Data, Technology and Innovation: Solutions for Sustainable Health Care Costs
Blue Daily
| 3 min read
Key Takeaways
- AI and analytics have helped Blue Cross Blue Shield of Michigan cut $55 million in administrative costs and more than $10 million in vendor‑contract expenses in the past two years, easing pressure on premiums.
- Our fraud‑detection program uses data tools to flag suspicious billing and false claims, working with other plans and law‑enforcement agencies to curb waste, fraud and abuse.
- Advanced analytics identify early signs of chronic conditions such as pre‑diabetes and chronic kidney disease, allowing care teams to intervene sooner and reduce costly complications that drive roughly 75 cents of every health‑care dollar spent in Michigan.
Health care costs are rising at a pace that is not sustainable for families, employers or the health care system. Doing more of the same will not change that trajectory. To make health care more affordable, the system has to work differently — delivering better outcomes while reducing waste and unnecessary spending.
Technology is one of the ways Blue Cross Blue Shield of Michigan is helping drive that change. When used responsibly, technology can improve how health care is delivered, improve the health of the people we serve and make the best of the health care dollars we responsibly steward for our members and customers.
Using technology to reduce waste and spending
Not all health care spending leads to better health. Some costs come from inefficiencies, administrative work and billing errors that do not improve patient outcomes. These costs ultimately show up in premiums and out-of-pocket expenses.
Blue Cross uses technology, including artificial intelligence, or AI, to identify unusual billing patterns and inefficiencies across the business. This helps reduce inappropriate spending before it becomes part of the overall cost of care. Over the past two years, these efforts have saved $55 million in administrative costs that did not end up flowing downstream into our members’ premiums.
Technology is also used to review contracts with vendors and providers more efficiently. These tools have helped identify opportunities to reduce costs in complex agreements, resulting in more than $10 million in savings.
These tech tools require relatively small investments but produce meaningful savings. Lower administrative costs help reduce pressure on rising premiums and support long-term affordability.
We want our members and customers to know that Blue Cross does not use AI to make medical decisions about patient care. We use these tools to support our employees by reducing manual work and allowing more focus on member needs.
Protecting affordability by addressing waste and fraud
Waste, fraud and abuse add significant costs to the health care system and affect everyone who pays for health care.
Blue Cross uses data and analytics to identify suspicious billing patterns and false claims. Our Corporate Fraud Investigations team uses these tools to protect members from costs driven by fraudulent or wasteful activity.
This work includes collaboration with other health plans, providers and law enforcement agencies, because addressing fraud requires systemwide effort.
Using data to improve outcomes and prevent costly complications
Technology also supports affordability by helping improve health outcomes. Better outcomes mean better health for our members – fewer complications, fewer hospital stays and lower long-term costs.
Chronic conditions account for about 75 cents of every dollar spent on health care in Michigan. Helping members manage their conditions earlier helps reduce costs over time while improving quality of life. Blue Cross uses advanced analytics and machine learning to identify early signs of conditions such as prediabetes and chronic kidney disease. When these conditions are identified early, care teams can intervene sooner and help prevent complications that are costly for patients and the system.
Blue Cross is expanding these tools to other areas, such as musculoskeletal conditions, to help people plan care earlier and avoid avoidable complications.
Innovation focused on affordability
By using technology to support better outcomes for our members’ health and responsibly steward their premium dollars, Blue Cross is working to build a more sustainable health care system for people across Michigan.
Learn more about how Blue Cross Blue Shield of Michigan is addressing health care affordability at mibluedaily.com/affordability.
Image: Getty Images
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