Healthy Workers, Healthy Wallets Driven by AI

An In-depth interview with CXA Group Founder and CEO Rosaline Chow Koo on her innovative platform for employee wellness, insurance, and benefits

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At the 19th annual Human Resources Conference, Rosaline Chow Koo, Founder and CEO of CXA Group, delivered a riveting keynote speech on the effects of Big Data and AI on employee experience. Following her keynote, Koo met with AmCham China to discuss the story and technology behind her company's cutting-edge platform. CXA is a true innovator and disruptor in the employee wellness sector, making it possible for employers to allocate existing insurance funds to keep employees healthy through a corporate-funded virtual wallet and dynamic mobile platform.

Koo shared insight into how the platform resolves both employer and employee pain points, reduces shared costs, and increases overall wellness. Throughout the relaxed interview, the light jazz-filled atmosphere of the impromptu cafe interview location set the background for an in-depth discussion on how CXA’s platform leverages AI and digitization to change the employee insurance and wellness game.

Background

You have a very interesting, and maybe unlikely, background. Could you tell us a little bit about yourself?

My father left China in 1919 on a dragon boat to the US and ended up in Mexico originally, and then made his way up to San Francisco where he hid in Chinatown as an illegal alien for 40 years. When he was 59, he wanted to marry and have children, so he turned himself in to the authorities and fortunately the government gave him amnesty and citizenship.

He met and married my mother in Hong Kong, who was there making money for the family after her property was repossessed by the government in Guangzhou. She waited until after my younger brothers were born in the US to tell my father that she had left two daughters behind in China. My father sponsored my half-sisters to the US, but sadly they arrived in the midst of the 1965 Watts Riots in South Central Los Angeles, where we lived in a neighborhood as the one non-black family. We were bullied a lot, but learned good survival skills like fighting and running really fast. So, we’re all originally from China. I migrated to Asia 22 years ago.

Before we get to CXA, can we talk about your previous startups?

CXA is my third startup. The other two were also tech startups during the dotcom boom – one in unified messaging and the other a regional payroll BPO. I’ve been in the HR space for a long time. Before that, when I was a banker in NYC, one of my roles was helping HR with their retirement plans. This is my fourth job working with HR. I ran an insurance company focused on selling to the workplace and then I led Mercer Marsh Benefits for 8 years across the 14 countries of Asia Pacific.

There’s something that particularly stands out about you and CXA. You saw these pain points in the area of employee benefits. How did you know the right technology to solve them? I read that you got your undergraduate degree in cybernetics.

I was an engineer, but a failed engineer. I studied engineering, but I was also in tech during the dotcom boom.

What is a cybernetics degree?

It’s human factors engineering and man-machine interaction. A lot of people with that degree either went into robotics or developing cockpits in airplanes. It was super early AI, and I got into it because I didn’t like hardcore engineering on its own. I really liked psychology, biology, business economics, and physiology. I went to college and studied this in the 80’s – very early-days of thinking about the human experience when interacting with computers or machines.

Has that background translated to what you’re doing now?

It has! It’s not just about technology. It’s how you think about the experiences of those using your technology. It’s the interactions between machines and people and how we need to enhance the whole customer experience and journey. To me, all of our technology is just that. The questions we’re asking are about behavioral change. How do you nudge someone and help them, knowing what you know about them, to decide what’s best, and then drive them to healthier behavior? Do you want to wait until you have late stage cancer or, what’s important enough to motivate you to change your diet, your exercise, your sleep, and your reactions to stress?

CXA Platform and Function

Can you expand upon how the platform accomplishes those things?

We’re running trials at work now, all of us in four different cities. I’m wearing a FitBit for the very first time. A lot of people are not personally motivated until they hit that moment of truth or crisis. So, we’ve put all our employees into teams of 10, and in each team there’s a senior leader – like your boss. If everyone does not achieve 10,000 steps a day, you don’t get as many points. So, there’s a lot of peer pressure.

Also, if you’re trying to change your diet and you do it in teams, you’re all eating together. You know that you’re not the only carb-free person and you’re sharing the experience and the challenges. We found that doing it in the workplace, where you spend most of your time – exercising together, eating together, and thinking about mental health – it’s actually a pretty fun way to bond with colleagues and to learn new habits over time.

It’s like “gamification”. 

We gameify everything.

How is the competition organized within the office setting?

We have 25 teams of 10 competing, and we’re going through the trials together. In the beginning, we all took blood tests, weighed ourselves, and we each know if we are personally pre-diabetic or pre-hypertensive. Then, we get a personal recommendation on how to improve our health based on our blood tests and current lifestyle habits. Everyone has to log their food. We want to learn at CXA: How do you motivate people to lose weight, get inches off their waist, and improve their blood sugar? It’s hard. We’re running trials to see how small changes over time can lead to weight loss, smoking cessation, better eating and sleeping, and feeling better about yourself.

How many weeks in is this?

Next week is week eight, the final week. We’re all going to weigh ourselves next week and then take the 2nd set of blood tests. We’re trying to uncover what motivates different people to change. With leadership buy-in, peer pressure and dollars in their wallet, recognition and team participation, could all of that help? We’ll do it together so that no one feels that they’re alone in this.

This sounds like a really comprehensive system. When this is a real product and ready, how do you bring this out?

Most of the core product for employees is ready and launched. We’re piloting and implementing the corporate-wellness products now. Most of the personal employee platform is already there and has been working for five years. Now we’re taking it up a level. It’s not just the wallet, insurance, health assessment, and marketplace anymore. Now we want to know how to get people who are pre-diabetic to not-diabetic, pre-hypertensives to modify their lifestyles and to reverse their diabetes. This way, we can help HR focus their interventions on those at risk and the unhealthy so that we can help control their rising healthcare costs.

How do you institutionalize this if another company wants to adopt this technology? For CXA, what does that look like, is there a manual?

No, it’s a mobile app where we aggregate all the different providers involved with employee benefits. It’s a marketplace where each employee can see what drives them to get healthier. We have all of the apps that can track the leaderboard by team and by individual. We built it such that it’s self-service. We have a marketplace that integrates the insurance companies, the check-up providers, the TPAs and all of the gyms, smoking cessation, obesity management, nutritionist, stress management, dentists, TCM, second opinions, checkup bookings – everything.

Is all of the information that these people need to do this all in the app at all times?

Yes. If we had a health check-up for you and we found out that if you smoke, you don’t exercise, and that you’re not sleeping well, it will actually nudge you to get better and better.  Your company can also reward your e-wallet if you do lose weight, quit smoking, or improve your blood glucose.

Is it the results of finding out that those things are true that would nudge me or is it push notifications?

That’s what we’re trying to figure out, and that’s why we’re running trials. What we’re finding is that each person’s motivations are different so we need to link goals to motivations. We’re researching how to use the platform’s AI to figure out what works for you, based on your motivations, your goals, your medical claims, your blood tests, your preferences, your age, and your family status. We want to figure out how best to nudge people to change.

A big focus in HR right now is instant feedback, because millennial workers are especially receptive to it. Are other tools in place within the CXA platform to provide meaningful feedback?

A lot of employers ask us to put recognition and thank-you cards into our system to build up community and show appreciation. This is instant recognition. It’s a corporate community. If a manager recognizes you through the application, everyone else can see it. That’s the value of this, and it can be done instantly.

Disruptive Technologies and CXA

Is there currently AI in the platform?

Yes, but it’s very simplistic at this stage. We take just a few things: claims, blood tests, habits, and some wearable data. Soon, we’re going to be able to use continuous-monitoring medical device meters that track your insulin levels and add that to it. It’s essential for every group. The more data you have, the better it is. 

In a work setting, if you wanted groups to do this, groups would buy these meters, and then an e-service provider would be connecting through the cloud?

We’re trying to build a virtual version of this. Some people lose weight by going to the gym or yoga classes, so we included yoga and Pilates providers. Others want to do it by changing the food they eat. Everyone has different preferences, and we have thousands of options.

Are there any other forms of disruptive technologies that you are integrating, implementing, or expecting to see CXA use in the future?

AI’s just part of the technology. What we had to do was to digitize the paper into structured data. Blood test results are PDF and claims are paper receipts. We need to convert it into data, then convert the data into insights, and finally feed this data into the AI.

Are there any wellness dimensions right now that you can’t measure or that you can see something like greater processing power helping you to do that in the future?

I think integrating all the disparate data from fragmented sources and the AI piece are key. We’re starting to take genomics for example. The West has already moved into precision medicine. I think that once you have that data, you actually start moving towards early detection and prevention and prediction of future disease prevalence and insurance premium pricing. And if you succeed with early detection and successful intervention, then we start providing HR the insights they need to bend the cost curve.

Even better, what if your company could pay for a lot of that for you by shifting their existing insurance treatment spend into early detection and prevention?

So, you’re giving people those next steps, as opposed to just information.

Exactly. I didn’t know until I started tracking things myself that 10,000 steps a day would be so much work. I found out that I was usually only walking 2000 steps a day before I started measuring.

This seems like a total-life solution that is just as comprehensive and threaded throughout your entire life similar to WeChat. It’s like WeChat for health.

Yes, it is WeChat for health in the workplace, but also financial wellness and lifestyle. You don’t want to be super-healthy and then have no money when you stop working. Then, you’d never stop working.

We talked about the app being WeChat-integrated. Is it a stand-alone app everywhere outside of China?

Yes. A lot of Chinese companies are using corporate WeChat, which is all on the mobile app. They don’t want their employees to download another app, all they want is to go there directly. WeChat has this open-platform strategy where everything is made possible. The technology here is much more advanced, in terms of connecting to different vendors and marketplaces on mobile. It’s much easier.

CXA Inside and Outside of China

Considering that WeChat offers connectivity and interconnection between surrounding markets and vendors, is that still a pain point for you in other regions?

It’s not as easy in other regions as it is in China, because WeChat is part of life here. In other countries, there’s no WeChat equivalent. Is it WhatsApp? But you can’t integrate anything into WhatsApp. You have to download the CXA app in other markets.

Do you have any regional strategies at the moment? Do big and small companies all benefit from the CXA system?

We’re not just in China as our platform is already being used in 20 countries by different corporations. We want to build an ecosystem across many countries. Now what’s happening is, not only is HR using us for their employees, but the largest banks are white-labelling our SAAS platform for their SME customers and for their SME employees. Even if you work for a tiny company or startup, you finally get access to the same things that the large companies do.

Was that by design or did that come about organically?

It was by design, because before I ran Mercer, I ran an insurance company in 2002 where I was in charge of their BancAssurance channel. We sold to everyone except the SMEs, so it’s an untapped channel which I’ve been thinking about for years. I’ve been focused on HR and the workplace for so long and finally figured out the best value proposition and approach to help HR in big and small firms – shift their existing insurance spend into prevention to improve employee health, cutting the escalating cost increases.

That’s beautiful.

The great news is, for the price of insurance and what you spend on insurance, you can do all of this. That’s the neat thing about this. We’re trying to change the whole insurance brokerage industry that HR used to see as a necessary evil and transform it into a force for good. They used to tell me, “You guys add no value.” We asked ourselves what we should do. So, I have invested all my family savings of US $10 million to build my dream and change the game, and add great value for each of our employers and employees.