BATON ROUGE – Blue Cross and Blue Shield of Louisiana uses big data and new tools to draw insights that lead to timely and precise decision-making, which staff can act upon to solve members’ healthcare issues.
Somesh Nigam (left in photo), Ph.D., Blue Cross senior vice president and chief analytics and data officer, and Gina Laird (right in photo), Blue Cross senior vice president of Benefit Operations, presented the innovative ways Blue Cross is using artificial intelligence (AI) to provide outstanding service last week at the America’s Health Insurance Plans (AHIP) forum in Chicago. More than 500 people were expected to attend the annual meeting, representing stakeholders across the healthcare industry.
AI allows Blue Cross to harness the massive amounts of claims and other data it has available from members, providers, caregivers and others to design interventions or confirm new ways of doing things. Using data to improve member programs and services and show what’s working well has helped Blue Cross deliver better care and experiences for members. Blue Cross is also using data insights to partner with network providers in boosting health outcomes for patients. Developing these targeted interventions allow Blue Cross staff to fulfill their mission to improve the health and lives of Louisianians.
Using integrated data with machine learning and natural language processing, for example, enables Blue Cross customer service advisers to proactively reach out to members. Members often see this as outstanding service compared to calling in and waiting to speak to someone.
In their talk, “Enhancing Customer Service with AI, Natural Language Processing,” Nigam and Laird describe how their teams pinpoint issues and reach out to members before they might have a complaint. Blue Cross identifies and connects those members with the information or resources they need to resolve issues.
“Members reach out to us often at the most vulnerable moments in their lives,” Nigam said. “This collaboration shows that providing AI-driven and timely interventions for members can enhance care coordination and enrich their experience, as well as decrease complaints.”
This insight also helps Blue Cross make strategic decisions about how to use resources and share information, so staff can refine their approach as needed.
“We’ve improved the member experience, creating less stress for members, including those with complex cases, as we offer assistance before there is an issue,” Laird said.
Nigam and Laird were invited to speak at AHIP Institute because of Blue Cross’ recognized leadership in using AI for developing interventions and doing more personalized outreach to members. This strategy has led to improved health outcomes, lower costs, higher member engagement and an overall better member experience.
Nigam, who joined Blue Cross in 2017, has more than 25 years of experience at major technology, pharmaceutical, medical device and health insurance companies. Previously, he was vice president of Information and Data Governance and Health Informatics with IBM’s Global Chief Data Office. In his prior roles, Nigam was senior vice president and chief informatics officer at Independence Blue Cross in Philadelphia and vice president of health informatics at Johnson & Johnson.
Nigam is a sought-after speaker at national healthcare analytics conferences and forums and has published numerous articles in peer-reviewed journals.
Laird has been with Blue Cross for more than 25 years. In her leadership role in Benefit Operations, she puts her passion for helping others to work every day to create meaningful experiences for Blue Cross members, providers and employees. Laird oversees the company’s membership, claims and customer service operations, ensuring Blue Cross continues to deliver high-quality, efficient insurance administrative services that put the needs of the customers first.
To see more points of view on health industry innovation, visit Blue Cross’ Thought Leadership page at https://news.bcbsla.com/thought-leaders.