vision to Reality
How MetLife Applied
Blockchain to Solve a
Difficult Health Insurance
Challenge
By Zia Zaman
Working with well-placed partners, the global insurer
launched the world’s first automated insurance solution
for gestational diabetes in Singapore, taking enterprise
blockchain technology from the highly aspirational to
the incredibly practical and meaningful. Along the way,
it uncovered the potential, and limitations, of distributed
ledger technology’s uplifting impact on both underserved
communities and society as a whole.
In September 2016, a colleague in new insurance idea based on a
our innovation center LumenLab smart contract (contracts that
walked into my office with a verify and carry out credible
bold idea. At LumenLab, we’re transactions without third parties),
accustomed to this; based in to which I responded, “Wouldn’t
Singapore, we were established it be great if we could make an
to build disruptive businesses for insurance payout as effortless as
MetLife. “Lumen,” a measure of getting a soft drink from a vending
light, symbolizes our commitment machine?”
to illuminating new paths for This ambitious idea took
solving problems faced by people advantage of the technology
in Asia today. underlying Bitcoin: blockchain, or
Still, I underestimated just how more precisely, distributed ledger
pivotal this moment would be. technology (DLT).
He enthusiastically pitched a
Cognizanti 17Validating learn is an exceptionally fast and
inexpensive way to challenge
opportunities assumptions, eliminate risk and
Back then, Bitcoin had yet to reach transform uncertainty into valuable
its peak valuation, and while there insights – be it consumer pain
was a lot of talk about use cases points (what we call “jobs-to-
in the enterprise, nobody, in any be-done”), product-market fit or
industry, had gone and done it. technology readiness.
LumenLab thrives on challenges
The process runs in two stages:
like this.
exploration and experimentation.
Over the course of our four-year During the exploration stage, we
existence, we’ve developed and frame the problem and define
refined our own “test & learn” what success looks like. We then
process for building new ventures refine the true job-to-be-done for
(see Figure 1). We measure the customer and generate ideas
success in terms of knowledge for how to build solutions. At the
gained through small experiments, end of this stage, we have “fallen
which can subsequently turn in love with the problem” and may
into commercial impact. Test & have found new ways of solving it.
The test & learn framework
PHASES TOOLS BEHAVIORS
1 Define and align on ❙ Goals and bounds
scope and success INNOVATION
EXPLORATION
FRAME ❙ Context capturer
❙ Into-the-wild interviews
2 Understand our consumers
❙ Persona builder
and unlock great insights CURIOSITY
EXPLORE ❙ Jobs-to-be-done finder
Generate a range of ❙ Solution developer
3 EXPANSIVITY
ideas, and align ❙ Ideation sprint
CREATE on the best ❙ Rule breaker
Develop and ❙ Value proposition
4 refine our solution
EXPERIMENTATION
BLUEPRINT ❙ Competitor mapper
to setup for success EXPERIMENTALITY
❙ What-if financials
Set-up and run ❙ Assumption mapper
“pretotypes” to ❙ Adaptive planning
5 test and learn VELOCITY
EXPERIMENT efficiently ❙ Experiment designer
Launch our pilot to ❙ Minimum viable product
6 build and move BRAVERY
PILOT ❙ Elevator pitch
toward scale
Figure 1
18During the experimentation stage, low in cost but still represented a
we formulate a value proposition, latent coverage gap for customers.
run small-scale experiments to It needed to be a niche market
test our assumptions, and iterate so we could keep it small enough
until we’re confident with building to experiment. And we needed
a pilot. The result is real-world a short claim period, with a high
validation that can be used to build enough incidence rate to ensure
commercial products – without the we could learn enough about the
risk and uncertainty that typically end-to-end customer experience
accompanies new ventures. in a short time span. After much
deliberation, a team member’s
Using blockchain to pregnant wife suggested a
serve the underserved solution: gestational diabetes
mellitus, or simply GDM.
When we set out to build the
world’s first blockchain-powered GDM is a form of diabetes that
health insurance application, we develops during pregnancy,
needed to make sure it offered occurring either when an
real benefits. Do the benefits expectant mother can’t produce
of blockchain line up with real enough insulin, or the insulin
customer needs? Is the technology is not working well enough to
ready for actual insurance act on the sugars in her body.
customers? Can we align the This leads to excess glucose in
right group of partners to build a the bloodstream, which can be
system on blockchain? These are passed on to the baby. Associated
just some of the questions we had complications during pregnancy
when we started, and we would and labor include excess birth
methodically answer every one of weight, premature birth and, in
them as we moved forward. some serious cases, stillbirth.
GDM affects one in five pregnant
Our first challenge was to find a women in Singapore1 and, crucially,
proper product scope. We needed is typically not fully covered by
to cover a risk that was relatively general health insurance. In other
GDM affects one in five pregnant women in
Singapore and is typically not fully covered by
general health insurance. In other words, we’d
found a real, addressable need that cut across
the population.
Cognizanti • 19words, we’d found a real, address- different systems. We needed
able need that cut across the clinics to help us distribute Vitana,
population. electronic medical records (EMR)
providers to record customer data,
Hence, Vitana was born. But we
and a technology provider with
couldn’t do it alone.
deep expertise with DLT to help us
implement our ambitious plans.
Assembling the right
partners Because MetLife doesn’t have
a traditional insurance business
A key benefit of blockchain is that in Singapore, we also partnered
it eliminates many of the processes with Swiss Re to reinsure the
that add to the cost of insurance risk and offer valuable insight on
for customers – including under- product design and delivery in the
writing, onboarding and claims Singapore market. Additionally, the
processing. Our vision for Vitana Monetary Authority of Singapore
was to shortcut the process to (MAS) provided the regulatory
provide a frictionless experience for sandbox that made the whole
customers. We wanted customers experiment possible.
to sign up in just a few minutes and
our policies to be issued completely Our team of collaborators also
hassle-free. To top it off, we wanted consisted of Singapore’s largest
to completely eliminate the claims clinic group, Singapore Medical
process for customers afflicted with Group (SMG), EMR start-up Vault
GDM. This meant payouts would Dragon, and business services
automatically appear in patients’ provider Cognizant. Together –
bank accounts upon diagnosis – over the course of six months – we
zero paperwork. developed a customer journey,
reengineered clinical processes
To realize this vision, we had to and built the technology that
connect disparate data from many turned Vitana into reality.
Our vision for Vitana was to shortcut the
process to provide a frictionless experience for
customers. We wanted customers to sign up in
just a few minutes and our policies to be issued
completely hassle-free. To top it off, we wanted
to completely eliminate the claims process for
customers afflicted with GDM.
20The truly transformational moment happens
at the “claim” stage. From a customer’s
perspective, it’s all invisible and completely
frictionless.
Vitana in practice virtually simultaneously. All parties
– clinics, insurers, reinsurers and
Vitana has two elements: a regulators – now have visibility of
mobile app for customers and a new policies in real time. It doesn’t
blockchain back-end to act as just strengthen communications; it
the source of truth for all involved eliminates much of the transaction
parties. But for all the technology costs for the parties interacting
involved in Vitana, our focus was with one another.
on the customer journey.
The truly transformational moment
Early in her pregnancy, after happens at the “claim” stage.
being informed about the risks From a customer’s perspective,
of GDM and being told about it’s all invisible and completely
the innovative new coverage, the frictionless. Around Week 25, the
expectant mother is encouraged expectant mother is tested for
to sign up by simply downloading GDM by her clinic, which updates
the app and entering her her EMR with the results. Should
government-issued ID number. the customer test positive for
The app automatically connects to GDM, the EMR automatically
the customer’s electronic medical writes the result onto the
records and populates personal blockchain. The smart contract
information. All that remains is then executes, and a payout is
for the customer to answer three automatically triggered to the
simple underwriting questions and customer’s bank account.
enter payment information. This
takes about two minutes – and she Again, all parties are instantly
is instantly covered. notified, and the insurers – in this
case, us – can process the “claim”
A smart contract is automatically and make the payment, without
created, encrypted and deployed the customer ever contacting
to an Ethereum blockchain. MetLife.
This creates a policy document,
which is emailed to the customer
Cognizanti • 21Triggering the smart contract
When downloaded, the Vitana app automatically connects to the
patient’s electronic medical record and deploys a smart contract to the
blockchain. All parties now have visibility into new policies in real time.
If the patient tests positive for GDM, the EMR automatically writes
the result onto the blockchain, which executes the smart contract and
triggers the payout to her bank account.
MOBILE APP BLOCKCHAIN
INSURER
ELECTRONIC REGULATOR
HEALTH RECORD
REINSURER
Figure 2
Takeaways to date partnership and was pivotal in the
cocreation of this initiative. At the
Vitana was designed as a time of writing, many conclusions
time-bound experiment in the are still to be drawn; however, some
sandbox of MAS. As a progressive lessons stand out already:
regulator, MAS delivered on
the spirit of a public-private
22and at a fraction of the cost of
traditional systems, meaning we
We found a real customer need
will be better equipped to serve
in GDM, and blockchain helped
customers’ micro-protection
us put together a seamless,
needs.
frictionless experience for
customers afflicted by the
condition.
Getting data prepared to go
Offering real value to expectant
onto blockchain might be more
mothers in a time of need has
difficult than setting up and
been a rewarding and gratifying
executing the distributed ledger
experience. We are serving the
technology.
underserved; the potential for us to
insure future risk pools will increase When we designed the process
access to and inclusion with flow in partnership with the clinic,
insurance. This is arguably Vitana’s we needed to rewire existing
greatest potential legacy. processes, which was an incredible
change management effort, and
even then we weren’t able to
eliminate all manual steps.
Real-time shared data across
all parties using blockchain is A word of caution: Operating on
invaluable. blockchain increases the required
trust in the integrity of the data
It is our firm belief that as the and the reliability of the processes
technology matures and new that other parties use to feed
platforms emerge, the future of to the ledger. You can’t just go
data will be decentralized. One back and change a record when
added benefit is increased data it is immutable. This is not what
protection for customers, whose you typically hear at Consensus
data can be shared in encrypted conferences,2 but it is a lesson
fashion only. we will remember for our future
Using blockchain, we can imagine solutions.
a world where we can offer new
services and products more simply
When we designed the process flow in
partnership with the clinic, we needed to rewire
existing processes, which was an incredible
change management effort.
Cognizanti • 23The beauty of blockchain is that it makes it
clear to first-time insurance buyers that if
“this” happens, then “this” is what you get,
automatically. Effectively, it increases trust
between insurer and customer, which is the
basis for fulfilling relationships going forward.
The future of ❙❙ Fully automated back-end:
Our back-end processes will
blockchain in eliminate all manual steps to
insurance ensure the smooth servicing
As we continue to gather insights of future products. This will
from the early success of Vitana, enable faster, cheaper and more
many insights and lessons emerge efficient processing.
for potential future blockchain- At a meta level, this is a peek into
based experiments. These key the future of our industry and
insights stand out: possibly a way to include the next
❙❙ Parametric insurance: This is a two billion people in the world of
type of insurance that does not insurance, driving greater financial
indemnify the pure loss, but inclusion of our four identified
ex ante agrees to make a underrepresented segments:
payment upon the occurrence women, middle-class farmers,
of a triggered event.3 Its key octogenarians and people of faith.4
benefit is around simplicity and
It works because of two factors:
targeted accessibility to create
simplicity and trust. The beauty of
low-cost, niche products.
blockchain is that it makes it clear
❙❙ Frictionless experience: to first-time insurance buyers that
We expect sign-up for the if “this” happens, then “this” is what
product to be simple (minimal you get, automatically. Effectively,
underwriting) and claim it increases trust between insurer
payments to be automatically and customer, which is the basis
triggered based on an objective, for fulfilling relationships going
quantitative result for the forward.
customer. This reduces risk of
fraud and eliminates the need
for the traditional claims process.
24Endnotes
1 Salma Khalik, “Diabetes Fight Focuses on Pregnant Women,” The Straits Times, March 29, 2016,
https://www.str aitstimes.com/singapore/health/diabetes-fight-focuses-on-pregnant-women.
2 Consensus is the annual gathering of the cryptocurrency and blockchain technology world. For
more information, see https://www.coindesk.com/events/consensus-2019.
3 This means the agreement takes place before the event occurs.
4 LumenLab Annual Report 2018: http://lumenlab.sg/2018/12/20/annual-report-2018/.
Author
Zia Zaman joined MetLife in July 2014 as the Chief Innovation Officer for the
company’s Asia region and Chief Executive Officer of LumenLab, an industry-
first innovation center. As a member of MetLife’s Asia Leadership Group,
he is responsible for steering the company’s innovation agenda across the
region and around the world, with a passion for finding new ways to help the
underserved.
Much of Zia’s inspiration for new thinking sprouted on the two campuses where
he studied. Zia holds an MBA from Stanford’s GSB. His most formative early
years were spent at MIT, where he wrote about probability, traveling salesmen
and hockey goalies while pursuing his undergraduate and master’s degrees in
electrical engineering and operations research. Zia can be reached at
Zzaman@metlife.com | linkedin.com/in/zia-zaman-4ba46.
Cognizanti • 25Healthcare
Digital Helps Geisinger
Redesign Primary
Care Services
By Jaewon Ryu, M.D., Karena Weikel, Juliann Molecavage,
Rebecca A. Stametz & David Riviello
How can healthcare be made easier for both patients and
physicians? This regional U.S. healthcare organization
is answering that question by closing care gaps and
streamlining workflows with a data-informed, platform-
centric approach.
At Geisinger, we work to keep comprises nearly 1,800 physicians,
people healthy, and a key 13 hospital campuses, two research
component is developing centers, an innovation institute,
innovative ways to identify and a medical school and a health
manage clinical conditions, ideally plan with more than 550,000
outside of the hospital setting. members. In addition to fulfilling
While this may seem unusual for its mission to bring better health
a health organization with more to its patients and members,
than a dozen hospital and trauma Geisinger has a long-standing
campuses, this notion of making commitment to quality, medical
health easier is front and center in education, research, innovation
our approach to patient care. and community service.
Geisinger is a non-profit, For many years, the practices of
integrated health system that the U.S. healthcare industry have
dates to the 1915 founding of made hospital admissions and
its flagship hospital, Geisinger emergency departments central
Medical Center in Danville, PA. to care delivery. Not only are
The physician-led system now these sites more expensive for
Cognizanti • 27providing care, but they haven’t conditions and even proactively
always delivered the best health determining whether they’re at
outcomes or experiences either. risk for developing a disease that
could be prevented. That’s where
Our focus instead spans the
our Anticipatory Management
care continuum, where we’re
Program (AMP) app comes in.
increasingly building programs to
manage populations outside the
hospital walls, with a particular
Assessing risk to
emphasis on expanding primary improve care
care access. This orientation makes At Geisinger, we’re no strangers to
healthcare easier by meeting innovation. We’re well recognized
people where they are. It’s easier to as one of the earliest adopters
get to a clinic than a hospital, and of electronic health records
the home is even more convenient (EHR) and for our development
still. We are uniquely positioned to of transformative approaches to
do this because of the breadth of care delivery (see Quick Take,
our organization, which is designed page 30), such as ProvenCare®
to improve care for more than 1.5 or, more recently, the Fresh Food
million patients in Pennsylvania Farmacy or Geisinger at Home.
and New Jersey. Continuing this tradition of
innovation, the Steele Institute
To meet patients in these locations
for Health Innovation was formed
instead of in hospital facilities,
in 2018. This institute forges a
patients need to stay as healthy
new generation of leading-edge
as possible. We can help them do
solutions that aim to drive greater
this by getting a complete picture
affordability, improve quality and
of each patient’s health status,
increase access.
enabling them to manage existing
To meet patients in these locations instead of
in hospital facilities, patients need to stay as
healthy as possible. We can help them do this
by getting a complete picture of each patient’s
health status, enabling them to manage existing
conditions and even proactively determining
whether they’re at risk for developing a disease
that could be prevented.
28With AMP, we recognize that Closing gaps
improving care quality, identifying
gaps in care and the patient’s risk with digital
for developing an illness are all Previously, identifying and closing
tightly intertwined. The industry gaps had been a largely manual
often defines care gaps as missed process. The ambulatory and
health screenings based on patient primary care practices used paper
gender, health status, socio- forms to list patients’ care gaps,
economic factors and age. These making it difficult to capture
screenings include mammograms, discrete data such as errors or
colonoscopies, prostate and omissions caught by physicians.
nephropathy screenings, regular Our teams needed a more
hemoglobin A1c (HgbA1c) tests effective way to create a complete
and dozens more. and accurate view of patients and
care gaps, ideally embedded in
By filling these gaps, Geisinger
the physicians’ workflows. We
can take better care of individuals,
also needed to be more proactive
understand our communities’
about identifying potential
disease burden more deeply
conditions, not just current
and coordinate interventions
documented health.
appropriately. Each of these
capabilities is important to
Geisinger as we, and the industry,
move steadily away from fee-
for-service business models and
toward value-based models in
which reimbursements are based
on the quality of health outcomes.
Without complete health
information, it becomes that much
more difficult to optimize health
outcomes.
Cognizanti • 29Quick Take
The Doctor Ordered Food
Geisinger prescribes healthy food combined with clinical
intervention and education to take on Type 2 diabetes
By Allison Hess
At Geisinger, our Fresh Food week using fresh fruits, vegetables,
Farmacy™ program is showing us whole grains, lean meats and
that grocery carts filled with lean other staple items. Patients work
meats, whole grains and fresh fruits with care teams to set and meet
and veggies are as effective as some goals to control their diabetes
medications. and may receive food prep and
meal planning advice, nutritional
Type 2 diabetes is a major issue in
guidance, health education classes
the central Pennsylvania communi-
and healthy recipes.
ties we serve. To meet our patients
with uncontrolled Type 2 diabetes We rely on data analytics to show
where they are, we had to address a our Food Farmacies are improving
key obstacle: food insecurity. Type population health, closing care
2 diabetes responds to a better gaps and reducing the cost of
diet, but many of our patients with care. Data from our initial patients
the condition regularly experience enrolled in our first Fresh Food
hunger and/or don’t have money Farmacy in Shamokin, PA, shows
for or access to healthy foods. those patients experienced an
average two-point drop in HbA1c
Our Fresh Food Farmacy program
levels, along with lower weight,
addresses those problems. We
blood pressure, triglycerides
opened our first Food Farmacy in
and cholesterol. In comparison,
2016 and launched two more this
common diabetes medications, on
summer. The Farmacy
average, help to lower a patient’s
provides food
HbA1c by a half point.
for patients
and their Published data shows there is an
households $8,000 to $12,000 cost savings for
to make 10 every one point in HbA1c reduction.
meals per Applied to our results, we could
30potentially see medical savings of services, including
$16,000 to $24,000 per patient foot exams,
per year. mammograms and
colonoscopies.
These patients also had 27% lower
emergency room usage and 70% While frequent check-ups, as well
lower hospital readmission rates, as devotion to prescribed therapies
as well as higher participation in and physical-fitness regimens, can
primary care and specialty care contribute to better outcomes, our
services, compared with a similar Fresh Food Farmacy demonstrates
unenrolled population. Patients that a proper diet can go a long way
receiving eye exams increased toward enabling those with chronic
more than 16%, and more patients illnesses to live healthier lives.
participate in other preventive care
Author
Allison Hess is the Vice President of Health Innovations at Geisinger. A
12-year Geisinger veteran, she focuses on building transformative, scalable,
measurable and sustainable solutions that improve health, care delivery
and the patient experience while lowering cost. Allison earned her bachelor
of science in health education with a concentration in psychology from
Bloomsburg University. In addition to several certifications, she is currently
pursuing her MBA and has been recognized for her leadership and
employee engagement efforts within the
organization. Allison can be reached at
mediateam@geisinger.edu.
Cognizanti • 31Being both a provider and payer reading or high body mass
enabled us to combine data index – that enable us to say
captured in Geisinger Health Plan with confidence that he or she
medical claims with clinical data in may be suffering from an as-yet
the EPIC™ EHR and, in doing so, undiagnosed disease. Armed
migrate from an analog process with this data during an exam,
to a digital one. This enables us a physician can decide which
to capture diagnosis information screenings or interventions are
from the health claims. All the appropriate, and our care teams
claims data funnels into a data and health coaches can help
warehouse, which stores data from ensure these happen.
a legacy health plan system, as well
When we introduced the EHR-
as claims data from the recently
embedded application in 2017,
implemented Cognizant TriZetto®
we targeted our patients 65 years
Facets® core administrative
of age and older, many of whom
platform.
have multiple chronic and complex
Using custom algorithms, we were conditions and visit their primary
able to generate insights from care physicians several times a
these combined data sets and year. We recently extended the
deliver them to our physicians feature to cover patients with
using AMP, which was developed disabilities, as well.
and deployed in partnership with
our innovation and care teams.
When a physician pulls up a
patient record, she accesses this
application and information as part
of her workflow right at the point
of care. This makes it easier to keep
an accurate and relevant record
of a patient’s clinical conditions,
thereby triggering the right
interventions and care plan.
With these data sets and
algorithms, we can find clinical
markers in a patient’s EHR – such
as an elevated blood glucose
32While the app and its underlying analytics,
algorithms and data warehouse help streamline
patient management for teams, a key
ingredient in the primary care redesign was to
make it easier for care teams to communicate
regularly about the patient’s care.
Keeping it simple complications is coded E11.9. But in
a clinical record, physicians might
To address physicians’ time write “Type 2” or “Type II” or “Type
pressure, we introduced several Two.” Given this, we had to map
program components that have the data carefully so that claims
added to AMP’s success. For data could interact meaningfully
example, the app’s user experience with the EHR.
is optimized into the current
workflow to decrease duplicate Daily, weekly and monthly
effort; physicians tell us the application use reports, analytics
interface is intuitive. We partnered and dashboards suggest that
with our end-users to ensure the physicians have widely accepted
product’s ease of use, including the app. The reports also help target
the use of color cues, like red to individual teams or physicians who
mark an item as incorrect. Ongoing exhibit sub-optimal app use.
one-to-one and group training
sessions emphasize the correlation Redesigning primary
between closing care gaps and care with data
more effective care teams. This
The app is one aspect of our
helps keep the focus on the clinical
broader primary care redesign,
problem, not the technology
where we’ve implemented a
solution.
team-based care model for a
We’ve had to overcome several defined patient panel. Instead
challenges along the way. For of being a single practitioner,
example, the health plan’s claims each physician is teamed with
processing system captures data additional staff such as nurses,
coded according to the ICD-9 case managers, health managers,
or ICD-10 healthcare industry community health assistants
coding standards. However, the and pharmacists, all supporting
EHR system allows physicians comprehensive care for patients.
more freedom in their note-
While the app and its underlying
taking verbiage. In the ICD-10
analytics, algorithms and data
code set, Type 2 diabetes without
Cognizanti • 33warehouse help streamline patient Patients have benefited from the
management for teams, a key app in many ways. For example,
ingredient in the primary care physicians say their typical 15- to
redesign was to make it easier 20-minute appointment blocks
for care teams to communicate don’t provide ample time to
regularly about the patient’s care. cover all their patients’ health
For example, teams conduct daily issues, especially those with
10- to 15-minute huddle meetings, multiple chronic conditions.
run by trained moderators, to Appointments would run long,
plan their days as efficiently as making physicians late for other
possible by being more proactive patients, or subsequent follow-up
rather than being reactive. Items appointments would be needed
covered may include appointment to cover missed topics, which
cancellations and schedule increased inconvenience and cost.
openings, newly discharged Physicians were bearing the brunt
patients who need follow-up visits, of the stress of trying to manage
patient calls for advice that indicate this situation.
a need for a visit, or patients with
Now, whenever a patient 65
multiple care gaps to address.
years or older schedules a visit,
Data drives the care teams. the system automatically blocks
Whiteboards, aka “huddle boards,” double the appointment length,
display aggregate data, results or 40 minutes instead of 15 or 20.
and targets. Physicians use their While not every patient may need
personal dashboards to identify that additional time, simply adding
individual patients. Care gaps that a time cushion has taken some of
aren’t addressed during a visit are the pressure off providers, who
investigated promptly as “missed generally report a greater sense of
opportunities.” fulfillment. We have rolled out that
capability to all of our ambulatory
care sites.
Whenever a patient 65 years or older schedules
a visit, the system automatically blocks double
the appointment length, or 40 minutes instead
of 15 or 20. While not every patient may need
that additional time, simply adding a time
cushion has taken some of the pressure off
providers, who generally report a greater sense
of fulfillment.
34Anchoring new sometimes by shifting patients to
other providers or recruiting new
attitudes providers.
The AMP app is an anchor for an
This effort and others implemented
extended program in which we
at Geisinger are all part of the
track every variable possible related
value-based care model and
to primary care. The goal has been
outcomes-driven business model.
to fully inform the primary care
These models require much
teams with all of the information
more than simply getting away
inputs available. To that end, the
from using current procedural
EHR needs to be as comprehensive
technology coding widgets for
as possible so the care teams can
billing. They require changing the
adapt the care plans accordingly. In
physician culture and mindset, as
turn, great care management helps
well as addressing all the factors
patients avoid chronic conditions,
that affect a patient’s health.
worsened symptoms, hospital
admission or emergency room visits, Whether we are providing fresh
all of which add to healthcare costs. produce to diabetic patients or
developing a precision medicine
Understanding the disease burden
therapy, it’s our physicians and
is also important for deploying
primary care teams that connect
care programs and resources
our patients with these services.
appropriately. The data helps us
The app helps these teams, and
better understand the patient load,
our associates, successfully care
or panel, each physician is carrying.
for communities and individuals.
Two physicians may each have a
2,000-patient panel, but if one
group largely comprises younger,
healthy patients vs. older patients
with multiple chronic conditions,
the workload will not be balanced.
Previous procedures to monitor
panel size and track patients didn’t
ensure accurate, up-to-date
primary care physician data in
EHRs. Now, provider groups review
records, and the physician who
sees a patient the most frequently
will have that patient attributed
to him. The system also tracks
provider productivity. Whether
a provider’s panel seems overly
light or heavy, it can be balanced,
Cognizanti • 35Authors
Jaewon Ryu, M.D., J.D., is the President and CEO at Geisinger. Before
coming to Geisinger, he served as president of integrated care delivery at
Humana and previously held leadership roles at the University of Illinois
Hospital & Health Sciences Systems and at Kaiser Permanente. Dr. Ryu
received his undergraduate education at Yale University and his medical and
law degrees from the University of Chicago, after which he completed his
residency training in emergency medicine at Harbor-UCLA Medical Center.
Karena Weikel, A.S.A., M.A.A.A., F.A.H.M., C.S.F.S., is Vice President, Risk and
Revenue Management at Geisinger. She is a risk professional with 17 years of
healthcare experience and is responsible for managing Geisinger’s overall
cost of care, trend mitigation, data management, vendor relations, under-
writing, provider economics, risk adjustment, operational and regulatory
reporting, rate filing support, and organization-wide financial analytics for all
lines of business.
Juliann Molecavage, D.H.A., M.S.H.A., B.S.H.M., is Associate Vice President,
Quality and Primary Care Services at Geisinger Health. Her focus is on
quality, primary care practice redesign and information technology solutions
and operations, and she has led many organization-wide strategic initiatives.
Juliann graduated from Walden University with a doctorate in healthcare
administration. She is responsible for overseeing quality initiatives for the
Geisinger Medicine Institute as well as the implementation of new models of
care for Geisinger.
Rebecca A. Stametz, D.Ed., M.P.H., is the Associate Vice President, Product
Innovation in the Steele Institute for Health Innovation at Geisinger. She
directs a cross-functional, design-led department that deploys software
engineering and advanced analytics to create and deliver enhanced value
through health information technology throughout the care continuum.
As a principal, her research focuses on program implementation, medical
transparency, family-patient engagement and learning healthcare system
models. Rebecca holds a master’s of public health from East Stroudsburg
University and a doctorate of education in adult education from Pennsylva-
nia State University.
David Riviello is Senior Clinical Informatics Analyst in the Steele Institute for
Health Innovation at Geisinger. His primary role in this initiative has been
to advance the analytics and algorithms feeding AMP and measuring key
performance indicators. David earned a B.S. in mathematics at Bloomsburg
University.
The authors may be reached at mediateam@geisinger.edu.
36Scan the above image to hear Gary Beach’s thoughts on the future of learning. See inside cover for instructions to download the Cognizant AR app.
Commentary
A Radical Rethink to
Replenishing the Talent Pool
By Gary Beach
Four-year degrees are so old-school. To flood the workforce
with the emerging skills needed today, businesses and
employees alike need to relearn how to learn, with faster
and less costly approaches to upskilling.
All is not well in the global talent which finished last, was already
arena. The digital “skills gap” that experiencing a skills imbalance.
emerged earlier this decade is The first signs emerged in 1942,
widening into a chasm. According when the U.S. War Department’s
to International Data Corp’s Army General Classification Test
Futurescape 2019 report, two indicated that 40% of Americans
million jobs in artificial intelligence aged 17 to 24 had the cognitive
(AI), the Internet of Things, cyber- ability of an 8-year-old.3
security and blockchain will remain
By 1983, officials in the Reagan
unfilled by 2023 due to a lack of
Administration were so concerned
human talent.1 Some experts claim
that they commissioned a report
the only solution is a structural
entitled “A Nation at Risk,” whose
reset focused on how individu-
ominous conclusion warned: “Our
als learn. Most agree that the
once unchallenged preeminence
transition won’t be easy.
in commerce, industry, science
That’s because the skills gap has and technological innovation is
deepened over time. It started being overtaken by competitors
in 1964, when the International throughout the world. … If an
Association for the Evaluation of unfriendly foreign power had
Educational Achievement fielded attempted to impose on America
the First International Math Study the mediocre educational
(FIMS), which ranked student performance that exists today, we
math proficiency of students in 13 might well have viewed it as an
developed countries.2 The U.S., act of war.”4
Cognizanti • 39You can also read
