Highmark continues to make investments in technologies that improve member, customer, and provider experiences. Our technology innovation focuses on achieving better health outcomes and lower costs, with an emphasis on personalized, proactive care. Initiatives also support increased health equity by providing greater access to care and community resources.
Highmark’s advanced analytics group, led by Vice President Ian Blunt, works behind the scenes to make better health possible for more people. “We’re the center of expertise for big data, data science, machine learning, AI, and other sophisticated techniques,” says Blunt. “Our team ensures Highmark members get the right health care support, at the right time, based on data and analytics.”
These terms — big data, data science, and artificial intelligence (AI) — are often used interchangeably. However, they are three different integral elements, all working in concert at Highmark:
Big data first emerged in information technology around 2010. It was a recognition that businesses of all kinds were amassing large volumes data but not using it effectively. With four million members and an extensive provider network, Highmark uses a great deal of data in its daily work.
Data science is the discipline that uses big data for a greater understanding of a business. Data scientists design tools and build models based on different sets of data. Blunt’s team at Highmark has developed 80+ predictive models to improve member care, customer service, and provider efficiency.
Artificial intelligence — AI — is the underpinning technology of data science. AI helps to digest and synthesize big data. Highmark is a thought leader in the responsible use of AI and advanced analytics to help improve the health care industry.
“Building in-house data models allows Highmark to connect all the pieces,” explains Blunt. “We have created a near real-time system that supports personalized care.” Technologies under Blunt’s leadership help deliver efficiencies to customers, members, and providers in several ways:
Care management includes improving outcomes, cutting costs, championing preventive care, and ensuring access to care. One example is prior authorization for care. Technology can interpret a Highmark member’s policy, claims, and chart to uncover the clinical evidence needed for human approvals.
Call Center representatives get prompted with the caller’s data immediately upon contact. The system listens to the call and automatically displays summary notes triggered by specific policy questions. The caller gets the correct information quickly from representatives trained for optimal proficiency.
Ambient listening, like in the Call Center example above, is also currently piloted in some clinical providers’ offices. Exam notes are automatically recorded by the provider’s device, so they can spend more time focusing on their patient. “Ambient listening is a very significant step forward,” says Blunt..
Highmark uses “look-alike” data modeling to draw correlations between population groups, public health data, and member-provided data. For example, Highmark Health Research Institute conducted a study1 on the relationship between lifestyle, location, and good health.The study validated what researchers expected, which is that a member’s quality of health primarily depends on where they live. Wealthier communities have better health and vice versa. Look-alike modeling identified members who did not participate in the study but have the same characteristics and care needs.
The work of Blunt’s team sits at the core of Highmark’s 360-degree Living Health strategy, which aims to improve the physical, mental, and social health of all members. The technology now in place can:
“I want to get health care delivery to be as simple as personalizing products, across a well-thought-out system,” says Blunt.
“Technology is the answer to that, putting best-in-class interventions in place to deliver better outcomes at a lower cost. Having a better member experience supports employees in engaging with their health care benefits. Members who get the right care at the right time — including preventive actions — reduce costs overall.”
AI and Data Analytics Improve the Employee Health Experience
A Strategy for Living Well
SDOH Screening for Employees | Highmark Health Research Institute
All references to “Highmark” in this communication are references to Highmark Inc., an independent licensee of the Blue Cross Blue Shield Association, and/or to one or more of its affiliated Blue companies.
Talk to your client manager today and we’ll help you find the right health plan for your company.
