VIDEO | Blue Cross & Blue Shield Head of Enterprise Data Science & AI: AI and ML Lead to Intelligent Service

(US and Canada) Derrick Higgins, Head of Enterprise Data Science & AI at Blue Cross and Blue Shield of Illinois, Montana, New Mexico, Oklahoma and Texas, speaks with Robert Lutton, Sandhill Consultants Vice President, about the company, his role, and driving business value outcomes through enterprise data analytics.

Higgins describes Blue Cross and Blue Shield of Illinois, Montana, Oklahoma, New Mexico, and Texas as a health insurance company on the payer side, one of numerous companies operating under the Blue Cross and Blue Shield umbrella. As a healthcare service corporation, he explains that the company manages healthcare reimbursement operations by paying the healthcare claims of the members they cover. It also uses channels like commercial markets, employer-based health insurance, retail markets, and government markets to sell healthcare plans.

As the Head of Enterprise Data Science and AI, Higgins ensures that the company reaps the maximum benefits of artificial intelligence and machine learning. He indicates that using them appropriately makes member services more intelligent and responsive. Further, leveraging a team of data scientists to deploy building capabilities while engaging with vendors and start-ups derive the best results, he adds.

Next, Higgins states that the organization is disciplined about its business value and how to quantify it. Being in leadership, he is accountable for target and return on investment. He asserts that one aspect of business value revolves around gaining operational efficiencies from new sources of revenue acquired through AI, while the other aspect is member experience.

As a for-profit insurance company, Blue Cross and Blue Shield needs to make an appropriate operating margin to stay in business, Higgins says. However, the overall organizational purpose is to stand with members in sickness and health.

When asked about the necessity of having a data and analytics background for the role, Higgins describes himself as a technical person with a Ph.D. He firmly believes that having different backgrounds offer different perspectives, and leaders can succeed if they have the right team.

Emphasizing delivering value through enterprise data and analytics, Higgins mentions the concept of smart healthcare, which reforms care delivery to better serve members. He affirms the need to create a positive impact on the healthcare ecosystem by delivering tailored healthcare through smart healthcare use cases.