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Highmark Taps Laguna for Conversational AI

Highmark Taps Laguna for Conversational AI

Highmark is collaborating with Laguna Health, a conversational artificial intelligence company, to ease the administrative burden on care managers, the companies announced on Wednesday.

Pittsburgh, Pennsylvania-based Highmark is an independent licensee of the Blue Cross Blue Shield Association. It has about 7 million members across Pennsylvania, Delaware, New York, and West Virginia. The company offers plans for Medicare, businesses, individuals and families. Laguna Health has a suite of AI-powered products that help care managers identify patients’ risk barriers.

Through the partnership, Highmark is integrating Laguna’s conversational AI technology into the insurer’s platform. When Highmark’s care managers speak with patients, Laguna’s technology will transcribe the conversation, give an overview of the patients’ issues that were discussed and provide actionable suggestions to address those issues. In addition, care managers will receive tips on how to better communicate with patients.

Laguna also has a supervisor dashboard that allows supervisors to track care managers’ performance.

The partnership comes at a time when care managers are often struggling to support patients due to administrative challenges, according to Yoni Shtein, CEO of Laguna Health. 

“They have multiple screens, they have multiple systems that they have to operate and all of that in tandem with actually paying attention to what the member is saying and acting on it in real-time,” Shtein said in an interview. “All of that creates a very high cognitive load.”

Benjamin Edelshain, vice president of clinical engagement and digital innovation at Highmark Health, echoed Shtein. He noted that the collaboration with Laguna helps reduce burnout for care managers, who are often bogged down with prepping and transcribing calls. It also improves the member experience and makes it easier for the insurer to prove patient outcomes.

“We think this is a no-brainer,” Edelshain said in an interview. “It yields customer value and helps us run our business more effectively, more efficiently. And we can demonstrate outcomes to not just our internal bookkeepers, but also, more importantly, our external clients who are always asking us for more information.”

Highmark will be paying Laguna in a typical software-as-a-service model, in which there will be a monthly subscription, according to Shtein.

He noted that there are many other conversational AI companies, but they are primarily on the provider side rather than the payer side. Conversational AI companies working with providers include Abridge, Ambience, Nabla and Suki.

“I think over the last several quarters, we’ve seen a dramatic hype cycle, if you will, on the provider side. There is probably as much need on the payer, health plan side,” he said.

Highmark is affiliated with the health system Allegheny Health Network, but Laguna’s technology is only being used on the insurer’s side at the moment, Edelshain said.

Photo: metamorworks, Getty Images

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