Impact & Insights


BCBS Louisiana CEO Steve Udvarhelyi on Driving a Better Consumer Experience with AI, Benefits Design

Udvarhelyi discusses how Blue Cross Blue Shield is enabling patient-driven care by looking at three key questions.

Key Takeaways: Patients have been demanding better and easier ways to navigate care and large plans are beginning to make big moves to address these concerns and bring about better care.

By Michaela Katz

Blue Cross Blue Shield Louisiana is working to deploy artificial intelligence, combined with benefits plan incentives, to shape a better customer experience for its members.

“We’ve developed a series of iterative predictive models using machine-learning, AI tools,” said Steve Udvarhelyi, President & CEO of Blue Cross and Blue Shield of Louisiana in an interview at the Health Evolution Summit. “We’re seeing results from trying to focus on a subset of people that meet two or three different criteria.”

Udvarhelyi explained the three questions the payer started with when designing the AI.

First, “Who is at high risk for events that you’d like to avoid?” said Udvarhelyi.

Although this first step sounds simple, it cannot be done blindly or without further analysis after initial identification of at-risk patients because there is a subset of people who are high-risk but there is little that can be done to decrease their risk levels.

Patients on dialysis, for example, are typically high risk but, “it’s very hard to get them off of dialysis unless you transplant them,” explained Udvarhelyi. “That’s an example of a high-risk person you can’t do much about.”

Second, “What can you identify that’s modifiable either by intervention from the physician or the care team, or a behavior change on the part of the patient?” he added.

Third, “How do you identify the individual characteristics of a person that make them more likely to engage with you to change?” Udvarhelyi said.

Blue Cross and Blue Shield of Louisiana is seeing success with this method of AI to enhance consumer-driven care and yield better outcomes.

“We find that if we really focus on a small number of people who are high risk, have modifiable factors and are likely to engage, we can make very significant improvements on a population basis,” said Udvarhelyi “We run that on daily and each day it’s a different group of people.”

Blue Cross and Blue Shield of Louisiana is just one organization working in this space but there are a number of others making strides toward aligning incentives and driving consumer-driven care.

“We need to be smarter as an industry,” Udvarhelyi said. “Those of us that are providing incentives to patients through benefit design and other things need to do it in a more precise and thoughtful way and understand how to incentivize and reward the behaviors that we want.”

Watch more episodes of the Health Evolution Interview Series. The next Health Evolution Summit is scheduled for April 1-3, 2020 in Laguna Niguel, California. 

Steve Udvarhelyi, MD
Strategic & Competitive Landscape Consumerism Digital Health

Treating Addiction by Addressing Stigma and Bettering Basic Education

Humana Segment President, Beth Bierbower and Geisinger EVP & Chief Innovation Officer, Karen Murphy, on the stigma of addiction and mental health disorders and how to address the public health crisis we are struggling with today.

Key Takeaways: It is no secret that addiction and depression rates are rising, but it is only recently that the health care industry has begun making strides to address these problems and move beyond opioids in treatment of pain.

By Michaela Katz

The opioid crisis has taken thousands of lives and rates of opioid prescription, addiction and overdose have increased dramatically during the past decade. But how did we get to a place where this was considered normal?

“The prescribing of opioids in medicine has led to the increase in addiction across the country. That’s evidence based,” said Karen Murphy, EVP and Chief Innovation Officer at Geisinger in an interview at the Health Evolution Summit. “I think the other mention is an increase in all types of diseases of despair and the self-medicating that’s happening across the country.”

Treatment for opioid addiction exists but, for several reasons, people often don’t seek treatment.

“There are a number of barriers to treatment. I think stigma is a big challenge where people are embarrassed to seek help and in self-denial, thinking that they don’t have a problem,’ added Beth Bierbower, Segment President of Humana in the same interview. “People oftentimes just don’t know where to turn to get help.”

Beyond shame or societal stigma is the fact that mental health is viewed differently than other aspects of health.

Given how much we know about the need for proper treatment of mental health disorders and addiction and the role that stigma plays in accessing treatments, it is important to address these growing trends not only with direct treatment but, also, with efforts to quell negative stigmas.

“Certainly when people take a health risk assessment, we do ask questions around alcohol use and substance abuse,” said Bierbower. “It’s really important how you phrase those questions to be able to elicit the right, accurate responses.”

In addition to asking the right questions, the right way, education needs to change to better be able to respond to, prevent and treat health problems like mental health and addiction that have previously been separated from health care.

“This is the largest public health crisis we’ve ever had. We have to start in basic education,” said Murphy, “The beginning of education has to start in health professionals’ basic education. So starting with medical school education of not only opioid prescribing but the challenges and triggers of addiction…alternatives to opioids and, the dangers really, of prescribing opioids.”

Further to acknowledging and eliminating stigma, changing health care education and better understanding the risks of opioid use and triggers of addiction, it is important that health care more broadly consider opioid alternatives.

“The other part is looking at different ways to manage pain. Where the first line of defense was opioid prescription for the last 2 decades, now we’re looking at other alternatives, more holistic alternatives” said Murphy, “At Geisinger, we’re looking, for example, at using virtual reality as a therapeutic.”

Beyond addressing societies response to addiction and mental health problems it is important to be better equipped to predict and prevent addiction.

“One of the things I think we can do better is, how do we start to anticipate somebody who might be at risk?” said Bierbower, “If we could start to recognize that when major events happen in people’s lives, that this is an opportunity for us to maybe get ahead of it and start to educate people about some avenues they have to seek help even before the problem is there.”

Watch more episodes of the Health Evolution Interview Series. The next Health Evolution Summit is scheduled for April 1-3, 2020 in Laguna Niguel, California.

Beth Bierbower
Clinical Transformation Cost + Value Consumerism

Driving Value Based Care and Learning from Other Industries

Blue Cross and Blue Shield of Minnesota President & CEO on the need to switch to value-based care and the lessons we can learn from other consumer-focused industries.

Key Takeaways: Shifting from fee for service to value-based care is critical in today’s industry. Craig Samitt shares insights about the need to move to value-based care and how the industry can do better in this shift.

By Michaela Katz

Moving from traditional fee for service to value based care promises large opportunities to drive prevention, address broad aspects of health and ultimately transform care.

It seems time that health care companies begin looking at their value beyond that of treatment.

“I think the greatest opportunity is for us to think as wellness companies, social determinant of health companies, protect and prevent companies, not just treatment,” said Craig Samitt, President & CEO of Blue Cross and Blue Shield of Minnesota in an interview at the Health Evolution Summit.

Despite the amazing possibilities that value-based care holds, the health care industry has not fully embraced value-based care as the majority type of provider service.

Progress in committing to value-based care has been slow and obstacles seemingly unmoving.

“I don’t think we’re changing fast enough. The problems that we struggle with or the obstacles to our progress are the same today as they were a year ago, 5 years ago and 10 years ago,” Samitt said. “We’ve been talking about value-based transformation. I actually sense we’re not making progress fast enough in the right direction.”

What are some of the challenges standing in the way of value-based care?

“My sense is that the challenge in the industry is that the profitability of sickness exceeds the profitability of wellness,” said Samitt.

If this is the case, then changes need to be made that financially incentivize wellness.

“We just need to be much more progressive and forceful in driving to value-based payment,” Samitt added.

That’s probably easier said than done but perhaps competition will drive this shift.

“We need to turn the traditional elements of our industry …on its head. I actually value greater competition. I value the vertical integration. I value the innovators and the disruptors,” said Samitt, “The outsiders, so to speak … look at an industry that could improve in service, and access and cost and they have nothing to lose. I would like us, the incumbents, to reinvent health care from the inside out. I think we can do it.”

Watch more episodes of the Health Evolution Interview Series. The next Health Evolution Summit is scheduled for April 1-3, 2020 in Laguna Niguel, California.  

Craig Samitt, MD
Clinical Transformation Cost + Value Consumerism

Future of Diagnostics: The Convergence of Data, Tech and Therapeutics

GE Ventures former CEO Sue Siegel and Section 32 Managing Partner Mike Pellini discuss the four aspects of health care coming together to advance diagnostics in ways never before possible.

Key Takeaways: Diagnostics in health care have historically fallen short compared to other sectors in terms of both spending and research. However, increased demands regarding personalized medicine, predictive measures and early identification of disease are pushing the industry to enable new breakthroughs in diagnostic science.

By Michaela Katz

Today, there is a huge disconnect between diagnostic spending and the health care industry’s reliance on the tools and findings. At the same time it’s becoming increasingly clear that diagnostics will only become more important, if not strategic, in the massive shift toward value-based care.

“Two percent of the spend goes toward diagnostics — and it fuels 70% of the spend on the decisions made from it,” said Sue Siegel, CEO of GE Ventures and Chief Innovation Officer of GE in an interview at the Health Evolution Summit.

This balance clearly doesn’t make sense but, fortunately, things are beginning to change.

“Diagnostics used to be about the today, and diagnosing disease, and now we’re moving into a world where it’s all about potentially diagnosing something…where there might be no action ability, or prediction. And there’s power to that,” Siegel noted.

What’s driving this opportunity to make diagnostics a more valuable part of the equation?

“There’s an emergence of data, the utilization of data, the mining of data in a way that we’ve never really been able to do until this point in time,” said Mike Pellini, MD, Managing Partner of Section 32 and Chairman of Foundation Medicine in the same interview.

Data is just one piece of the equation. Another is the emerging technology that enables new capabilities every day and not just for diagnostics or health care but for every industry.

“We have data, we have technology, we have diagnostics and we have therapeutics, and all four of these pieces are coming together in a way that we’ve never seen in our lifetimes or, frankly, anyone’s lifetimes,” continued Pellini.

It is clear that acknowledging the value of and increasing investment into diagnostics will have a large impact. This increased emphasis will allow for the application of predictive analytics, will decrease spending for unnecessary treatments and lead to earlier and better treatments of serious and life-threatening diseases.

Beyond its impact in the clinical setting, diagnostics will have far-reaching effects in areas key to the changing health care ecosystem.

“Diagnostics drives personalized medicine,” Pellini said. “Diagnostics are the linchpin to success in personalized medicine. Diagnostics are the linchpin to even value-based care.”

Siegel emphasized the importance of the potential role of diagnostics in achieving value-based care, “With the change into fee for value and what’s happening in the health care system, diagnostics has to play a role that is much more powerful than it’s had a chance to play in the past.”

Watch more episodes of the Health Evolution Interview Series. The next Health Evolution Summit is scheduled for April 1-3, 2020 in Laguna Niguel, California.  

Sue Siegel
Strategic & Competitive Landscape Clinical Transformation Cost + Value Consumerism