How Florida Blue prioritizes safe AI to lower costs and support members

July 01, 2024

When used responsibly, artificial intelligence (AI) has the potential to transform some of the biggest issues facing the health care industry. For health insurers, leveraging this transformative and generative technology with a secure and systematic approach can improve the customer experience, expand access to care and lower costs.

Using AI to improve customer experience

Florida Blue, Florida’s Blue Cross and Blue Shield health plan, is using AI so members can get the help they need in a secure, faster, personalized and more seamless way.

“We’re very intentional about how we use AI to care for our members and improve their experience,” said Anne Hoverson, vice president, digital transformation for Florida Blue. “We want to care for all the member’s needs when they reach out to us, whether that’s to make a payment, change their doctor, learn the status of a claim or better understand their benefits or a bill.”

Right now, Florida Blue members can chat with Sunny, the company’s in-house AI chatbot. Through computer-based conversations, Sunny can answer questions or direct members to the right service representative. As the technology expands, Sunny will be able to help members order medications or get in touch with a Florida Blue nurse to answer health and wellness questions.

And the results are promising — Florida Blue has near-100% satisfaction ratings among members using its automated chatbots or phone systems, which leverage natural language processing (NLP) technology. NLP helps computers decipher human language.

Health insurers, like Florida Blue, are also looking to AI for members calling customer service. “AI can act as a copilot for customer service representatives,” Hoverson said. “If the AI is summarizing information, searching for claims, digging through data and listing benefits, then representatives can focus on being empathetic to the members’ personalized needs and supporting any complex concerns.”

Lowering costs and expanding access to care

Addressing rising costs in health care is a major concern across the health care industry. The cost of care can delay people getting the help they need, which can lead to even more expenses down the road.

Health insurers like Florida Blue are looking for ways to reduce manual work and make internal processes more efficient, which saves money. “If we can operate more efficiently, we can pass those savings down to the member,” said Svetlana Bender, vice president, AI and behavioral science for Florida Blue. “We’re constantly looking for ways to remove administrative and repetitive tasks, so we can focus on our members.”

Florida Blue's parent company, GuideWell, recently launched GuideWell Chat, an internally built regenerative AI chat tool for employees that can help with coding, writing assistance, status reports and creating summaries. Employees have seen a significant reduction in time spent on these tasks, they learned new skills and can spend more time on other tasks.

One promising future use of GuideWell Chat and AI is the ability to extract insights from data. “For example, by having a better understanding of social determinants of health, we can help identify those members who have more needs and provide them the right solution at the right time,” said Bender.

Florida Blue also continues to streamline the prior authorization process, which can be a source of tension or delay between insurers and providers. Medical groups have noted that waiting for authorizations can adversely affect patient care and causes a significant administrative burden. In 2021, Florida Blue became the first U.S. payer to automate prior authorization approvals through AI-powered clinical reviews.

75% of the company’s prior authorizations for advanced imaging, hip and knee, and musculoskeletal requests for its Medicare members has reduced turnaround time on approved decisions to within 90 seconds.

More than 13,000 unique users submit more than 1.1 million prior authorization submissions annually with Availity AuthAI. This partnership ensures benefits are applied appropriately and members get the results they were expecting.

By automating the simple and most commonly approved authorizations, Florida Blue is freeing up its care teams to focus on more personalized and complex cases, enabling faster patient care and a more harmonized experience for those who need it most.

Moving forward with AI responsibly

“Using AI responsibly is our number one priority,” said Bender. “Florida Blue has implemented a multifaceted approach with strong ethical guardrails around AI: transparency, fairness, privacy, keeping a human in the loop and removing bias in the data and algorithms.”

GuideWell built its chat tool in-house so data never leaves the organization, and Bender said they engaged all company stakeholders in the process. “It’s important for us to connect everyone in the company around this technology because we all have to think about what this means for us as a company and the members we serve.”

“This tech offers a lot of opportunity, and our priorities are security, accuracy and privacy,” Bender continued. “We have our subject matters experts reviewing each use case and making sure our member’s privacy and health is first and foremost. We’re implementing a state-of-the-art framework that will allow us to implement high quality and secure AI solutions.”

As AI becomes more integrated across health care, Florida Blue is also working proactively with state and federal regulators to create and set guidance and build a framework for the technology. The company has also partnered with academics to stay ahead of the curve on technology and ethics with Carnegie Mellon, the University of Maryland and the University of South Florida.

Florida Blue insists on ensuring proper oversight while harnessing the potential of AI. By continuing to improve the patient experience with AI and empower employees to work at their highest levels, Florida Blue and other health insurers hope to also help make individuals and communities healthier by providing personalized access to the right care when they need it.

Learn more about Florida Blue

Florida Blue, the leading health insurer in Florida, has been providing health solutions to residents of Florida for nearly 80 years. Driven by its mission of helping people and communities achieve better health, the company serves more than six million members and all 67 Florida counties. Headquartered in Jacksonville, Florida, with more than 9,000 employees, it is an independent licensee of the Blue Cross Blue Shield Association.

For additional information visit floridablue.com. For the latest news and content, visit the Florida Blue Newsroom, and follow Florida Blue on Facebook, LinkedIn and Instagram @florida.blue; and X (formerly Twitter) @FLBlue.