How BCBSM AI Tools Are Helping with Chronic Kidney Disease Diagnoses
Lindsay Knake
| 3 min read
Lindsay Knake is a brand journalist for Blue Cross B...
Key Takeaways
- Blue Cross Blue Shield of Michigan’s 2023 pilot uses AI‑driven predictive analytics to flag members at risk for chronic kidney disease, prompting earlier urine and blood tests.
- Participants in the program saw a rise in screening rates, fewer emergency department visits and a drop in monthly healthcare costs.
- Early detection, especially for patients with diabetes or hypertension, can prevent progression to dialysis or transplant and reduce the financial burden of costly chronic conditions.
About 37 million adults in the United States have chronic kidney disease (CKD), but about 90% don’t know it, according to the National Kidney Foundation.
The disease develops slowly, so many people don’t get testing or diagnosis until the latter stages of CKD when it can seriously damage their kidneys.
Blue Cross Blue Shield of Michigan is using predictive analytics to change this and help members get a diagnosis much sooner. This helps with long-term health and helps members save money on expensive chronic conditions. Here’s what to know about this program and members benefit.
How Blue Cross uses AI tools to help diagnose CKD
Blue Cross launched a pilot program in 2023 to identify CKD by using the artificial intelligence (AI) tool predictive analytics and machine learning to analyze lab results to look for early indicators of the disease, including patients who are at risk of CKD, under-diagnosed or are developing CKD. Predictive analytics build complex models using medical records, member claims and demographics to assess risk of CKD. The model identifies members who are likely to be at a higher risk of the disease.
In the pilot program, Blue Cross shared that information with four groups of physicians, who could review the data and discuss screening options with their patients. The pilot group included thousands of patients, and the results showed patients in the program had an increase in urine testing and had fewer emergency department visits. Their monthly healthcare costs also decreased.
Urine testing, along with bloodwork, is a key part of diagnosing CKD, said Dr. Heather Stamat, Senior Medical Director of Provider Engagement at Blue Cross.
“It’s really encouraging news,” she said.
She advises people with Type 2 diabetes and hypertension to discuss a yearly CKD screening with their primary care provider (PCP). The early diagnosis helps with more successful treatment as well as preventing complications and more affordable care.
“The long-term result of not knowing if you have CKD is dialysis and a transplant. CKD is something that as long as you are aware and can get treatment, you can prevent that from happening,” Stamat said. “I am a big advocate of preventive screens and having an idea of where you stand. If you have any of those risk factors, you need to talk to your physician to get screened.”
Blue Cross is working to expand this program to more physician groups and members.
What is chronic kidney disease?
CKD is a form of kidney damage that leads to the loss of function. The kidneys are a filtration system that remove waste and excess water from blood and urine, in addition to maintaining blood pressure and helping to create red blood cells.
The early stages of CKD may not have obvious symptoms, but the more advanced stages may include:
- Changes with frequency of urination (more or less)
- Difficulty concentrating
- Dry, itchy skin
- Fatigue, weakness and lack of mental clarity
- Foamy urine
- Loss of appetite
- Muscle cramps
- Nausea
- Numbness or swelling of the feet and ankles
- Shortness of breath if fluid accumulates in the lungs
- Trouble sleeping
- Vomiting
- Weight loss without trying to lose weight
Without diagnosis and treatment, CKD can lead to kidney failure.
Having CKD increased the risk of other expensive chronic conditions and health problems such as, high blood pressure, heart disease and stroke. While CKD can affect anyone, common risk factors for developing the disease include family history of the disease, diabetes, heart disease and high blood pressure.
If Blue Cross contacts you about a higher risk of CKD, contact your PCP for next steps. If the Blue Cross contacts your PCP about the results, your PCP may order tests.
Photo credit: Getty Images
Read more:
