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BCBSTX’s Approach to AI

Empowering People, Transforming Health Care

Our Philosophy

Artificial intelligence (AI) will have a transformational impact on health care, giving us tools to quickly help our members, improve health outcomes and costs, support our employees’ productivity and optimize their skills.

For example, AI can help us:

  • Identify health issues earlier, giving us the ability to better support members’ access to the care they need.
  • Streamline administrative processes so healthcare providers can focus more on patient care. We do not use AI to displace clinical judgement or deny requests.
  • Summarize, synthesize, and simplify healthcare information to make it easier to understand.

BCBSTX's philosophy is to keep a human at the center of AI operations, guiding AI without displacing human judgment.

Responsible AI at BCBSTX

We believe in the importance of accompanying innovation with appropriate controls to support fairness, data security, and respect for privacy. BCBSTX is committed to safeguarding personally identifiable information, including protected health information (PHI), by prioritizing the confidentiality, integrity, and appropriate use of our members’ data. Please see our Privacy Notice for more information.

Our data use policies and procedures mandate adherence to HIPAA Privacy and Security Rule requirements. This includes following the “minimum necessary” principle as well as the use of non-sensitive and deidentified data attributes in AI models where feasible.

We continually strive to improve the services we provide to our members and our business stakeholders. Part of that effort includes providing members and our workers with modern technologies like automated decision-making, machine learning technologies, and AI that may process and be improved or trained with information. We use AI to support some aspects of our payment and health care operations. We have implemented a governance framework, which includes policies and procedures to help us responsibly evaluate how these technologies are developed, operate and use information, including personal information, in accordance with our policies and applicable law.

How We Use AI to Support Our Members

BCBSTX uses AI tools to drive better health outcomes and service to support our members. These are just some of the ways we deploy AI:

Proactive Clinical Engagement

Predictive models help us spot when members might be at higher risk for serious health issues, such as diabetes progression or hospital readmission. This insight can help us reach out earlier and connect members to extra resources and personalized guidance.

Enhanced Customer Service

AI tools can help our members get answers more quickly and reduce wait times. We deploy AI to help identify complex customer service calls and route those calls to our most experienced customer advocates. We also leverage GenAI solutions to provide members an easy-to-use chatbot to navigate benefits and health plan details as well as tools to help our advocates answer member questions more efficiently. This helps support a smoother experience for our members.

Claims Operations

As a leader in the national payer landscape, we recognize the value AI has in helping process claims more accurately and efficiently. We do not use AI to displace clinical judgement or deny requests. However, we may use AI to auto-approve Prior Authorization requests or notify claims operators of the likelihood of an error in claims data. We use technology to optimize our operations.