Blue Cross Uses AI to Help Members, Reduce Costs
Lindsay Knake
| 4 min read
Lindsay Knake is a brand journalist for Blue Cross Blue Shield of Michigan.
Blue Cross Blue Shield of Michigan is using Artificial Intelligence (AI) to benefit our members, including reducing administrative costs. But rest assured, we are not letting AI do our jobs and make approval decisions for you.
AI is more than generative AI such as ChatGPT; it includes machine learning, analytics, threat monitoring and contract management.
Here is how Blue Cross utilizes AI with security and productivity at the forefront of our work.
Responsibility with AI
As a company, we are committed to using AI responsibly and for the benefit of our members and employees. Blue Cross’ use AI and automation to augment the capabilities of our employees and improve productivity to deliver services for members.
As employees deal with sensitive data, it’s essential for Blue Cross to maintain security and privacy. Data integrity and accuracy, ethics, privacy and security are at the core of our use of AI. Our policies and best practice for employees to ensure appropriate use. We’ve developed internal tools that protect confidential data.
“Our AI tools are designed with privacy by default and data minimization principles, ensuring that only the necessary data is used for the intended purpose and nothing more. Regular audits and compliance checks are also in place to ensure adherence to industry standards and regulations, giving our members peace of mind that their data is handled with the utmost care and security,” said Brett Trelfa, Senior Vice President of Information Technology and Operations. “We also implement robust encryption protocols to protect data at all stages, whether in transit or at rest. This ensures that even if data were intercepted, it would be unreadable and unusable to unauthorized parties.”
Our focus on cybersecurity also allows employees to gain access to AI-enabled tools such as the editing tool Grammarly or design tool Canva. We don’t stop employees from using tools to increase their efficiency but rather help them gain access with trainings and limited data access.
Reducing administrative costs with AI
Affordability is at the forefront of what we do, and Blue Cross has a goal to save $600 million in administrative costs in three years.
Technology can help us achieve these savings. Tools such as ContractsGPT help us review contracts from vendors and providers to find opportunities to save money. ContractsGPT is a data analysis tool that helps us locate contracts and optimize our spending. Blue Cross has saved more than $10 million by reviewing contracts and saved employees significant time.
Our internal SecureGPT is a ChatGPT-like large language model to support day-to-day tasks such as editing, summarizing documents and coding. It offers employees safe generative AI tools that function as “co-pilots” for employees to optimize tasks and increase efficiency.
“BCBSM employees use machine learning models to lower the effort and time spent on administrative tasks, resulting in cost savings for our members. BCBSM has been using machine learning models for several years, particularly in Care Management, Risk Adjustment, Stars and HEDIS,” Trelfa said. “More recently, employees across the enterprise are harnessing productivity gains in their daily work from Generative LLM’s such as ContractsGPT, SecureGPT, Copilot, and more. As we look to the future, I expect even more valued to be derived from Agentic solutions – particularly those that focus on workflow orchestration.”
How Blue Cross uses AI for members
Identifying health conditions
Using machine learning and predictive modeling, Blue Cross Blue works with data and physicians to identify members and patients who are at risk for chronic kidney disease, prediabetes and other health problems. By identifying these conditions at an earlier stage, patients can work with their primary care providers to identify treatments and lifestyle changes. Not only does this help members live healthier lives, this can also help them save money on their long-term health care costs.
Predicting member claims costs
Blue Cross is also using machine learning to predict 12 months of member costs and identify what is driving increasing costs. This allows us to plan and determine how to use premium dollars to the greatest benefit for members.
Helping Medicare Advantage members
The Complex Issue Advocate Resolutions (CIRA) team works on resolving complex issues for our Medicare Advantage members. Using existing predictive models, the CIRA team members developed a platform to proactively identify members who needed assistance and then call to provide that support. This ensures Medicare Advantage members have the best possible experience and can get any issues promptly addressed even before they need to call our customer service representatives.
Blue Cross continues to innovate and develop these tools to improve member experience, reduce costs and increase productivity.
Are you interested in learning more about a career in IT at Blue Cross Blue Shield of Michigan? Visit mibluedaily.com.
Image: Getty Images
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