John Ninomiya

Q: In the healthcare field, there’s always a struggle to balance two issues: quality of care and cost efficiency. Could you tell us about that?

I’m not sure “balance” is the correct term to use. People often assume that on the one hand, you have quality and on the other hand you have efficiency—and that you have to trade one for the other in order to reach a middle ground. In fact, there’s a startling amount of evidence coming from both the actuarial world and the academic literature suggesting that spending more money on healthcare often results in worse clinical outcomes.

Q: Would you go so far as to say that cost efficiency and improved healthcare go hand in hand?

At the very least they are mutually consistent. There’s always the extreme case where if you spent nothing, then probably nothing would get done and you wouldn't have a very good healthcare system, but in the context of where we are today, there is a lot of room for much more efficiency even as we improve quality.

Q: Is this an idea that’s pretty widely accepted in the healthcare field?

People who study these issues understand it. Among healthcare providers there are those who read the journals and may have an intellectual understanding of it, but their day-to-day demands usually don’t permit them to implement much of this knowledge. There are some exceptions; some healthcare providers are quite innovative with regard to efficiency and quality. However, the healthcare environment is very tumultuous right now with a lot of conflicting different constituencies and goals, so I'm not sure that these ideas can always be heard above the other noise.

Q: What aspect of the healthcare field do you think will change the most in the next decade?

I think that the application of information technology to healthcare is going to be very significant. When I first started working in the healthcare field 20 years ago, there was a feeling that we were on the verge of some remarkable breakthroughs as far as electronic patient records, but so far that hasn’t come to fruition. A lot of information technology is like that. There's an initial buzz about some new concept, but in the interim, we don’t have the infrastructure to make it happen. I think we’re finally coming up on a moment when a lot of things will actually happen with healthcare IT.

Q: What was your perception of Milliman before you came to work here?

Milliman enjoys a wonderful reputation in the insurance industry. I worked for several clients of Milliman before I came here myself. Meeting the individual consultants here and learning about the products and services they offered made me want to try to work for Milliman at some point in my career. I liked the people here, and I already knew that Milliman was reputed to have the best consulting resources in the industry.

I got my actuarial accreditation as fellow of the Society of Actuaries and then returned to school mid-career to do a PhD in epidemiology in a joint program offered by San Diego State University and the University of California at San Diego. I did this because I was very interested in healthcare issues. I worked part-time for Milliman while I was going through the process of my coursework and writing my dissertation. I’ve been working with Milliman full-time ever since I finished.

Q: How does Milliman handle work/life balance?

If you read our personnel and management statements, you’ll see that work/life balance is always described as a desirable and very important thing. I think that that's very real at the actual management level in our company. It’s certainly been true in my case.

Q: Imagine that it’s the first day of work for a new employee in your office in San Diego. What advice would you give her to help her do well there?

I would encourage her to take advantage of the opportunities that the organization affords to meet people who are doing a lot of innovative work. I think another thing I would urge her to do is to look for continued opportunities for professional growth and for upgrading one’s skills because that's certainly what our clients look to us for. Milliman is known for its consultants being absolutely on top of their game and on top of their professional skills.

Q: How possible is it to grow one’s career within the organization?

Milliman is very entrepreneurial and its structure really does cultivate—and perhaps demand—people who want to innovate. Milliman is looking for someone who is a bit more dynamic, someone who has ideas and is really interested in seeing those ideas brought into practice.