Regence uses its passion for innovation to make healthcare better
Regence was founded more than a century ago as one of the first health insurance models in the country, helping timber workers in the Pacific Northwest pool their wages to protect themselves and their colleagues from illness or injury. We continue that same spirit of innovation today.
Our longtime commitments to health data, to out-of-the-box tech solutions, to digital-forward health experiences and to artificial intelligence are not so much about technology as they are about developing the best tools to make healthcare more accessible, more personalized and more effective for the 3.6 million people we serve.
“We don’t chase shiny objects at Regence,” said Brooke Cowan, vice president of Applied AI at Regence. “We deliver innovation that produces real results for our members.”
Reforming prior authorization
We’re a national leader in soothing a pain point cited by Americans as one of the biggest issues in U.S. healthcare. We were the first health insurance company in the country to use a key national data exchange standard to make the prior authorization process faster and easier. Under our SmartAuth program, participating providers can make requests directly from a patient’s electronic health record, receiving faster decisions, while also reducing paperwork and human errors like sending the wrong records.
With SmartAuth, 94% of prior authorization requests receive an immediate response (meaning the request is approved or prior auth isn’t needed) within seconds. The other 6% of the time, requests are pended for human clinical review. Having nearly all requests receive automatic approval is a game changer for providers and for patients; the provider can move forward with next steps in the treatment plan while the patient is still in the room.
One of our provider partners, MultiCare in Washington, reported 140-230% productivity boosts using SmartAuth, as well as improved compliance and the ability to scale interoperability as a solution. Since using SmartAuth, MultiCare went from processing three to five prior authorization requests per hour to 10-12 per hour.
“Not only [does SmartAuth] ease the administrative complexity of healthcare, but the ability to receive transparent and actionable data at the point of service accelerates care delivery and increases adherence,” said Anna Taylor, assistant vice president of Population Health and Value-Based Care at MultiCare Connected Care. “When providers can spend more time collaborating with their patients on treatment plans, they have a better chance of improving outcomes.”
Using AI to improve customer service for our members
Most health plans’ benefit booklets are long and dense but also a critical source for what care is covered for each health plan member. With the help of AI, Regence customer service professionals can more efficiently serve our members over the phone by searching a member’s coverage policy using plain language.
Since launching, Customer Service Virtual Assistant has been used by more than 100 Regence customer service professionals serving over 400,000 members, cutting search time from nearly two minutes to just seconds.
That’s just one example of how we’re using AI to help our members. Another is using AI-driven data insights to pinpoint care interventions. We run many predictive models daily to identify members who might need care, and help them connect with preventive support before health issues become serious.
Improving care with strategic investments
A decade ago, Regence’s parent company helped launch Echo Health Ventures, a venture capital fund focused on investing in young companies with leading-edge solutions that make healthcare work better. These Echo portfolio companies could then partner with Regence and other health plans to help their members get the care they need.
Among the Echo companies Regence works with are Heartbeat Health, a virtual cardiology practice that makes cardiac care more accessible for Regence Medicare and commercial members, a critical aim in a country where heart disease is responsible for more deaths each year than all cancers combined. Read how a member used Heartbeat Health in their cardiac care.
Regence commercial members also now have access to Echo portfolio company Sempre Health, which makes prescription drugs more affordable by rewarding patients with increasing discounts for staying on track with their medications. About half of Americans don’t take their medications as prescribed, making the drugs less effective. But Sempre has saved millions of dollars for its members in prescription costs and helped people better manage their chronic conditions.
