重写医疗保健规则：Pooja Ika ' 12

If you were looking for a case study in complexity and dysfunction, you’d be hard-pressed to find a better example than the U.S. healthcare system. 很少有行业像它这样复杂得让人抓狂，也很少有行业像它这样需要重塑的时机成熟，而这正是普贾•伊卡（Pooja Ika）在2021年启动她的医疗保险优势（Medicare Advantage）健康计划——永恒健康（eteralhealth）时所面临的挑战。

 

虽然Pooja一年前才从巴布森学院（Babson College）毕业，但她在医疗保健行业的根基很深。 我的母亲是一名初级保健医生，父亲创办了医疗科技公司，他们在餐桌上的谈话经常围绕着捆绑支付和基于价值的医疗等话题。 从很小的时候起，她就知道她想在医疗保健领域产生积极的影响。 After Babson, Pooja’s focus n箭头ed to Medicare Advantage plans, the government-approved plans offered by private companies that replace Medicare and often provide additional coverage. 她解释说，在这个领域，她觉得自己可以做出有意义的改变。 “These plans cater to the 65-plus population, which, to me, is one of the most vulnerable outside of the Medicaid population in this country, because they account for a majority of our healthcare spend, and naturally, as we age, our health becomes that much more important.”

 

对于像Humana和United这样的大型全国性航空公司来说，eternalHealth旨在成为一个灵活的替代方案。Pooja认为，这些公司的运营平台陈旧、过时、分散，有15到20个相互隔离的部门，这些部门都利用不同的技术供应商来完成日常运营。 Instead, Pooja utilizes a single end-to-end, cloud-based platform from nirvanaHealth, her father Ravi’s company, to span all departments. 这使她能够降低内部成本和管理技术所需的员工数量，并利用人工智能、机器学习和机器人流程自动化（RPA）来自动化每天在健康计划中发生的大约2,000至3,000个功能。 一旦达到临界质量，永恒健康将能够将销售、一般和管理费用从收入的12-13%（行业标准）减少到8%，将这些节省下来的资金再投资给利益相关者、会员、供应商和经纪人，为所有人创造更有价值的体验。

 

eteralhealth目前在马萨诸塞州和亚利桑那州开展业务，虽然Pooja过去常常考虑将业务扩展到更多州的未来目标，但她已经认识到，正确的发展方式更为重要。 “We’ve worked hard to build our brand around what we’re doing in Massachusetts, and we want to grow deeper in the state,” says Pooja. “You need more volume to make it matter, to drive value to the providers, and be big enough to be a catalyst for change.” Pooja is aiming to grow the plan’s membership to 50,000 covered lives by 2027, a goal backed by a strong brand presence. 帮助领导这次行动的是发言人大卫·奥尔蒂斯（David Ortiz），他在波士顿有着深厚的根基，热情、值得信赖的性格与永恒健康正在建立的形象相一致：平易近人、可靠、以社区为中心。

 

Pooja is the youngest woman to launch a new Medicare Advantage Health Plan in the United States, and in 2023, she was named to Forbes Magazine’s prestigious 30 Under 30 Boston List. 她比其他所有的高管都要年轻，这让她敏锐地意识到选择合适的人的重要性。 为了重塑医疗保险优势体验，Pooja还需要明白这个行业从根本上已经崩溃的团队成员。 “I needed people who would be open to a fresh perspective and think outside the box. In addition to that, I needed people who are strong in their roles, but who did not have egos and were open to collaboration and doing things differently.” 如今，永恒健康可以自豪地说，它是一个由女性创立、拥有和运营的组织，普贾认为这在医疗保健行业尤为重要，因为80%的决定都是由女性为自己和家人做出的。 “Women are the key decision makers when it comes to healthcare, and having that insight within our organization allows us to be more competitive and hone in on what people are looking for in a health plan.”

 

作为一名有色人种的年轻女性，普贾意识到自己在健康计划首席执行官中是一个异类； 然而，这只会鼓励她更加努力地工作。 “My mom always says that respect is not given, it’s earned. So for me, I had to make sure I was earning everyone’s respect enough to be the leader that I needed to be.” Pooja以前也有过这样的经历，她回忆说，在贝博体育，她是为数不多的印度学生之一。 However, she knows there is power in representation, and she thinks about her cousins Arya ’18 and Priancka ’25, who followed her to 贝博体育app. “I want Priancka to know that anything in life is possible, because I’m a firm believer in the art of the impossible,” says Pooja. “I want her to have somebody to look up to, and to know that her dreams could be totally different than mine, but whatever she sets her heart to, if she is committed and puts in the work, she will be able to do it.”