AI IN ACTION: HOW WE’RE IMPROVING THE HEALTH CARE EXPERIENCE

As people's health needs become more complicated, they're looking for more support from those who help them stay healthy. What they want most is a trusted partner to guide them through the often-confusing health care system and make it easier to get the care they need without breaking the bank.

At GuideWell, we're always looking for new ways to make that happen. We have a demonstrated history of using innovative technology like artificial intelligence (AI) to make things better for our members and those who care for them. We believe that AI has the power to transform health care, and we’re committed to using it to deliver on our mission to help people and communities achieve better health.

Using AI responsibly

Our approach to how we develop and use AI is built on trust and puts people first.  Across our family of companies, our efforts are grounded in six core principles: transparency, fairness, human oversight and accountability, risk management, privacy, and robustness. We take great care to ensure every solution we develop and implement is in the best interest of those we serve.

Improving the customer experience

Since 2021, members of GuideWell subsidiary Florida Blue have taken advantage of an online tool that uses AI to assist with common requests such as viewing their insurance card, making payments, or finding a doctor. This personalized digital assistant service is available 24 hours a day, 7 days a week, and has earned an 80%-member satisfaction rate.

In addition, in 2022, Florida Blue became the first health insurance company in the U.S. to use AI to quickly review and approve clinical prior authorization requests. Since then, we’ve processed nearly 3 million prior authorizations, with a remarkable 78% of cases receiving approval in under 90 seconds. Notably, we’ve maintained a commitment to using AI for approvals, never for denials, and always with human oversight. These expedited decisions enable patients to get to the next step in their care journey faster.

GuideWell, along with other health insurance companies, has made a promise to work together to make the prior authorization process easier and faster.  The prior authorization process is critical to ensuring that services meet requirements for payment under a member’s benefits. By making this process simpler and less time-consuming, doctors can focus more on providing good care to their patients, rather than spending time on paperwork and administrative tasks.  

Empowering providers

Last year at GuideWell subsidiary Florida Health Care Plans (FHCP), which provides primary and urgent care, we launched provider assistance tools to automate clinical administrative tasks. Clinicians are leveraging AI to quickly draft more empathetic responses to patient messages and to generate accurate progress notes from exam room conversations through listening technology.

By automating these tasks, we're helping doctors and nurses respond to patient messages faster so they can spend more time taking care of patients. This helps reduce burnout and alleviate administrative burdens.

Identifying at-risk members

At Sanitas Medical Centers which provide comprehensive primary care services to Florida Blue members, we’ve developed advanced predictive models using machine learning to identify members at high risk of developing diabetes so Sanitas clinicians can proactively intervene with personalized care plans.

Additionally, we’re piloting a mobile app that uses AI, behavioral science, and gamification to engage patients with high blood pressure to take a more active role in managing their condition. The results are promising: the pilot program has an impressive high Net Promoter Score (NPS) of 86 and has successfully guided over 50% of participants to adopt healthier habits to control their blood pressure. These initiatives are ultimately driving improved health outcomes and reducing health care costs over time. 

A trusted partner

As a health solutions enterprise with customers across all 50 states, Puerto Rico, and the U.S. Virgin Islands, we know that millions of people trust us to do what’s right. We take this trust seriously, prioritizing the responsible and ethical use of AI to create transparent, fair, safe, and effective solutions.

As AI capabilities continue to grow and expand, so does the potential to reduce health care costs, and provide even better experiences and services for our customers and across our family of companies. At GuideWell, we will continue to use AI to accelerate our mission to improve community health and for the broader good. Learn more about how we’re harnessing the power of AI to improve health outcomes in the 2024 GuideWell Impact Report.

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