Opinions expressed by Digital Journal contributors are their own.
The U.S. healthcare industry cares for a population of over 330 million people. With the diversity and size of the United States, there are a myriad of challenges that impact both providers and patients alike. These issues contribute to the public perception of the healthcare system being complex, expensive, and even dysfunctional. The healthcare system needs innovators who are willing to devote their lives to tackling its challenges. Honoured with the 2024 Global Recognition Award for her contributions to the Healthcare Industry and the ‘Go Above and Beyond’ award by her company, Ashwini Pai is one of these innovators in healthcare. How did she earn these awards and why were her contributions extraordinary? It all began in a city 8,000 miles away from the USA.
A colourful and technological birthplace
Growing up in the leading city of exporting information technology in India, Bengaluru, Ashwini is widely aware of technology’s potential for impact on people’s lives. This environment ignited her interest in tackling complex problems and analytical thinking. Ashwini decided to pursue a bachelor’s degree in chemical engineering from the esteemed BMS College of Engineering. This decision helped improve her analytical skills and built her foundation in core scientific principles.
“My upbringing in the technologically advanced and culturally diverse city of Bengaluru, coupled with my academic background has given me a unique blend of technological rigour and innovative thinking. This unique mix has proven instrumental in my successes, as I continue to spearhead key initiatives within the healthcare industry,” Ashwini mentioned, highlighting the significance of her hometown to her chosen career in healthcare.
Building a career in healthcare innovation
When Ashwini graduated from university, she started her career in the healthcare technology industry and has driven several impactful projects since then. One of her highlighted projects was when she served as the lead engineer in constructing a real-time member data integration system for the Pharmacy Data Platform. Her responsibilities were in designing a solution to integrate member eligibility information, health plan benefits, demographic data, and expanding to all lines of business (commercial, medicaid, or medicare). This project greatly improved operational accuracy and service efficiency across healthcare organizations.
“This solution truly enriched the platform, ensuring a holistic view of the member’s data thereby facilitating streamlined services. The impact of this data integration project extended beyond internal operations. The digital capability to quickly identify healthcare enrollees via the platform empowered more efficient customer relations. This project stands out for me because it genuinely transformed our operational efficiency, enriched our member data management, and most importantly, expedited our customer service — all vital elements in effective healthcare management,” Pai said, referring to the project’s success.
Another significant project she led was the creation of a single source of truth for provider data. She brought together disparate data into a single, unified platform. “My efforts have greatly benefited healthcare providers and patients alike. This actionable, accurate, and holistic view of provider data enables strategic decision-making, fosters reliability, and promotes transparency,” she stated.
Steered by Ashwini, her team expertly constructed an automated bulk data update tool using AI predictive modelling. This innovative tool is capable of identifying structured and semi-structured data, and automating data updates in the provider application. Traditionally, these data updates, received from provider organizations and hospitals, took several months to process, and demanded intensive labour. This innovative application has dramatically reduced the turnaround time from months to just a few days, signifying a substantial advancement in the field and aligning with the pace of our digital era.
Ashwini has held a vital role in constructing a provider credentialing data repository for credentialing applications. This pivotal development enabled seamless bidirectional, real-time data integration between the intake and credential verifier application. Her contribution has not only streamlined the data exchange process but also considerably enhanced data availability and accuracy, further demonstrating her proficiency in creating impactful data solutions.
Most importantly, and considered her career’s turning point, her development of a comprehensive proof of concept (POC) which turned into a reality that aimed to tackle long-standing issues relating to inefficiency in calculating accumulator balances. Considering the long-standing problem with the traditional manual calculation of the accumulator balances and recognizing the need for greater accuracy and efficiency, she decided to have a solution for it.
“The POC had the capability to recompute Accumulator balances autonomously and validate these calculations against the traditional manually driven source of truth. This proved instrumental in identifying the underlying causes of data discrepancies that had previously eluded us. . The system allowed us to track the financial implications of these discrepancies through a set of automated reports. Moreover, it enabled us to monitor the progress of remediation for affected members effectively, “Pai’s discussion on POC’s impact on healthcare industry
Those were just a few of Ashwini Pai’s innovations that contributed to the healthcare community and won her the 2024 Global Recognition Award.
The long road ahead
Ashwini’s journey in driving change in the healthcare industry certainly hasn’t been smooth. There are a multitude of challenges she often needs to overcome. The fragmented systems, the sheer volume of data, and the fast-paced advancements of technology itself. Ashwini knew she needed to adapt quickly to every challenge. This pushed her to embrace change rather than resist it. For example, when she chose to lead the project that involved designing the Pharmacy Data Platform using big data analytics technologies: “I embraced continuous learning, adaptability, and maintained a driven attitude throughout the project… Ultimately, facing and overcoming this challenge has positioned me at the forefront of our rapidly advancing industry, enabling me to make meaningful contributions that enhance healthcare outcomes,” she explained.
Looking ahead, Ashwini is committed to leveraging her skills and expertise to construct solutions that make quality healthcare accessible and affordable for everyone. She aims to bridge the gaps in the healthcare industry. Also, she continues to share her knowledge and experience by mentoring interns and being a judge for Artificial Intelligence excellence in technology awards and cybersecurity awards, while cherishing living with her family in Richmond, Virginia.
