As part of our commitment to continuous improvement, and in response to challenges the healthcare ecosystem has faced relative to artificial intelligence (AI), Blue Cross and Blue Shield of Minnesota completed an enterprise-wide evaluation of the current and transformative potential of AI. This evaluation focused on not only the current and future impact on our operations and services, but also the profound positive impact on our members and clients.

At Blue Cross, we believe that AI, when harnessed responsibly, is a powerful tool to help manage the operational aspects of healthcare more effectively and efficiently, enhance the member experience to be more personalized, improve healthcare affordability, and promote healthier outcomes so we can all live our healthiest lives.

We acknowledge that with new technology comes new challenges and responsibility, such as removing bias and keeping confidential health data safe. As the nation's most trusted health plan,¹ we are committed to exploring and leveraging the ways AI can help us better serve members, providers, clients and our community.

To enable this, we established a governance structure that follows the National Institute of Standards and Technologies AI Risk Management Framework and emphasizes the need for transparency and interdisciplinary collaboration.

When it comes to deploying AI, fairness and data security are non-negotiable.

Here are just some of the ways we are leveraging AI to revolutionize healthcare and enhance your life and the lives of the people you care about.

1. Improving the way we work

Teams across Blue Cross already use AI to simplify and personalize member communications, streamline processes to improve the member experience, and boost operational productivity.

One example is integrating AI in Blue Care Advisor^SM, our all-in-one navigation and care management solution, to provide members personalized provider and next best action recommendations. With this technology, Blue Care Advisor users are two times more likely to seek and receive preventive care services than members who are not registered users,² unlocking the ability to better close gaps in care. The solution’s AI functionality is a primary contributor in helping to improve member health and lower the cost of care for both participating members and employers.

Earlier this year, Blue Care Advisor launched a pilot for an AI-powered chatbot that empowers members to quickly get answers to their questions while reducing care management-assisted calls and related costs.

Blue Cross is investing in generative AI to automate the provider experience as well, including credentialing, claims submission, and preauthorization — all with the goal of lowering the cost of care. Cost-saving enhancements like these help us reduce administrative costs while improving the efficiency and effectiveness of our member services.

2. Predicting the future

Predictive analytics is an increasingly critical component of our healthcare management system. The power of analytics enables us to take proactive steps to keep members healthy while managing the costs of their healthcare. In short, it helps us understand our members better so we can help them live their healthiest lives.

Matt Hunt, Chief Experience Officer at Blue Cross says, “Leveraging data to enable new technology will be critical for proactively addressing health issues and keeping healthcare costs under control.³ With continued improvements, we can put tools into the hands of our members that will help them through every step of their healthcare journey and give them access to healthcare products and services they need — faster and more efficiently.”

Examples of how predictive modeling assists us daily include:

• Identifying an individual member’s current and projected health risks so personalized and timely interventions are provided to close gaps in care (e.g., Blue Care Advisor next best action functionality)
• Correlating an individual’s historical health data with their current actions to fill in and bridge gaps in self-reported data 
• Identifying members who are at risk or are currently affected by social determinants of health (SDoH) equity gaps to help them get the care they need in a compassionate and culturally sensitive manner
• Analyzing population health data to create insights and predictions for potential challenges and future needs, so we can create targeted interventions and customized programs that contribute to improving the health of entire communities

3. Getting to a faster "yes"

Claims are a rich source of data that relates to both healthcare utilization and member engagement. AI modeling uses past claims history to identify patterns that can help automate the approval of claims faster in the preauthorization process.

Member claims history is one source behind Agent Assist, an AI-powered tool which streamlines and simplifies member communications. Member Services agents respond faster and more effectively to a caller’s questions, so members are more likely to get their questions resolved during a single call, with less wait time.

We have also implemented an especially important practice across the enterprise that ensures we never allow a machine to deny member care. If the data does not clearly indicate a request should be approved, a clinician reviews the case and decides the appropriate action.

AI is enabling Blue Cross to transform complex business processes and simplify the member journey. With appropriate human interventions and guardrails, we are making healthcare more efficient and affordable and arriving at a faster "yes."

AI for a healthy future

Our current AI initiatives lay the groundwork for the future as we discover new possibilities, learn from experience, and continually monitor the healthcare and technology landscape for better, smarter ways to operate.

We promise to leverage AI in ways that align with the quality standards members and clients have come to appreciate and trust in Blue Cross.