Blue Cross Blue Shield of Massachusetts and Burlington, Mass.-based Tufts Medicine are partnering on a new health plan for BCBS employees, as well as AI implementation to streamline prior authorization.
The HMO, Tufts Medicine Alliance Network, includes access to Tufts Medicine, Boston Children’s Hospital and Dana-Farber Cancer Institute. The HMO also provides next-day primary care access and specialist access within 21 days, according to an Oct. 22 news release.
BCBS told Becker’s that about 35% of its workforce lives within the plan’s region, and that the plan will be available during their open enrollment. BCBS and Tufts Medicine said they are considering expanding the HMO’s availability to other employers in the future and are collaborating on similar offerings.
BCBS and Tufts Medicine are also working on prior authorization automation using healthcare technology company Humata Health’s AI platform. This initiative applies to all BCBS members receiving care at Tufts Medicine, but BCBS intends to expand this implementation to other providers in the future.
BCBS and Tufts Medicine are aiming for implementation in early 2027. They said the effort would cut prior authorization processing time for select imaging services, such as MRIs, from days to minutes. The organizations also expect to expand the solution to other services.
“The prior authorization efforts were prompted by a desire to streamline processes, remove unnecessary delays, and reduce administrative friction for members and providers,” the organizations told Becker’s. “The primary goal is to significantly reduce the time it takes to get an approval.”
The organizations said that “the AI automation does not eliminate human involvement but reframes it.” The AI relies on the same clinical criteria as manual review, and requests that need more information or do not meet the criteria are escalated for clinician review, abiding by the current procedure.
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