Rohan Kulkarni — Healthcare and Life Sciences Practice Leader, HFS Research[00:04]
Greetings and welcome to HFS Unfiltered. My name is Rohan Kulkarni and I lead the Healthcare and Life Sciences practice here at HFS Research. My guest today is Nani Iyer, who leads growth and strategy for Wipro’s healthcare business. In the fall of 2022, HFS published its HFS Horizon for Payer Service Providers report. We evaluated 21 service providers across four dimensions of why, what, how, and so what, to categorize them into three horizons. Horizon 1 service providers support functional transformation and help reduce costs. Horizon 2 providers drive enterprise business transformation at scale to impact cost and experience. In Horizon 3, providers leverage deep healthcare expertise to craft domain-specific transformation that addresses costs, experience, and health outcomes—the triple aim of care. The horizon study is unique in its construct. Unlike a ranking study, each horizon reflects a set of capabilities aligned to specific industry challenges that require addressing. It’s a practical tool for making high-confidence buying and partnering decisions for health plans. The Healthcare Horizons report boldly indicated how healthcare funding is shifting and its implications for service providers. In 2020, enrollment in self-insured employers surpassed enrollment in plans underwritten by health insurers. Self-insured employers will increase direct-to-provider contracts, both for primary and acute care, to drive improved employee productivity instead of just reactive care. A shift in this market dynamic could make a positive change in aligning HCPs to health versus just volume-driven sick care. The shifting markets are forcing healthcare enterprises, both health plans and providers, as well as new entrants, to create new business models that require a new level of vertical integration. Integrated delivery networks, or IDNs, such as Kaiser Permanente and UPMC have shown that the power of vertical integration across the healthcare ecosystem can be powerful, though the impact has been rather limited at this point. Lastly, the services market is attracting service providers of all stripes to address the AAA challenges: to reduce costs, to enhance experience, and improve health outcomes. Service providers evaluated included consulting shops, IT service providers, BPOs, and healthcare domain specialists. So that said, Nani, let me ask you: I thought Wipro did really well in the study. Its strategy related to its positioning, matching the outside-in perspective with what Wipro intends to address. What are your views of the horizon study?
Nani Iyer — Growth and Strategy Leader, Wipro Healthcare[02:41]
Thank you, Rohan, for this discussion today. I’m absolutely delighted to be here with you for this videocast. The HFS Horizon reports offer a unique approach that goes beyond the conventional 2-by-2 ranking system. It focuses on guiding payer organizations in selecting partners based on capabilities and areas of expertise. For service providers like Wipro, this report provides valuable insights into the future direction of the industry and emphasizes the significance of the impact we can make for our payer customers. It fosters closer collaboration between the industry and service providers like us by identifying areas of partnership and mutual benefit. At Wipro, we are proud to be categorized as a Horizon 2 enterprise innovator in the study. We actively support our payer customers in their healthcare transformation journey by reducing administrative costs and enhancing member experiences. Our digital platforms play a crucial role in the individual market and Medicare sectors, enabling us to deliver tangible results. Moreover, our digital operations leverage proven automation playbooks across claims, provider operations, and member operations. And finally, our digital transformation initiatives involve modernizing legacy systems by seamlessly integrating them with today’s digital interfaces and cloud technologies. The market dynamics portion of the HFS Horizons study sheds light on how payer organizations are transitioning from risk-bearing insurers to service providers for self-funding employers and government programs. In fact, your report says that 80% of the payer business is now services business. This shift underscores the need for alignment between payer clients and service providers like us. This is where the HFS OneOffice vision of actionable digital transformation comes into play. By leveraging collaborative cross-functional enterprise operations powered by integrated emerging technologies, we can bridge the gap between payer customers and service providers. We continuously strive to enhance the employee experience and the end customer experience by improving our platforms and offerings. All in all, Rohan, I would say the HFS Horizons report is a study which I have read end to end, and I would encourage everyone who wants to get a better understanding of the intersection of technology and healthcare insurance in the US and around the world to read it.
Rohan Kulkarni — Healthcare and Life Sciences Practice Leader, HFS Research[05:10]
Thank you, Nani. That’s very kind and I appreciate your words. Let me ask you this: you lead the strategy function at Wipro’s healthcare business. Talk to us briefly about what the future holds for Wipro Healthcare.
Nani Iyer — Growth and Strategy Leader, Wipro Healthcare[05:10]
So this report is truly exciting, as it showcases Wipro’s capabilities and serves as a guide for our future endeavors. So that’s where my function comes in, and I see your report as a lighthouse for us to take the next steps. We firmly believe that we have all the necessary building blocks, both through our own products as well as partnerships, to offer comprehensive solutions for our payer clients, whether it’s commercial, individual market, self-funded plan administration, Medicare Advantage, or state Medicaid. As an example, we’ve invested in and developed a modern digital platform called EMAS for state-managed Medicaid information systems. This platform leverages HealthEdge, Salesforce, and some of our own IP to create a modular and modern solution for state MMIS systems. We also possess in-house expertise in claims systems, enrollment, and billing platforms, and we collaborate with payer clients to modernize their legacy systems and transform operations. Our future plans, Rohan, revolve around bringing together these building blocks and creating transformative out-of-the-box offerings for our payer clients. We aim to infuse concepts like design thinking and generative AI to develop engaging member experiences. Our goal is to provide optimal healthcare experiences without compromising the human touch. Consequently, we are investing on three fronts. A: integrating our platforms to create industry-leading out-of-the-box solutions for payer clients. B: crafting pragmatic point solutions for value-based care that combine design thinking, analytics, AI, IoT, and our member engagement capabilities. And finally, innovating solutions around price transparency by leveraging generative AI to create exceptional member experiences while addressing the triple aim of care. Net-net, we are really geared up to provide innovative out-of-the-box solutions for our payer clients to help them in their journey of digitization and transformation. And I would say, Rohan, your report has been instrumental in creating the strategy.
Rohan Kulkarni — Healthcare and Life Sciences Practice Leader, HFS Research[08:28]
Thanks, Nani. That was excellent, and I’m kind of excited about the fact that your go-forward strategy is a combination of the mature and stable expertise that you bring, as well as the excitement of adopting emerging technologies and new models there. So I wish you and Wipro the very best, and thank you very much for joining me here.
Nani Iyer — Growth and Strategy Leader, Wipro Healthcare[08:28]
Thank you, Rohan, for this discussion. Really excited.
