Thought Leaders in Artificial Intelligence: Ram Swaminathan, CEO of BUDDI.AI (Part 6)

Sramana Mitra: Last question. When you look around in your space, where would you point new entrepreneurs to look for white spaces? 

Ram Swaminathan: In general, you should look for problems by not reading some Forbes article. The challenge is more on the ground. The more that entrepreneurs can talk to functional workers in that particular domain, the better.

The first way to start is, of course, to look at Forbes, Wired, and all of these magazines to find areas where they are pointing at problems. The next step is to take some of these problems and see what relates to the functional workers and the journey they have gone through in life. They need to spend the time and go meet people. 

Sramana Mitra: Ram, this is not what I am looking for. This is what we do. We train people on methodology. I am not looking for methodology. I am looking for specific problems to solve. 

Ram Swaminathan: In healthcare, I can give a laundry list of problems to be solved. Let me start with prior authorization. Prior authorization is an incredible problem to be solved today, because it results in denials. These are straight losses of revenue for hospitals. Some of these prior authorizations can be very costly. It can start from $5,000 up to $50,000.

The second problem would have to be the unstructured data. The unstructured data in healthcare is also a detriment for even coming up with vaccination for COVID. I put these two things into one sentence. It will ring a bell right now because there are 19,000 research articles published. How in heaven’s earth is any one pharma company going to read those 19,000 articles? It’s a mind-numbing number.

There are research papers from South Korea, India, Brazil, China, Russia, America, and Europe. You have all these research papers that have to be interpreted. You have to understand the efficacy that each method has taken and be able to help get the essence to a discovery team within a pharma company. This is a massive, ongoing problem.

I think startups need to tackle the problem of the unstructured nature of data sets and be able to interpret the insights. The hospitals need that as well. The physician needs that from a different angle. For example, they need it for clinical documentation improvement. When a physician documents in a hospital setting, there is always constant feedback that the physician gets from a Clinical Documentation and Improvement team within the hospital.

The reason why that happens is that the physician documentation has a direct impact on reimbursability. This means that they are giving so much importance to the way the physician is documenting. Is he or she documenting all of the diagnosis, procedures, and all the drugs being administered? All of that matters, and if something is missing, then you need technology to flag it. That also is not there. That is an area that we are innovating.

I think we need more entrepreneurs focusing on CDI problems in hospitals. Also, there is the age-old reimbursement problem. America is heading towards value-based care. Medicare is telling these organizations, ”You go manage that life in this population and I am going to pay you $18,500. You go manage the equity levels of these patients and bring their risk levels down.”

Numerous problems need to be solved here. You need software to predict the risk level of the patient. You need software to predict the disease progressions, and you need to predict things earlier so that the care plan can be altered. You can prevent the patient from getting into risky positions. There are a lot of problems that need to be solved. 

Sramana Mitra: Very good. I love your passion and precision. I think it will be good for entrepreneurs who are looking for problems to solve. On your business, my observation is that you have a bigger opportunity in the collections business model than the codification business model. 

Ram Swaminathan: Yes, billing is an incredible business model. The reason why we took baby steps is that medical coding is one of the hardest problems. 

Sramana Mitra: Yes, you needed that technology in place before you could start the other model. Very nice talking with you. Thank you for your time.

This segment is part 6 in the series : Thought Leaders in Artificial Intelligence: Ram Swaminathan, CEO of BUDDI.AI
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