Transforming the care experience for healthcare’s emerging consumers

Published November 27, 2019

“We all know that the healthcare system is complex and often confusing,” says Greg Sweat, M.D., Blue Cross and Blue Shield of Kansas City’s (Blue KC) Chief Medical Officer. Three years ago, the Blue KC team saw that one-by-one, the top companies in other industries were turning toward simpler, more personal solutions. “We [as consumers] have this expectation of being known when we engage with companies,” he says, pointing to the example of Amazon, which personalizes product recommendations and search results for its shoppers in real time. 

So, under the leadership of Blue KC’s Vice President and Chief Innovation Officer, Jason Spacek, they began working to bring a similar solution to healthcare. One that would prioritize primary care and behavioral health by removing barriers to both, with an aim to reduce downstream spending on other, more expensive types of care.

The Spira Care solution

The result was a new plan—Spira Care—that gives members access to primary care service centers located throughout Blue KC’s service area, in addition to a variety of in-network hospitals and specialists. These Care Centers are one-stop-shops for primary care for adults and children including integrated behavioral health services—all available at no extra cost beyond a member’s monthly premium. Select prescriptions are also available on-site for the member’s regular copay. 

The cherry on top of this simpler approach to healthcare? On-site Care Guides who provide an optimal customer experience for Spira members. Their role is part-customer service, part-care coordinator—something that doesn’t exist in traditional provider offices. They serve as members’ primary contact for both care and coverage, and can help with anything from answering questions and explaining benefits to scheduling specialist appointments. 

Bringing their vision to life 

Spacek and his team spent months working with healthcare’s emerging and future consumers—millennials—to identify where they disconnected from the current system and co-design a solution. To get this model right, the team spent hours in all-encompassing, free-flowing conversations at customers’ homes to not only hear, but also see, what was important to them. 

Prioritizing Human Connection

“The overarching theme we saw time and time again was that people don’t want just more technology,” says Dr. Sweat. “At the end of the day, healthcare is arguably one of the most personal experiences we have. [Consumers] want something that brings human connection to the forefront of this experience.” 

For example, in an early concept of Spira Care, members would check in for their appointment at an electronic kiosk. “People didn’t like that idea,” adds Dr. Sweat. “They wanted someone to know they were there.” 

So Blue KC listened: “When [our members] come through that front door, they will see these big words: ‘Care Lives Here,’” says Member Experience Coordinator Jocelyn Burgette. “And that’s our mission. Members are now greeted by a Care Guide—no kiosks, no phones, no glass walls. It’s just like greeting a family member.”

This familiarity extends to the exam room, where doctors can get to know their patients and invest in their long-term care. Because they are not paid on a traditional fee-for-service basis, they are able to spend the time they need to provide everything from preventive care and nutritional counseling to behavioral health, chronic condition management and more. 

And that’s providing a better experience for doctors, too. “What makes this model different is that I have time to sit down and talk through a diabetic diet or how mental health can affect other health problems,” says Dr. Jason Bessey, a physician at one of the centers. “These seem like little things on the surface, but they really are the big things.” 

Early Results Are Encouraging

Blue KC currently operates six Spira Care Centers in Kansas and Missouri. An additional Care Center will be opening in the first quarter of 2020. 

The market’s response to the Spira Care concept has been extraordinary. Membership has grown from a little more than 1500 members on January 1, 2018 to nearly 30,000 by August 2019. And they’ve already seen promising results since the launch of the offering with an increase in primary care visits, a decrease in specialist visits and a lower overall cost of care for consumers. 

Results from Spira Care's first year infographic
Results from Spira Care's first year: Primary care physician visits went up 56%, specialist visits went down 52%, and total cost of care went down 15%.

The model has also had a positive impact on customer experience and quality of care.

“So far this has been the best experience I’ve had with [a] medical practice,” says Blue KC member Jen Rowland. “I had medication that needed to be refilled and a referral made to an outside provider. Everything was taken care of for me. I showed up at the other provider, and … I didn’t even have to provide an insurance card, as they already had it all in the system.”

The success Blue KC has had with Spira Care in redesigning healthcare, with a strong patient-centered focus, has yielded promising initial results, inspiring Blue KC to continue to invest in and grow this model of healthcare within the Kansas City region. They plan to build more Spira Care Centers, with 10 expected to be completed by the end of 2020 and will continue to make innovations as the healthcare industry and consumer expectations change and evolve. 

Blue Cross and Blue Shield of Kansas City is independent licensees of the Blue Cross Blue Shield Association, an association of independent, locally operated Blue Cross and Blue Shield companies.