Blue Cross Blue Shield's Kari Hedges on Fixing Healthcare

Thirty years in healthcare gives you a particular kind of clarity. Kari Hedges, Senior Vice President of Market Solutions at the Blue Cross Blue Shield Association, has spent three decades watching the American healthcare system evolve — from paper records and fax machines to electronic claims and artificial intelligence.

On today’s episode of the America's Work Force Union Podcast, Hedges joined National Labor Office Executive Director Merrilee Logue to discuss what has improved, what remains broken and what Blue Cross Blue Shield is doing to close the gap for the 18 million union members it serves.

• Healthcare data interoperability remains one of the most urgent unsolved problems in American medicine, with fragmented records systems putting patients at direct risk of delayed or missed diagnoses.
• Blue Cross Blue Shield's use of electronic prior authorization has shown that 84 percent of cases can be resolved instantaneously, with provider efficiency improving by up to 230 percent.
• Telehealth and behavioral health integration are expanding access for union members who face shift-work barriers, rural geography or reluctance to seek in-person mental health support.

How 30 Years With Blue Cross Blue Shield Shaped One Leader's Mission

April marks a milestone for Kari Hedges. Three decades after joining the Blue Cross Blue Shield system, the now Senior Vice President of Market Solutions at the Blue Cross Blue Shield Association is still driven by the same conviction that brought her to the industry: working families deserve a healthcare system that works as hard as they do.

Hedges said the labor market has always occupied a central place in her professional identity. Union members, trades workers and public employees, she argued, count on their health benefits in ways that make the quality and accessibility of coverage critical. For Hedges, that sense of obligation is personal.

A College Emergency Room Visit That Changed Everything

Hedges traced her understanding of healthcare's structural failures to a hospital emergency room visit during her college years in Kentucky. Her mother, a high school math teacher in a Chicago suburb, carried Blue Cross Blue Shield coverage through her teachers' union. But in the 1990s, the connectivity between Blue plans across state lines was limited, and resolving an out-of-state claim required her mother to contact a union representative to help navigate the system.

That experience, Hedges said, is precisely what she has spent her career working to prevent. Today, the Blue Cross Blue Shield Association processes more than 400 million claims annually for members receiving care outside their home plan's market — a volume that reflects how fundamentally the system's infrastructure has changed.

What Three Decades of Progress Actually Looks Like

When Hedges entered the industry, electronic data interchange for claims was still being launched. Paper medical records were standard. Fax machines and physical mail moved the administrative work of healthcare. Today, she said, 98 percent of healthcare claims are processed electronically — a transformation she credited to sustained collaboration across the industry.

Logue added that the administrative evolution is only part of the story. She pointed to the growing recognition of behavioral health as equally important to physical care as one of the most meaningful shifts of her own career. Union members, she noted, face compounding pressures like long hours, physical demands and chronic stress, which make mental health support not a luxury but a necessity.

Hedges connected that shift directly to the expansion of telehealth. Whether a worker lives in a rural area with few providers, works a shift that conflicts with clinic hours or simply feels more comfortable seeking mental health support from home, telehealth has opened access that did not previously exist. The pandemic accelerated adoption, she said, but the underlying need was never new.

When the System Fails: A Daughter's Fight to Save Her Mother

The most urgent remaining challenge, Hedges argued, is data interoperability, and she illustrated it with an extremely personal story.

In recent years, her mother's health declined rapidly despite being treated by multiple physicians within the same healthcare system. Each doctor addressed only the immediate episode at hand. No one was synthesizing the full picture. Her mother was hospitalized repeatedly for dehydration and related complications without anyone identifying the root cause.

Eventually, a specialist in a different health system agreed to take a comprehensive look, but had no access to her prior records. The original system told the family it would take at least a week to retrieve the records, and that retrieval would require a physical visit to pick up a CD.

Hedges explained how she used her mother's patient portal credentials to screenshot every accessible record, such as lab results, imaging and scans, and uploaded them directly to the new physician's system. That workaround enabled the specialist to identify what others had missed. Her mother required emergency surgery.

Hedges explained that most patients don’t know how to navigate a fragmented system the way she did. The problem is not that physicians lack commitment. The problem is that the systems they work within are not built to share information. Without interoperability, care suffers.

How Blue Cross Blue Shield Is Building the Infrastructure for Better Care

In response, Hedges said Blue Cross Blue Shield has built an interoperability hub focused on clinical data exchange, enabling a patient's physician to access a real-time, comprehensive view of that person's health history. The association is currently exchanging clinical messages for hundreds of thousands of members and is working to further scale that capacity.

Prior authorization is a related pressure point that Hedges addressed directly. She said nearly half of all prior authorizations are still submitted by phone, fax or mail — a pace that trails the electronic claims experience by a wide margin. Blue Cross Blue Shield is deploying an industry-standard data language to automate the process.

A study involving a Blue Cross Blue Shield plan and a provider group called Multicare Connect Care found that when using this common framework, 84 percent of cases required no prior authorization, with determinations made instantaneously. For cases that did require authorization, approvals that previously took days were resolved in a fraction of the time, and provider staff reported efficiency improvements of up to 230 percent. The goal, Hedges said, is to complete prior authorization approvals before a patient leaves the doctor's office.

Artificial Intelligence and the Responsibility That Comes With It

Hedges addressed AI carefully, framing it as a technology with significant potential that must be deployed with equal discipline. She argued that the interoperability work already underway is what makes meaningful AI possible — because AI can only perform as well as the data it can access. Fragmented, siloed patient records limit what AI can do. Seamless data flow across providers, hospital systems and health plans creates the conditions for AI to uncover insights no individual clinician could find manually.

Logue emphasized that any application of AI in healthcare must be transparent, equitable and centered on patient welfare. That commitment, she said, is central to Blue Cross Blue Shield's mission.

In closing, Hedges said the current technological advancements are benefiting ordinary Americans — including union members and working families who have always depended on their coverage to be there when it matters most.

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