#522 Actionable Insights: From Claims Data to Member Experience with Ramesh Kumar | ShiftShapers

In this episode of ShiftShapers, host David A. Saltzman talks with Ramesh Kumar, CEO and co-founder of zakipoint health. Ramesh shares how a personal mission to help his father navigate healthcare led to a professional pursuit: transforming overwhelming claims data into actionable insights for employers, advisors, and members.

The conversation explores the evolution of predictive modeling, the growing importance of fiduciary responsibility in plan design, and how AI-powered platforms are helping advisors simplify benefit decisions and improve outcomes. Ramesh offers real-world examples of how data can shape plan strategy, change behavior, and improve care—before costs spiral out of control.

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🔑 Key Takeaways from This Episode

📌 Claims Data Is the Starting Line—Not the Finish

TPAs can’t block it. Advisors must request it. With the right tools, data can reveal inefficiencies and drive smarter decisions.

📌 Predictive Modeling Meets Personalization

Ramesh explains how modern AI doesn’t just stratify risk—it tailors messages and care nudges to drive better action at the member level.

📌 Fiduciary Awareness Is on the Rise

High-profile lawsuits and rebate opacity are forcing plan sponsors to demand better data—and use it.

📌 AI Is Rewriting the Navigation Experience

Agentic AI will soon act as your members’ personal guide—making healthcare access faster, smarter, and more human (even if it’s not human).

📌 Member Engagement Must Be Proactive

You can’t educate after the ER visit. The future belongs to platforms that reach members before the bill comes.

⏱️ In This Episode

00:00 Introduction to Ramesh and zakipoint health

02:00 From personal mission to industry disruption

04:00 The problem with too much (bad) data

06:00 Turning claims into strategy: risks, costs, gaps

08:30 How fiduciary pressure is reshaping advisor roles

10:00 Making healthcare navigation member-centric

14:00 Predictive modeling and behavioral segmentation

16:30 Agentic AI and rethinking healthcare workflows

19:00 AI in mental health, coaching, and chronic care

20:45 What's next for advisors and tools

22:00 Ramesh’s 5-year vision: frictionless healthcare access