Blue KC plan cuts co-pays for doctor visits

A doctor's appointment with no paperwork or co-pays might sound like a dream, but Blue Cross and Blue Shield of Kansas City is working on creating just that.

The Kansas City insurer teamed up with Shawnee Mission Health to launch a new plan, Spira Care, that will roll primary care and insurance into one offering.

“The goal is to not have all of that administrative paperwork thrown at patients. There’s no asking for your credit card when you walk through the door,” said Dr. Greg Sweat, Blue KC's chief medical officer. “The overall experience should be drastically different.”

Blue KC will open two Spira Care-branded clinics in 2018; one in Olathe will open in January, and a second location will open in April in Shawnee. Sweat said the clinics will offer primary-care visits, routine lab tests, X-rays and behavioral health services at no additional cost.  

Staffed by Shawnee Mission Health physicians, the clinics also will be open for extended hours and see walk-in patients. They also will have on-site pharmacies that can fill the most common prescriptions at a regular co-pay level. Sweat said telehealth also will be covered through the plan, meaning patients should be able to talk to their doctor by phone.  

“It’s a wild advancement in primary care,” Sweat said. “It’s pushing the market a little bit to expand value-based care. We feel really excited about it.”

The two Spira clinics will be connected to Blue KC’s exclusive provider organization (EPO) plan, which includes nine area hospitals in its network. For non-emergency services, however, patients must stay in-network for coverage.

The plan includes the use of personal-care guides that answer patient questions and provide pre-visit and post-visit information. The care guides also will be able to compare costs for services outside the Spira Care clinics, such as specialist procedures.

Sweat said the model also should benefit physicians, who would face less paperwork and a smaller patient panel.

“We don’t want them to be seeing 25-30 patients per day as fast as they can,” he said. “We want incentives around high-quality care, customer experience.”

Blue KC also sees focusing on primary care as the best opportunity to reduce health care waste. With primary-care physicians driving patients’ health care decisions, equipping providers and patients with cost information can help bring down spending.

“I think we’ll see amazing uptake in 2018,” Sweat said, adding that the model would be easy to scale. Blue KC hopes to open Spira Care clinics in Kansas City and North Kansas City next.  

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