Banner Health’s Integrated Insurance Model Advances Care Coordination and AI Use
Banner Health, a nonprofit health system based in Phoenix, Arizona, launched its insurance company, Banner Plans and Networks, in 2011 under the leadership of Chuck Lehn, who has been with the organization since 1986.
The health plan now serves 3.5 million patients annually, offering Medicare, Medicare Advantage, and Medicaid plans, including a joint venture with Aetna. This integration of health system and insurance operations provides unique advantages in terms of data access and care coordination, facilitating improved patient engagement and provider collaboration.
Lehn emphasizes a shift in the health insurance narrative towards rewarding the maintenance of health rather than just treatment. The plan prioritizes member service quality through continuous feedback mechanisms, regulatory compliance involving departments of insurance and Medicare/Medicaid agencies, and sustaining provider network engagement. Providers in the Banner system benefit from seeing the broader impact of their care beyond individual patients.
Recent policy changes have presented challenges and opportunities. Updates in Medicare Advantage star ratings and risk adjustments require careful management to optimize performance and compliance. The COVID-19 pandemic accelerated virtual care adoption, creating a backlog of demand and new challenges with Medicaid coverage redetermination, necessitating strategies to maintain coverage while adhering to regulations.
Technological advancements, particularly AI, are viewed as critical tools for operational efficiency and consumer satisfaction. AI applications are used to automate administrative tasks such as prior authorization, enhance call center interactions, and identify potential issues like scheduling with non-contracted providers to prevent surprise billing. These technologies help reduce costs, improve decision-making speed, and enhance overall member experience.
Operating a health plan connected to a health system offers enhanced access to electronic medical records and scheduling data, enabling better care coordination and member outreach. This integration leads to improved preventive care completion rates and strengthens provider-patient relationships. Banner Health’s approach reflects broader industry trends towards leveraging integrated health and insurance models supported by technology to address compliance, regulatory challenges, and market demands.