Blue Cross using AI to improve value-based care

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Blue Cross of Idaho is becoming nationally recognized for its use of artificial intelligence with value-based care. File photo

MERIDIAN – As part of its value-based care initiative, Blue Cross of Idaho is using artificial intelligence to notify primary care providers when patients are at risk of developing serious health issues.

The project has been under development for almost a year and has grown from two to 23 staffers.

“It’s not magic,” said Marc Roberts, director of analytics for the company. “We’re not trying to look for weird correlations you wouldn’t expect. A lot of them are obvious.”

National attention

The artificial intelligence (AI) or machine learning (ML) project has drawn national attention, including a mention in the Wall Street Journal.

“On one of its first data runs, the automated ML program made a startling discovery: Blue Cross patients who get regular teeth cleanings and dental checkups have markedly better cardiac health in the following year,” the paper noted. Other correlations bore this out, meaning Blue Cross will look at ways to encourage members to seek preventive dental care, which is cheaper than heart-related costs.

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Marc Roberts

Blue Cross didn’t develop the AI program on its own. It’s been working with experts in the field, including DataRobot, software from a Boston-based specialized predictive modeling company, and IBM Watson Health, which uses the Watson AI system best known for winning the Jeopardy! TV show against humans in 2011. DataRobot took tasks taking two to three months and reduced them to a week, while Watson helps correlate disparate claims into a single medical episode, Roberts said.

But Blue Cross still needs to work with the software for insights. “It helps us do the grunt work of predictive modeling and automates manual processes,” Roberts said.

For example, diabetes and renal disease are often connected, so the system could track where patients are in the disease cycle, said Drew Hobby, senior vice president of health care economics.

Primary care

What’s new is Blue Cross sharing information with primary care providers (PCPs), Roberts said.

“We think the next level of effectiveness is sharing with the PCPs,” he said. “When PCPs have that information, they can reach out and care for the members,” potentially before a serious health issue, he said.

The notification tells PCPs a member they’re caring for is predicted to be a high-risk member in the next 12 months, based on information such as recent diagnoses and prescriptions the PCP might not know about, combined with demographic information, Roberts said.

“The PCP would reach out to a patient and say, ‘Hey, I noticed you’ve been to the emergency room or started a new prescription, and I’d love to get you in for a checkup,’” he said.

On a monthly basis, such notifications will typically be fewer than 1% of a PCP’s patients, he said.

“As we’ve tested the model, 95% of the people do have a high-cost event in the next year,” he said. “We feel quite confident that not only is it a short list, but a very highly accurate list.”

PCPs started getting the AI data in November, but so far the program is promising, Hobby said.

“The initial feedback is that the PCPs love getting more data.”

Value-based care

Value-based care means instead of being reimbursed by how many services are provided, providers are reimbursed by outcomes, a method intended to reduce health care costs for businesses. At this point, 70% of Blue Cross of Idaho’s claims are in a value-based care arrangement, Hobby said.

In traditional primary care, case managers interact with people with major complications, but that’s often after-the-fact, Hobby said. With value-based care, case managers can interact more proactively and better identify patients in greatest need of help, he said.

While it will take six months before Blue Cross will have outcome data on AI, the value-based care program itself is starting to show results. In 2018, Blue Cross of Idaho paid out approximately $20 million in shared savings payments to its value-based care providers.

Blue Cross adds value-based care partners

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Blue Cross of Idaho recently announced it has seven new value-based care partners. The partnerships are aimed at reducing health care costs.  Photo by Sharon Fisher.

Blue Cross of Idaho has announced new value-based care arrangements with seven Idaho provider groups as of January 1. The Meridian-based company now partners with providers on 25 shared savings arrangements in group, individual, and Medicare markets.

New partners are Catalyst Medical Group, Community Health Center Network of Idaho, Independent Doctors of Idaho, Portneuf Quality Alliance, Primary Health Medical Group, Saint Alphonsus Health System, and Saltzer Medical Group.

Value-based care means that, instead of being reimbursed by how many services are provided, providers are reimbursed by outcomes, a method intended to reduce health care costs for businesses. This is a trend that’s been going on for a while but is increasing among providers and insurers. While it’s too soon to tell what effect it will have on patient costs overall, St. Luke’s Health Partners, partnering with SelectHealth, has also been working on value-based care, said Dave Self, chief administrative officer, and he said that has helped that company keep health care costs essentially flat for its own employees.

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Drew Hobby

“We deliver to them the data that will help them better manage the care,” said Drew Hobby, vice president of provider network management. “They get to know what’s going on with patients,” because the providers don’t always have the visibility that a patient has gone to another provider, he said. “It gives them opportunities to have more data.”

Blue Cross was particularly interested in Primary Health because it was one of the first groups in Idaho to not only implement electronic health records, but to look at internal clinical data to improve performance and give patients better care, said David Peterman, CEO of Primary Health Medical Group, based in

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Dave Self


Saint Alphonsus Health System offers a similar value-based care program called Saint Alphonsus Health Alliance.

Micron lobbyist Mike Reynoldson moves to Blue Cross of Idaho

reynoldson_mikeMike Reynoldson has taken on the role of director of governmental affairs for Blue Cross of Idaho.

Reynoldson spent the last decade as the Idaho governmental affairs manager for Micron Technology. In his new position, he will oversee legislative and regulatory efforts, and act as a liaison to state and federal health entities for the company. He replaces Julie Taylor, who held the position for 23 years.

“It’s a great opportunity. Going from one great Idaho company to another great Idaho company,” Reynoldson said. “I’m excited about the issues they’re involved with and the customers they serve.”

As a lobbyist for Blue Cross, Reynoldson will continue to roam the hallways of the Idaho State Capitol when the Legislature is in session. He has more than 22 years in local, state and national government affairs work, representing companies in policy development, strategic planning, coalition building, lobbying, public relations and political activity.

Reynoldson said the fast pace of change in Micron’s industry has prepared him to work for a major insurance company at a time of great change for the health insurance industry.

“I think I have a good background to develop policy related to the changing health care industry,” he said. Blue Cross of Idaho is involved in a number of legislative issues this year.

“I’m excited to learn more about those and get to work,” he said.

In addition to Micron, Reynoldson has also served as the Idaho public affairs manager for US West and Qwest Communications, as the executive director of the Idaho Republican Party and as a field representative for the Republican National Committee.