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Personal Connections Through Machine Learning: How Blue Shield of California is Leveraging Technology to Reach Members Most Vulnerable to COVID-19

Blue Shield of California is using technology to deliver personalized care, in this case by identifying and contacting members with heightened needs during the pandemic

After struggling through weeks of intense body aches and fatigue with COVID-19, Marissa Duenas found herself feeling paradoxically grateful that she had contracted the disease.

“I lost my husband last year,” Duenas said. “When I had COVID, it was so stressful without him; still (it) helped me to realize, ‘Marissa, you have your insurance, you have your job, you have your family and your friends. You have to keep going!’”

One thing that helped Duenas persevere was getting a call from a woman she refers to as her “angel” – a Blue Shield of California case manager who checked in to find out what she might need to get through the disease safely.

Since Duenas, 68, lives alone. Her adult daughters had picked up her pet dog so she did not have to care for it during her illness. Duenas’ biggest challenge was buying and preparing food. The case manager was able to set her up with two weeks of meal delivery, a service Blue Shield has been providing to members who test positive for COVID-19 during the pandemic. 

An innovative program aimed at the pandemic

The outreach was part of a Blue Shield’s focus on using technology to deliver personalized care, in this case by identifying and contacting members with heightened needs during the pandemic. The approach includes members, like Duenas, who tested positive, as well as those most likely to suffer serious negative outcomes if they get COVID-19. Combining the latest artificial intelligence technology with old fashioned personal connection, Blue Shield was able to reach tens of thousands of members with personalized options and advice.

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Dr. Terry Gilliland

“We contacted our most vulnerable members through phone calls, email and print mail. We offered additional education about COVID-19 and how to protect yourself, as well as what actions to take if they feel ill,” said Terry Gilliland, M.D., executive vice president of Health Care Quality and Affordability at Blue Shield.

AI to predict COVID-19 risk

The algorithm aspect of the program came through collaboration with Cogitativo, a Berkeley-based firm that works to improve the healthcare system through data science. Together, they built a risk-scoring engine to identify which members were most likely to end up in the hospital, on a ventilator or even dying if they get COVID-19.

“We’re trying to identify your aunt, your dad, your brother or sister, based on clinical conditions and structural barriers to health care,” explained Gary Velasquez, Cogitativo CEO.

Just as COVID-19 has not stopped challenging wellness in America, Blue Shield is not ending its outreach efforts. The next phase of the project will focus on another factor that places some members at higher risk.

“As the pandemic has evolved, we have learned that certain races and ethnicities have higher rates of COVID-19 than others. For this reason, we are planning outreach efforts that are focused specifically toward African Americans, LatinX, Native Americans and Pacific Islanders,” Gilliland said.

Blue Shield also has its eye on other ways to personalize care using AI, or machine learning. Both Gilliland and Velasquez have been pondering AI’s potential for prioritizing the distribution of the COVID-19 vaccine, once produced. And Blue Shield is working on an AI-based Member Experience Forecasting Tool that would help better serve members.

These projects are part of a movement in health care to employ algorithms to get the right care and information to the right patients, in real time.

Velasquez looks forward to working with Blue Shield on more such projects in the future, he said, because of the two companies’ culture of collaboration.

“Blue Shield is willing to innovate, willing to listen. They say, that's an interesting question,” he said.

Blue Shield measured the campaign’s success so far in a high engagement rate, noting that the clickthrough rate to the Blue Shield website was much higher than the industry average.

An even more important indicator: stories like Duenas’. Now that she is feeling great and back to working from home as an accounting clerk, Duenas looks back on the experience with emotion.

“Just to feel that somebody’s calling you to know how you’re doing, it’s probably the best experience ever I had,” Duenas said. “Knowing that other people care for you, and your insurance is there when you need them.”