Reimagining primary care through a personal touch

Health care can be complicated, expensive and, too often, inconvenient. But what if it isn’t?

What if a doctor visit allows for one-stop-services for checkups, lab work, x-rays and even treatment for mental health conditions, all under one roof? No scheduling hassles. No repetitive paper work in office after office. Not even any copayments.

This is primary care, reinvented in Kansas City. 

Working with consumers to better understand what they wanted in their health care experience, as well as what was missing, a new delivery model for primary care, Spira Care, was developed. Through Spira Care, Blue Cross and Blue Shield of Kansas City (Blue KC) lowered costs and improved care.

“We have a unique opportunity and an important obligation to consumers to experiment with new strategies and innovations that improve patient care and experience, as well as lower costs,” said Greg Sweat, M.D., vice president and chief medical officer at Blue KC. “Spira Care allows us to personalize care and meet patients’ needs that for far too long had been unmet.”

The high cost of outdated care

More than $3 trillion is spent on health care each year, and 90 percent of every health care dollar is spent treating people with chronic conditions, many of which are preventable or could be managed more effectively. With more than 60 percent of Americans having at least one chronic condition and growing evidence that behavioral health conditions like depression are linked to common illnesses such as diabetes, patients and physicians are seeking ways to better prevent, treat and manage chronic disease.

Spira Care sees the patient as a whole person and provides a holistic approach to care that is resulting in fewer intensive medical interventions and avoiding unnecessary costs.   

The centers, which are offered to Blue KC members through employer-sponsored health plans, offer integrated, personalized care in one location, eliminating the need for patients to make multiple appointments or travel to different offices. They offer open access to care teams, routine lab draws and x-rays, along with integrated behavioral health services, all with no copay. Patients can get their prescriptions filled at the centers, and the on-site behavioral health specialists can immediately take referrals and initiate treatment as necessary, focusing on recommendations that increase the patient’s ability to manage their mental health and chronic condition simultaneously.

Breaking down barriers to guide the patient journey

Patients are supported by personal Care Guides that can answer questions about costs, benefits and quality of care. Spira Care was designed to be a one-stop-shop, but for health care needs that go beyond what can be addressed by the primary care facilities, the Care Guides assist patients with care coordination, referrals and cost comparisons. The personal Care Guides, all nurses or those with a background in health benefits, are trained in understanding the needs and concerns of the patient throughout the care journey. 

To make sure patients receive the care they need, when they need it, Blue KC offers gas cards to some to aid with the cost of transportation if they are referred to a different facility.

Personalized care is producing results

The first center opened in January 2018 with 1,500 patients; today there are six Spira Care Centers with more than 30,000 patients. Currently, compared to non-Spira Care patients, Blue KC is reporting a 25 percent increase in primary care visits, 52 percent fewer specialist appointments as well as a 41 percent reduction in hospitalizations and a 21 percent decrease in emergency room visits. And for those participating in Spira Care, the total cost of care is down by approximately eight percent.

“Our goal with the Spira Care centers was to make health care more personable, more accessible and more affordable,” added Sweat. “We are adding the conveniences of today’s world without losing the human connection patients desire.” 

Blue Cross and Blue Shield of Kansas City Senior Vice President and Chief Medical Officer, Dr. Greg Sweat and Dr. Michael Munger, Medical Director of Primary Care Transformation at St. Luke’s Health System in Kansas City discussed preventing and managing chronic conditions through primary care as part of  the BCBSA and American Academy of Family Physicians’ sponsored POLITICO Live event: Combating Chronic Conditions.

Additional Resources: 

• See how Blue Cross and Blue Shield companies are working to improve primary care to address chronic diseases and lower costs.
• Read our latest issue brief on addressing the high cost of treating chronic diseases. 
• See the full paper: Trends in Spending Across Key Chronic Health Care Conditions Among Privately Insured Adults, 2000-2015.
• Read our Insights piece: Confronting the burden of chronic disease.