Rewriting The Rules of Healthcare: 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. Few industries are as maddeningly complex, or as ripe for reinvention, and that is precisely the challenge that Pooja Ika embraced when she started her Medicare Advantage health plan, eternalHealth, in 2021.

 

Although Pooja had only graduated from Babson College a year earlier, her roots in healthcare ran deep. With a mother who is a primary care physician and a father who builds health-tech companies, dinner-table conversations often centered on topics like bundle payments and value-based care. From an early age, she knew she wanted to make a positive impact in the healthcare field. After Babson, Pooja’s focus narrowed to Medicare Advantage plans, the government-approved plans offered by private companies that replace Medicare and often provide additional coverage. This was a space where she felt she could make a meaningful difference, she explains. “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.”

 

eternalHealth is designed to be a nimble alternative to the large national carriers like Humana and United, which operate on platforms that Pooja describes as old, antiquated, and fragmented, with 15 to 20 siloed departments that all leverage several different technology vendors to perform their day-to-day operations. Instead, Pooja utilizes a single end-to-end, cloud-based platform from nirvanaHealth, her father Ravi’s company, to span all departments. This allows her to reduce internal costs and the number of employees required to manage the technologies, as well as to leverage AI, machine learning, and Robotic Process Automation (RPA) to automate approximately 2,000 to 3,000 functions that occur daily within a health plan. Once critical mass is reached, eternalHealth will be able to reduce selling, general, and administrative expenses from 12-13% of revenue, the industry standard, to 8%, taking those savings and reinvesting them back into their stakeholders, the members, providers, and brokers to create a more valuable experience for all.

 

eternalHealth currently operates in Massachusetts and Arizona, and while Pooja used to think about future goals in terms of expanding to more states, she has learned that growing the right way is even more critical. “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. Helping lead the charge is spokesperson David Ortiz, whose deep Boston roots and warm, trustworthy persona align with the image eternalHealth is building: approachable, reliable, and community-centered.

 

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. Being younger than all the other executives she would recruit to her leadership team made her keenly aware of the importance of selecting the right people. With the goal of reinventing the Medicare Advantage experience, Pooja also needed team members who understood that the industry is fundamentally broken. “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.” Today, eternalHealth can boast that it is a woman-founded, owned, and run organization, which Pooja feels is particularly important in the healthcare industry, where 80% of all decisions are made by women for themselves and their families. “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.”

 

As a young woman of color, Pooja is aware that she is an anomaly among health plan CEOs; however, this has only encouraged her to work harder. “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 has also been in this position before, recalling that at Fay, she was one of only a few Indian students. However, she knows there is power in representation, and she thinks about her cousins Arya ’18 and Priancka ’25, who followed her to Fay. “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.”