Share ThisAt Highmark, we're not just talking about the future of health care; we're building it. By strategically integrating artificial intelligence (AI) into our case management practices, we're transforming how our dedicated team members work. This isn't just about efficiency; it's about empowering our clinicians to deliver an even better experience for our members.
In this article, we take a deeper dive with Judy Arrow, vice president of health engagement operations, to explore how Highmark is leveraging AI with Laguna Companion to streamline workflows, reduce administrative burden, and enhance the overall experience for both our clinicians and members.
You'll also hear directly from the clinicians who piloted this impactful tool, sharing their firsthand accounts in the video below.
Jim Janovyak, registered nurse case manager: Laguna Companion is an artificial intelligence-powered virtual companion that works alongside what we're doing as specialty case managers. And so my daily role as a specialty case manager is to call our members and make sure that they have everything that they need.
Jude McGuire, pediatric behavioral health coach: The first time I used Laguna Companion, I was a little bit skeptical how it was going to really be implemented and go through. After it was introduced, I realized how awesome it was and what a great tool it could be.
Michelle Glass, registered nurse case manager: Laguna Companion has saved me an immense amount of time researching, documenting. It's providing us insights, real-time transcription, and then post-call documentation at the end of our call.
Jim Janovyak: Some of the barriers that we run into before Laguna really is time management, especially when it comes to documentation. And that can be as time consuming as the time you spend with the members themselves.
Jude McGuire: The tool absolutely makes it easier to optimize the care coordination. Just the simple fact that we don't have to multitask, and all the information's saved in one place.
Luanne Klimchock, registered nurse case manager: And it's a nice way to refresh my memory of the last interaction with the member. In a way, it feels like picking up the call right where we left off. So it's good for the member to know they don't have to tell their whole story again.
Laguna Companion provides feedback immediately after the call has been captured, once the note has been summarized. And I check it every time. I've had one excellent, and the rest have been very good.
Michelle Glass: My very first call was with a member that had a really poor connection and he had a very strong accent. I had a very difficult time understanding him and I wasn't really even aware of the feature of the real-time transcription at the time. The Laguna team showed me that. The call went so smooth after that because I could follow along, read along, I could hear what he was saying. It led to a much better interaction for both of us.
Jude McGuire: I was working with a mother and I didn't realize that she sounded a little bit tense, but Laguna knew. So Laguna suggested to ask her about her supports. It was something I didn't have to think about. Like, it just was able to flow within the call.
Michelle Glass: Using Laguna Companion has really improved day-to-day work, my overall job satisfaction. I'm able to outreach many more members through the day.
Luanne Klimchock: I am able to spend more time with members. I am able to work faster a lot of times.
Jude McGuire: The biggest benefit of this tool for Highmark members is they get 100% of the clinician's attention which makes them healthier and they have a better experience with Highmark.
Jim Janovyak: One of the things as a registered nurse, and I'll share this sometimes with our members, is that I went into being a nurse so that I could care for people. And so, tools like this are real-time examples of Highmark taking the initiative to really be member first and to focus on the needs of their members. And that fits with my ethic.
Catherine Clements: In our first interview, Judy, you shared how Highmark is evolving case management. Laguna Companion is a big step in that evolution. Tell me more about the decision to implement this technology into case management operations.
Judy Arrow: Our primary driver was to drastically reduce the administrative burden on our case managers. They were spending nearly 16% of their time on manual documentation, leading to increased workloads, potential for errors, and decreased job satisfaction.
We recognized that clinically intelligent conversational AI, built with deep health care expertise, could be the answer to scale personalized case management efficiently while addressing these challenges. We saw the transformative potential of a generative AI solution, but selecting the right platform was key.
Laguna Companion immediately stood out because it's built for care management, offering unparalleled clinical integrity. Laguna's approach centered on our philosophy of keeping the “human at the helm,” so clinicians review and ensure clinical accuracy on all documentation.
It also provides deep customization to meet the nuanced needs of health care workflows, unlike generic AI tools. It doesn't just enhance productivity with AI transcription and smart summaries; it provides real-time insights and immediate feedback after the call, alongside advanced analytics. This empowered our case managers by using AI to augment their capabilities, enabling them to truly work at the top of their license.
Catherine Clements: How does this tool directly support Highmark's case managers?
Judy Arrow: Laguna Companion fundamentally transforms how our case managers work. It's an AI partner that guides conversations with real-time notifications and generates comprehensive, tailored call documentation and suggested follow-up actions, including insights into areas like oncology or maternity where program nuances are critical.
This frees our clinicians to focus entirely on listening and engaging with members, leading to deeper understanding and improved health outcomes. Our most experienced case managers confirm that Laguna's summaries often surpass what they could create manually.
The system is also integrated with our clinical platform, Predictal, ensuring seamless workflow.
Transparency is paramount; a clear AI disclaimer at the start of calls has led to an exceptionally low decline rate, showcasing strong member trust. This high acceptance and our detailed edit tracking allow us to continually refine the system's performance, ensuring both accuracy and member trust.
Catherine Clements: Highmark serves a broad member population. How did we intentionally shape and implement Laguna Companion to meet these needs, ultimately leading to a more personalized and positive member experience?
Judy Arrow: To address Highmark's diverse member population and ensure a highly personalized experience, we purposefully engaged social workers and behavioral health specialists in our pilot. Laguna collaborated closely with us, analyzing a broad range of call recordings to ensure the AI was finely tuned to all member needs. This collaborative approach ensures that Laguna's output, like our post-call documentation summaries, is individualized.
Laguna enables our clinicians to devote more time to meaningful conversations, deepen relationships, and provide targeted support that resonates deeply with each member. The system’s real-time transcription capabilities also overcome issues like poor audio and language barriers, ensuring consistent, high-quality interactions across our diverse membership. This ultimately fosters greater trust and facilitates improved adherence to care plans.
Catherine Clements: What were your initial expectations for the pilot program, and how did the results compare?
Judy Arrow: Our expectations were exceeded across the board. We aimed for a 60% reduction in documentation time, and Laguna Companion delivered a staggering 66% decrease, from nearly eight minutes to under three minutes per call. This dramatically freed our clinicians, enabling them to focus on complex cases and deeper member engagement. Beyond just time savings, we saw other significant gains: a 10-12% increase in productivity across all pilot teams, along with an impressive 99% accuracy in clinical content generated. Edits required are minimal and are continuously decreasing.
What truly highlights the impact is the improved clinician experience: over 90% satisfaction rates, a 14% increase in their ability to focus on members, and a 27% improvement in pre-call preparation. The Laguna Insights Dashboard also provides the managers with invaluable team and individual views of efficiency, quality, process adherence, and staff well-being, enhancing management impact and staff development.
Catherine Clements: And which of these datapoints did you find the most compelling?
Judy Arrow: While the 66% reduction in documentation time and subsequent productivity gains are powerful metrics demonstrating ROI, what's truly compelling is the swift and enthusiastic adoption by our clinicians. We designed the pilot to include staff with varying tech comfort levels and seeing everyone — from tech-savvy to more hesitant — embrace Laguna as a “game-changer” after just a few calls was amazing. Their elevated job satisfaction, confidence, and increased capacity for empathetic member interactions demonstrate that Laguna delivers beyond mere efficiency; it empowers our case managers to be better clinicians, which is a testament to its holistic value.
Catherine Clements: That’s incredible. It sounds like a very intuitive tool. Now that the pilot has proved its benefit, what’s next?
Judy Arrow: Building on the successful pilot and remarkable benefits, we’ve rapidly scaled Laguna Companion across our entire 300+ case management team. This expansion is critical to further optimize our operations, elevate the quality of our interactions, ensure compliance, and most importantly, deliver enhanced, personalized support to our members at scale. The platform's continuous learning ensures it adapts to program nuances and clinician preferences, always maintaining consistency and accuracy.
Catherine Clements: Looking ahead, how do you see AI and other emerging technologies further transforming case management practices?
Judy Arrow: Looking ahead, AI and emerging technologies will redefine case management across four strategic pillars that need to be rooted in trust and credibility.
As vice president of health engagement operations at Highmark Health, Judy Arrow, RN, MSN, CCM, oversees a diverse team of licensed clinicians and customer-facing staff. This team is responsible for the management of Highmark's clinical programs and support services, encompassing case and disease management (including specialty), behavioral health, pharmacy, social work, and wellness initiatives. Judy brings over 25 years of management, operational leadership, and clinical experience in both the provider and health plan landscape, with a strong focus on leading teams that deliver case and disease management services for commercial and government programs. Judy is a Registered Nurse with a Master of Science in Nursing from Carlow University, specializing in Case Management and Professional Leadership, and she holds a Certified Case Manager (CCM) certification.
Highmark Health and its subsidiaries and affiliates comprise a national blended health organization that employs more than 42,000 people and serves millions of Americans across the country.
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