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.”
Dr. Udvarhelyi is President and Chief Executive Officer of Blue Cross and Blue Shield of Louisiana (BCBSLA). He is a board certified internist and has more than 25 years of experience in the health insurance industry. Prior to joining BCBSLA, he was with Independence Blue Cross (IBC) in Philadelphia for almost 20 years, most recently serving as Executive Vice President, Health Services and Chief Strategy Officer. Prior to IBC Full bio ›