After building a “digital front door” for members, this Blue Cross plan is using AI to help navigate better experiences, lower costs

Updated on April 8, 2024
artificial intelligence in healthcare

Throughout the entire healthcare ecosystem, there are countless programs and strategies designed to help inspire and motivate people along their personal health journeys. 

As someone who has dedicated my career to creating better consumer experiences, I’ve seen firsthand how people can get overwhelmed with the sheer volume of information and opportunities presented to them, creating the inability – or, at the very least, a sense of unease – to navigate some of the most critical aspects of their lives. When someone can’t tell which healthcare options are right for their personal situation, an easy, and unfortunately too frequent, choice can be to disengage and stop trying altogether. This is not good place to be for either your health or your wallet.

At the start of 2023, Blue Cross and Blue Shield rolled out a new technology tool designed to address all pain points that can get in the way of understanding and utilizing health plan benefits. We call it Blue Care Advisor. By integrating claims, benefits, deductibles, health and wellness programs, and customer service into one application, we built a “digital front door” for members to walk through. 

The conception of Blue Care Advisor marries two objectives that we as a payer place great importance on: creating a positive member experience and impacting the affordability of care. On the experience side, Blue Care Advisor is all about anticipating needs and recommending “next best actions,” based on someone’s personal health goals, health assessment, and claims-based data. More and more, these capabilities are leveraging predictive analytics and AI.

Much like the massive expansion of telemedicine during the pandemic, AI is having its “mainstream” moment in the national conversation regarding the future of healthcare. In reality, payers like Blue Cross have been using algorithms and predictive modeling in healthcare for many years. What has everyone’s attention right now is how fast AI is able to advance these capabilities. 

Today, at any given moment, Blue Care Advisor can rank more than 140 clinical conditions by the most important need for each individual member. We’re also investing in the use of GenAI to improve member communications. We’ve just begun to integrate GenAI into our service capabilities through use of an “agent assist” tool – enabling our call center teams to respond to member inquiries more effectively and in real-time.

All of our plan’s commercial markets members have access to Blue Care Advisor, totaling more than a million users across our state. The satisfaction performance data has been very encouraging, as the tool is focused on helping the member achieve their health goals. 

For example, populations with an elevated risk of chronic health issues are often at a loss for the greater amount of care they require. Through computer modeling and AI analysis, Blue Care Advisor is able to predict and place at-risk members into categories based on their health profiles and recommend the next best action to take. This information is also used by our case management nurses to conduct proactive outreach and guide members toward the most appropriate options for their circumstances.

As a chief experience officer, I am focused on customer satisfaction. Feedback has been exceedingly positive, with 62 percent of members returning to Blue Care Advisor at least once every 90 days. Additionally, 78 percent of members report the ability to understand medical costs, while 87 percent say they are satisfied with customer service. 

One of the areas I’m most excited about is the emerging data that shows a real correlation between usage of Blue Care Advisor and the actual lowering of healthcare costs with certain conditions. I am keeping a close eye on this research and look forward to sharing results as they become available. 

We know that preventive care allows conditions to be identified early, helping our members stay healthy and mitigating costly care down the road. The challenge is that less than half of American workers receive employer-enabled preventive care screenings. Blue Care Advisor is seeking to change that. Recent program data encompassing mammograms, wellness exams, cervical cancer tests, colorectal cancer tests and HbA1c tests indicate that registered members are twice as likely to schedule exams compared to those who are unregistered. 

As with all consumer experience tools, satisfaction and improvement are driven by feedback from actual users. And for all of its potential the outcomes and recommendations from AI are only as good as the data it uses to learn. I’m committed to ensuring that our blueprint for driving the next best action continues to be revised and updated by what we hear from real people and what we teach the machines to value, while simultaneously doing our part to address one of our nation’s most pressing issues.

Matt H
Matt Hunt

Matt Hunt is CXO for Blue Cross and Blue Shield of Minnesota.