Artificial Intelligence Saves Payers Time, Money

BHIBlog

BHI’s Roxanna Cross was recently interviewed by Managed Healthcare Executive® magazine on the topic of AI, machine learning, and health insurance.

The premise was simple: AI can save health plans money while improving care delivery and outcomes. An excerpt follows:

“At Blue Health Intelligence (BHI), which provides clinical data expertise for Blues plans around the United States, programmers attacked the problem of high-cost claimants, defined as members having annual costs surpassing $250,000. This group comprises fewer than 2 in 1,000 of all claimants but it accounts for 9% of all healthcare costs. Such patients tend to have rare and/or chronic diseases that involve frequent trips to the emergency department, expensive medications, and high-cost specialty care and testing.

If an insurer can identify these patients early and intervene before their health worsens and healthcare costs spiral out of control, both patients and payers win, says Roxanna Cross, associate vice president for product management at BHI. And it’s a perfect problem to be solved with AI.”