Impact & Insights

Digital Health

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

Cambia CEO: Healthcare Needs to be Radically Focused on Consumers

Mark Ganz on making consumer needs a company priority and what that means at Cambia.

Key Takeaways: Across the health care industry, companies are working to better address consumer needs and create a better experience. This focus on the customer is pushing for personalized health care experiences, better stewardship of patient data and addressing consumer needs before they arise.

By Michaela Katz

Consumers are increasingly demanding a better health care experience—one that matches the consumer-focused aspects of other industries, notably retail. As such, it is crucial that health systems and plans understand the importance of making consumer-driven changes.

“When I became CEO I couldn’t believe how out of step health care was with all other aspects of my life and the lives of the people we serve,” said Cambia CEO Mark Ganz in an interview at the Health Evolution Summit. “You would think something that was so personal and so important would be the most consumer-focused industry. And yet, it’s the least.”

But what does it mean to be consumer-focused in health care?

There’s not one correct answer. Generally, however, it includes efforts to make health care a better, easier to understand experience for each individual and put the consumer at the center.

“It’s all about personalizing the experience and recognizing that when you talk about populations in healthcare, N equals 1. Or 1 plus the caregivers and family around them,” said Ganz. “People don’t want to be told what to do. They want to be offered options.”

Another big consideration in the push to consumer-focused health care is the use of patient data. Many organizations currently act as if once data is collected patients relinquish control of their data. If anything, the opposite is true.

“We are stewards of their data and everything we do needs to be built around how does that data flow to them and with them when they go on their journey,” said Ganz.

Ganz added that Cambia is making strides in its efforts to radically focus on the consumer, but its journey isn’t done and, it won’t be done alone, which is why the company partnered with Blue Cross and Blue Shield of North Carolina earlier this year to improve patient experience.

“There’s an alignment of values and vision and we both want to change the world,” said Ganz. “I think what we can do for consumers together versus what we could do separately is very, very compelling.”

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.  

Mark Ganz
Strategic & Competitive Landscape Cost + Value Consumerism Digital Health
2019 CEO Briefing Room Report

2019 CEO Briefing Room Report

After decades of being considered futuristic, artificial intelligence (AI) is getting real in health care for customer experience, care management and cost competencies, among other use cases. Smart payers, providers, and life sciences organizations, in fact, are looking across industries to learn from companies that have already implemented AI to reap impressive results.

Created in collaboration with Oliver Wyman

Download pDF to View Full Report
Digital Health