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Episode 2114 Transcript:

00;00;01;14 - 00;00;05;15

Announcer

And now America's Healthcare Advocate, Cary Hall.

00;00;05;19 - 00;00;21;25

Cary Hall

Hello, America. Welcome to America's Healthcare Advocate show broadcasting coast to coast across the USA. Here on the HIA Radio Network. You can find out more about us by going to the website AmericasHealthcareAdvocate.com. If you've got a question or comment, send me an email. I'll be happy to answer it.

00;00;21;26 - 00;00;32;11

Cary Hall

Do anything I can to help you. In studio with me today some guests from Blue Cross and Blue Shield of Kansas City. Very happy to have them here. Maggie Parker is the director of large group. Welcome.

00;00;32;13 - 00;00;32;28

Maggie Parker

Thank you.

00;00;32;29 - 00;00;33;27

Cary Hall

You're first time here

00;00;33;27 - 00;00;34;09

Maggie Parker

Thanks for having me.

00;00;34;10 - 00;00;52;20

Cary Hall

Anna Finnegan, vice president of Spira Care. She has been here before. Welcome her back. So we're happy to have them in studio with us today. We're going to talk about a couple of things. The large group concept. What? Blue Cross and Blue Shield brings to the large group market. This is show that I've wanted to do for a very long time.

00;00;52;26 - 00;01;09;01

Cary Hall

And we're going to get to do it today. So employers out there, brokers out there. If you fall into the category of large group, we're going to talk about that. We're going to talk about why these programs are different. And we're going to talk about how you have access to Spira Care now. And that's another piece of this I think you're going to find very, very important.

00;01;09;08 - 00;01;29;22

Cary Hall

My producer today, Mr. Garner Cowdrey, he's the man behind the microphones over here. And Dave Thiessen behind all the cameras, who does all of our video work and posts all these shows on our YouTube and podcast platforms. There are 15 podcast platforms. If you listen to one of the shows, like it, follow or subscribe. It doesn't cost anything to subscribe, by the way.

00;01;29;22 - 00;01;45;25

Cary Hall

So if you choose to do that, please, we would love to have you. But I also want to say hello to one of our affiliates in Amarillo, Texas, KGNC 710AM and 97.5 FM. Got a nice, note from them the other day airing the show down there. I think we've been on down there about five years now.

00;01;45;25 - 00;02;10;01

Cary Hall

So hello to Amarillo, Texas. So let's start if you can. Maggie, let's just talk a little bit about, the large group offering. And you know, what's unique about the way BlueKC does is you've got a very large book of group business, some some of the bigger groups, the city, the AfL-CIO, you've got some pretty large groups in here, but start out with the size of large group, and let's just go from there.

00;02;10;02 - 00;02;33;26

Maggie Parker

Maggie absolutely will appreciate the opportunity to come in and talk. Thanks for having us. So when we when we think large group as it relates to BlueKC large group, the that market segment is really our 100 plus employers. So if you have, 100 or more employees enrolled on your plan, that is going to fall into our large group book of business or our large group segment.

00;02;33;29 - 00;03;02;13

Maggie Parker

Within that segment, we have over 340 large group customers that we work with closely. The value of BlueKC really is the the local presence, right. Our opportunity to collaborate with our customers, sit down with them. Because we are local and we have that local presence. Our, team of sales individuals is able to really help collaborate and customize health insurance plans alongside our our customers and broker partners.

00;03;02;13 - 00;03;20;25

Cary Hall

So so, you know, BlueKC has won multiple awards, the J.D. Power Award for customer service. And it's something you guys have always prided yourself on. You always find it amusing, when I when you talk about some of these national plans out there and somebody gets on the phone and asks them, can you tell me about the hospitals north of the river?

00;03;20;25 - 00;03;38;16

Cary Hall

And they ask you what river? You know, you're not talking to somebody in Kansas City. Yeah. So talk a little bit about how your customer service model blends in with large group to help the broker. Sure. Okay. And to help the employer so that the human resource director is not running back to his office going. We're having all kinds of problems.

00;03;38;17 - 00;03;40;05

Cary Hall

Yeah. Let's talk a little bit about that.

00;03;40;06 - 00;04;01;22

Maggie Parker

I think that's a great point. Thanks for bringing it up. So from a customer service perspective, we have a variety of layers to help support our our groups, our brokers, our members. I'll start at the member level right where you have your call in customer service options or and those individuals. Yes, our, our award winning customer service agents, we really pride ourselves on that.

00;04;01;22 - 00;04;24;22

Maggie Parker

In fact, our our corporate some of our corporate goals include the insurance of understanding and making sure that our members have, really good customer experiences. When they call, I call in from the then we talk about kind of the broker support, right? We talk about the group, support that really falls on to the, the sales team.

00;04;24;22 - 00;04;41;01

Maggie Parker

And we really pride ourselves in those relationships. We've, we've been in, the Kansas City metro for over 85 years. And that's, that's super important to us. And we continue to really pour into those relationships on the broker side as well as our, our customer group, group customer side.

00;04;41;08 - 00;04;49;27

Cary Hall

So let's let's switch gears a little bit and talk about ASO. So can you define a so for the audience. And then let's talk about that and how that interacts with the brokerage community.

00;04;50;02 - 00;05;23;05

Maggie Parker

If you don't mind I'm going to take a step back and really just talk about maybe what a fully insured plan is. Yeah. So our fully insured plans, those are group health plans where employer groups seek out a commercial health insurer right to insure the plan. And then when with that arrangement, the health insurance BlueKC or other carrier then would pay those claims on behalf of that group employer plan in itself and self-funded model BlueKC is really only hired to administer those claims.

00;05;23;07 - 00;05;27;14

Maggie Parker

The payment of those claims really falls on to the employer group.

00;05;27;20 - 00;05;32;25

Cary Hall

Are you handling stop loss for these large groups? It certainly can. So you do have the ability to do that?

00;05;32;25 - 00;05;44;00

Maggie Parker

Absolutely, yes. Stop loss is an option that we can write. They can carve in that stop loss coverage with BlueKC. Or they can carve out that stop loss coverage if that is something that they're interested in doing.

00;05;44;00 - 00;06;06;13

Cary Hall

And so when you talk about, you know, working with the brokers on this is is, is there do you see a lot of noise now around this whole issue of PBMs? You know, we're you're laughing. Yeah. You know, you see companies like Aetna pulling completely out of the marketplace, on on the ACA side etcetera. And, and United is having problems as well.

00;06;06;13 - 00;06;16;04

Cary Hall

But so talk a little bit about the PBM and how you guys handle that on the large group side. And your thoughts on that. Absolutely. And what is a PBM? Let's start by telling the audience, I think.

00;06;16;04 - 00;06;48;24

Maggie Parker

That's a great idea. Pharmacy Benefits Manager (PBM) in the insurance world, I think, as you know, there, there's an acronym for everything. So I appreciate the opportunity to clarify that upfront. So PBMs are yes, they are the big three, the Optum the ESI and the CVS. Those are what we call kind of a big box PBMs. There are also a lot of boutique PBM opportunities or excuse me, organizations popping up for for groups to really evaluate.

00;06;49;02 - 00;07;11;22

Maggie Parker

They have some flexibility in, in some of their offerings. But ultimately we are seeing the pharmacy spend for group health plans expanding so much that we we now find that that is one of the larger line items. When they when they take a look at what their health plan spend is allocated for. So BlueKC, we work with Optum as our preferred PBM.

00;07;11;24 - 00;07;36;19

Maggie Parker

However, as we move into 1/1 of 2026 for our ASO customers, our self-funded customers, as we just described, those individual groups have the opportunity to carve out to a different PBM if they so choose the integrated PBMs that we have chosen for 1/1 of 2026 include Smith Rx, Capital Rx and Med Impact.

00;07;36;21 - 00;07;46;29

Maggie Parker

So as our customers are going to evaluate, what vendor partners they want to work with in 1/1/26, that list is expanded a bit as we, as we move toward that date.

00;07;47;02 - 00;08;03;20

Cary Hall

So when you're looking at those three different PBMs, are you looking at the standpoint if they're offering different formularies, maybe. Are some of them offering drug importation from Canada is in Australia? We are what are there some different benefits between the different PBMs and how they're approaching it?

00;08;03;20 - 00;08;40;14

Maggie Parker

Absolutely. We anticipate, yes, that as as groups are going to evaluate some of these PBM solutions, there are a number of formulary changes. There's discount opportunities or changes. There's changes oftentimes in the rebate mix or the rebate guarantees in which they are being promised to the group. However, I will say, Cary that whenever we're talking about the opportunity to carve out this, line of business within our market, BlueKC isn't involved in that contract negotiation.

00;08;40;14 - 00;08;46;25

Maggie Parker

When that contract negotiation really happens directly with the group and broker and that other PBM. So oftentimes times...

00;08;46;25 - 00;08;47;22

Cary Hall

You’re there to help if they need.

00;08;47;22 - 00;09;02;22

Maggie Parker

100%. We want to be able to take a look at that, illustrate how BlueKC's offer is standing up. And and perhaps then how to compare and contrast, and really spread, those different options.

00;09;02;24 - 00;09;17;04

Cary Hall

Wonderful. All right. When we come back to the break, we're going to talk about the future. What is BlueKC planning for next year? What do they have in in the hopper right now that we're going to hear about that's going to affect brokers and it's going to affect the large groups. We'll be right back after the break.

00;09;17;10 - 00;09;48;17

Cary Hall

You're listening to America's Healthcare Advocate broadcasting here on the HIA radio network. Coast to coast across the USA. If you want information, go to the website bluekc.com or give them a call at (833) 467-2145. Stay tuned. We'll be right back with more.

00;09;48;20 - 00;10;06;15

Cary Hall

Welcome back to America's Healthcare Advocate, broadcasting coast to coast across the USA. If you want to find out more about us, go to the website AmericasHealthcareAdvocate.com. All the shows are posted up there, plus our 15 podcast channels and our YouTube channel. So you're a broker and you want to tell somebody about these opportunities with Blue Cross.

00;10;06;15 - 00;10;26;23

Cary Hall

You can use the show to do that. You can also share it inside your group if you want to do that as well. And you can also reach out to the good folks over at Blue Cross at (833) 467-2145or the website bluekc.com. All right, Maggie, let's go back and talk about, you know, what's going to happen in 2026 and your enhanced ASO.

00;10;26;23 - 00;10;31;03

Cary Hall

And then the integration into Spira Care. So let's talk about those three things. Super.

00;10;31;03 - 00;10;55;28

Maggie Parker

Thanks. As we talk about ASO: “administrative services only” that and self-funded health plans. It's one in the same when we talk about, Blue Cross and what we have to offer. We currently offer an ASO product today. However, as we move toward 1/1 of 2026, we’ve really taken market feedback and expanded some of the optionality and functionality within our ASO product.

00;10;56;01 - 00;11;19;20

Maggie Parker

So as we take a look at 2026, we have the option now to have additional flexibility related to the PBM carve out as we just discussed. So that is one of the enhancements that we are taking a look at. For 1/1 of 26. You'll notice over the next several years we will continue to, iterate on that flexibility and the optionality that we have available to groups.

00;11;19;26 - 00;11;43;23

Maggie Parker

So I'd love to come back, and discuss with with you at that point, the additional flexibility options that we have. We're really looking into that clinical solution, some of those, unbundling of programs to really take our administrative expenses, lower and allow groups to identify what programs they want to put in place that makes most sense for their membership.

00;11;43;26 - 00;12;01;02

Cary Hall

So you're looking at things that control cost of care. You're trying to hand it back to the employer and the broker say, okay, these are some things we're giving you three PBM choices. Look at the three. Which one do you think offers the best value? How does this affect cost of care. These are the kinds of things you're talking about right.

00;12;01;02 - 00;12;24;26

Maggie Parker

Sure. Absolutely. You know and to even to take that a step further as we look at, maybe specific point solutions within the market or different things like can condition management, as you mentioned, controlling those costs of care, controlling the overall, total cost of care for members. We are really looking at some of those high dollar options.

00;12;24;26 - 00;12;36;20

Maggie Parker

MSK, oncology, the PBM in in 1/1 of 26 is one of those areas that we find groups are really anxious and really interested in a evaluating those options.

00;12;36;20 - 00;12;37;08

Cary Hall

You know.

00;12;37;10 - 00;13;00;06

Cary Hall

When people hear cost of care controlling cost of care, they immediately go, okay, they're going to take away benefits. It's not about taking away benefits. It's about doing a better job of managing chronic disease and dealing with. So making sure that type two diabetic doesn't roll over and become a type one diabetic, because you've got them enrolled in a program where they're getting the A1 C's, they're doing the things you're supposed to do, am I right?

00;13;00;06 - 00;13;28;04

Maggie Parker

Yeah, absolutely. You know, we really value getting the right care at the right time. That's kind of a the intent of utilization management. Right. We don't want to jump to a, a maybe more acute care model or therapy when we could, we could take a step approach and try other options, as you mentioned. Yes. We want to make sure that those chronic conditions are controlled so that we don't have members end up in the emergency department or in the emergency room.

00;13;28;11 - 00;13;37;05

Maggie Parker

That is really the overall idea of that cost of care. And, making sure that we're managing that responsibly for our, for our members and groups.

00;13;37;06 - 00;13;52;15

Cary Hall

So I'm a large employer. I've got 300 employees, I run a trucking company, and my truck drivers are all over the country. How am I going to do a Blue Cross and Blue shield plan in Kansas City? If I have 300 truck drivers and 200 of them don't live in the Kansas City metro.

00;13;52;16 - 00;14;15;24

Maggie Parker

You got it. So from a national perspective, national employers tap into ourBlue Card network. So Blue Card is our national footprint. It is one of the largest networks with one of the most advantageous discount positions, in the market. We continue to see, that being a very broad network, and our employer groups have the ability to tap into that.

00;14;15;28 - 00;14;31;01

Maggie Parker

We have our then, more localized networks that we are able to do some more customization to through our provider relations team here at BlueKC. But you can you can rest assured that, traveling outside of the Metro, you have coverage through our Blue Card program.

00;14;31;02 - 00;14;41;02

Cary Hall

And the thing about Blue Cards, it's so nice is the local Blues have usually a better network than most of the national carriers because they're the local Blues.

00;14;41;03 - 00;14;41;16

Maggie Parker

Exactly.

00;14;41;16 - 00;14;50;06

Cary Hall

Like you. So to be able to say to the employer, well, you're going to broaden their access, not limit their access with a Blue Card, that's a big deal.

00;14;50;06 - 00;15;16;02

Maggie Parker

It's important. Yeah, absolutely. As we've identified, organizations have workers kind of all over the place post-pandemic. We've seen, remote worker increase. And so that then poses the question for someone who perhaps, maybe was a local company, they might have a workforce that's now outside of the area. And BlueKC is a solution for them. Through that Blue Card program.

00;15;16;04 - 00;15;21;00

Cary Hall

Talk a little bit about the integration of Spira Care now and some of the things you're doing there.

00;15;21;03 - 00;15;47;02

Maggie Parker

So we're really, really excited about 1/1/26. We have a lot of things coming, not just the ASO optionality, but as we move in and look at our our Spira Care program as it sits today, Spira Care is only offered on our Blue Select Plus network. That's our high performance network here in the metro. As we as we move toward 1/1 of 26, we're excited to expand Spira Care to our Preferred Care Blue Network.

00;15;47;02 - 00;16;08;29

Maggie Parker

Preferred Care Blue Network, often called PCB, is, more of our broad network. A lot of our employer groups leverage this network, as more maybe their buy up network option. And we're excited to be able to apply Spira Care access for those members and those groups, should they choose to put that optionality in.

00;16;09;05 - 00;16;16;03

Cary Hall

So that network, as an example, might have Children's Mercy in it, whereas one of the other networks would not have that.

00;16;16;04 - 00;16;43;09

Maggie Parker

So Children's Mercy is in both. I think it's a good distinction. Right. So Children's Mercy is in both PCB and Blue Select Plus (BSP). When we talk about network mix, from the Blue Select Plus side where you really see that narrowing is in your Saint Luke's facilities and your HCA facilities. So those are the two differentiators from a hospital system perspective.

00;16;43;12 - 00;16;46;22

Maggie Parker

When we talk about that broad network in that high performance network.

00;16;46;26 - 00;16;50;03

Cary Hall

And the high performance network includes which hospital systems.

00;16;50;10 - 00;16;54;20

Maggie Parker

So it includes all but the Saint Luke's and HCA.

00;16;54;22 - 00;17;11;13

Cary Hall

Wonderful. When we come back the break, we're going to switch gears now and we're going to start talking about Spira Care. And, you know, this is one of the best programs, primary care and mental health care programs I think you'll see anywhere nationally. Blue Cross, the Kansas City pioneered this concept. How many years ago was it, Sandy?

00;17;11;18 - 00;17;13;18

Anna Finnegan

About eight and a half when we launched it.

00;17;13;20 - 00;17;15;12

Cary Hall

That's amazing. I remember when it first launched.

00;17;15;12 - 00;17;15;24

Anna Finnegan

Yes. In Olathe.

00;17;15;24 - 00;17;18;09

Cary Hall

And I was like, Holy cow, they're really going to do this.

00;17;18;09 - 00;17;19;10

Anna Finnegan

Yes. It's really exciting.

00;17;19;13 - 00;17;21;19

Cary Hall

This is Danette Wilson's vision.

00;17;21;19 - 00;17;22;00

Anna Finnegan

Yes it.

00;17;22;00 - 00;17;40;25

Cary Hall

Was. And and and it's come to fruition and is doing phenomenally well. So we'll talk about this. We'll talk about some of some of the folks I know that had personal experience with it because, it's very unique in what it offers is not your typical primary care clinic that you may think of because the offerings are significantly different.

00;17;40;27 - 00;18;05;07

Cary Hall

And they're all over the metro. We'll talk about that as well. So we'll be right back after the break. You're listening to America's Healthcare Advocate Broadcasting here on the HIA Radio Network, coast to coast across the USA. If you want information about any of this, anything you're hearing about, call them at (833)467 2145or bluekc.com.

00;18;05;07 - 00;18;22;14

Cary Hall

It's all up on their website that you can reach out. You can go talk to Maggie, give them a call. They'll be happy to chat with you. Stay tuned. We'll be right back after the break with more.

00;18;22;16 - 00;18;41;00

Cary Hall

Welcome back to America's Healthcare Advocate Show, broadcasting coast to coast across the USA here on the HIA Radio Network. In studio with Maggie Parker, director of large group for Blue Cross and Blue Shield of Kansas City. And Anna Finnegan, vice president of Spira Care. We're going to switch gears now. We've been talking about the large group products, what they have to offer.

00;18;41;02 - 00;19;03;21

Cary Hall

You know, I will tell you, you know, I'm a 26 year recovering broker as I like to say, and the Blue Cross and Blue Shield products in this town are superior to almost everything else that's offered out there. And if you take the time to look at it, if you're the broker, you really should sit down with these folks and have a conversation about your large group client and how they can benefit them, and how they can do it differently than some of the other programs that are out there.

00;19;03;21 - 00;19;26;26

Cary Hall

There's some other programs at Perito, Berkeley, some of the other ones, but I think you'll find this program works significantly differently, especially with the local flavor and the fact that their customer service is superior basically to anything else in the Kansas City metro. So let's just start with Spira Care. So eight and a half years ago. This thing starts I remember being at lunch with Danette, and she told me she was going to do this.

00;19;26;26 - 00;19;44;20

Cary Hall

And I was like, Holy cow, this is going to be quite an undertaking to do it. And it started. So let's talk about the model. You know, where it is now from where it was eight and a half years ago and how it's grown. And you've got different, you know, it's really expanded from where it was when we first started.

00;19;44;20 - 00;19;45;05

Cary Hall

So let's go.

00;19;45;06 - 00;20;04;26

Anna Finnegan

Oh absolutely. So yeah, so eight and a half years ago we opened our first care center back in Olathe. I think you were there with us and you know what is really exciting about Spira Care, and with BlueKC, it is the bringing together of health insurance and primary care in a how do we help take care of our members?

00;20;04;26 - 00;20;25;29

Anna Finnegan

How do we take care of our patients? And as Maggie was talking about the goals of BlueKC, right. It's about, bringing affordability in. It's about managing health care costs, but it's also about how we help our community be healthier and how do we redefine the member experience, the patient experience. And that's what Spira Care has been about.

00;20;26;04 - 00;20;52;00

Anna Finnegan

And so from the beginning of our first care center and later in 2018, we are now fast forward in 2025, we have nine care centers across the metro, from the Northland to Johnson County, from, Wyandotte County, over in the Legends to Independence and Lee's Summit and everywhere in between. Our goal is all about how we help you live your healthier life.

00;20;52;07 - 00;21;07;19

Anna Finnegan

And so it is about creating a primary care practice that puts our patients at the center of everything we do, wrapped with the power of BlueKC and your network. So it is where we started and where we are has just continued to blossom.

00;21;07;22 - 00;21;24;27

Cary Hall

So, you know, I remember the first time I walked into the clinic and this doesn't look like a primary care, you know, it looked like a hotel lobby. I was like, you know, the big desk back there with everybody waiting there, and then you go, so talk about you go in your new yeah, go into Spira Care. You're going to have your first visit.

00;21;24;28 - 00;21;37;05

Cary Hall

Sure. Talk about how that works. And so here's a fact that I always find interesting. The average amount of time a patient spends with their primary care physician. What's the what do you think the average amount of time is?

00;21;37;07 - 00;21;40;27

Anna Finnegan

In a traditional primary care? It is usually like 6 to 7 minutes.

00;21;40;27 - 00;21;57;22

Cary Hall

Is 7.5 minutes. Your first one is ever got that right. Yeah. Yeah, yeah. Seven and a half minutes. That's it. You know she's typing away or he's typing away on the computer and they're talking to you simultaneously. And then here's a new prescription. Bye. Let's contrast that with what happens when you walk into a Spira Care.

00;21;57;23 - 00;22;17;01

Anna Finnegan

Yeah. So so separate from a traditional primary care that is about volume. It is about managing those symptoms, getting you in and out. And often the patient is responsible for managing all the next steps. Right. You need to go to a cardiologist. You need to go to the you gotta go figure that out Spira Care is different. It is an advanced primary care practice.

00;22;17;01 - 00;22;39;11

Anna Finnegan

And what that means is we have a multidisciplinary care team that puts our patients at the center of the care, but we work with you to do all of the things together. So you have a primary care provider who does spend more time with you. So we have longer appointment times. It is not based on rushing you in and out.

00;22;39;13 - 00;23;05;03

Anna Finnegan

It is about seeing you as a whole person and managing all the conditions that you have. We have behavioral health consultants, but we think about the whole person, your physical health and your mental health nursing staff that's made up of registered nurses, lpns, medical assistants. We have diabetes care specialists and ambulatory pharmacist. Care guides that are specialized in benefits as well as care management.

00;23;05;03 - 00;23;27;18

Anna Finnegan

So we can help you manage your care inside the care centers, as well as that care that extends to those specialists and that we can help connect you from here you are at primary care all the way through your next steps of care? So when you walk in as a new patient, our job is to help you not only take care of what you have going on right now, but it's all of the steps through that whole care journey.

00;23;27;19 - 00;23;38;14

Anna Finnegan

We never want you to leave our care center not knowing where to go next, what to do next. Our job is to help simplify that and help navigate that with you and for you as you go forward.

00;23;38;14 - 00;23;40;16

Cary Hall

And it's certainly going to take longer than seven and a half minutes.

00;23;40;21 - 00;23;43;17

Anna Finnegan

Oh, absolutely. It does. Absolutely it does.

00;23;43;25 - 00;23;47;02

Cary Hall

Yeah. The average time I think if I remember correctly is about 30 minutes.

00;23;47;02 - 00;23;48;13

Anna Finnegan

That it is, it is.

00;23;48;13 - 00;23;49;22

Cary Hall

And sometimes it's more than that.

00;23;49;24 - 00;24;10;25

Anna Finnegan

Right. And we and we get feedback we send out after every one of our appointments. We send out post visit surveys to our patients. And we hear consistently from them that they appreciate the time that we spend, that we listen to them, that we help, care for them, navigate, take away some of that complexity, that just exists within health care.

00;24;10;28 - 00;24;31;26

Cary Hall

So let's talk about the care guides, because this is really important. You made a very interesting point earlier. You go to a typical primary care practice you need to go see. I'll give you the classic example. My wife had a torn meniscus. We went to the primary care, facility. Her doctor, we got referred. We went to see the specialist, etc..

00;24;31;29 - 00;24;48;22

Cary Hall

Well, then it was up to us to decide, you know. Well, you need to get an MRI. Where are you going to do? Well, you have to figure that out. You can take care. That is completely different than the way Spira Care works. So what's beauty with Spira Care is you're not just handing it off to the patient saying here, that's your job.

00;24;48;28 - 00;24;58;05

Cary Hall

We're going to you're actually sitting down with him and saying, here are the facilities you can go to here, the doctors you can go to talk a little bit about that, because I think that's critical for people.

00;24;58;05 - 00;25;23;05

Anna Finnegan

Absolutely. And our care guides are we love them and they are fabulous. Our patients love them. And your example is a great one. If a patient has a torn meniscus and we need to send you off to specialty care and, we'll sit down with you. And this is where the power of BlueKC is so impactful for us, is that we can help you identify where it will be less costly for you as a patient.

00;25;23;07 - 00;25;45;04

Anna Finnegan

So we think about the total cost of care that there are some locations that will cost less or less expensive. We'll help you find a specialist in network. So you're not paying out of network rates. Will look at, where you live, and we will help you navigate those referrals. We'll even work to make sure that if there are medical records that need to be sent, we will help that.

00;25;45;06 - 00;25;48;02

Cary Hall

You mean you don’t have to get your own medical records and take them to the doctors office?

00;25;48;02 - 00;26;07;16

Anna Finnegan

Will help you with those things. If we take an X-ray, we need to transmit those X-rays to the specialists. We'll handle that for you. So there's a lot of places where health care is just broken and fragmented. So one of the things that we continually work on and try to innovate in is where can we bridge that fragmentation?

00;26;07;18 - 00;26;08;21

Cary Hall

And that's what you're doing.

00;26;08;21 - 00;26;09;04

Anna Finnegan

Yes.

00;26;09;04 - 00;26;28;21

Cary Hall

And so someone has a procedure done a surgical procedure or whatever the case may be. Your team is following up afterwards. You know, we talked about this a minute ago when we talked about not having to go in. One of the biggest problems with care is if you know someone has an issue, they the first thing they do and they get in, they have to do a readmit is they're right in the E.R..

00;26;28;22 - 00;26;34;22

Cary Hall

Yes. So talk about how your team follows up if they need in-home care, whatever the case may be.

00;26;34;22 - 00;26;57;07

Anna Finnegan

Right. So after a patient comes out of the hospital, we follow up with them. We try to get them back into our care centers so that we can. We have an ambulatory pharmacist who works with the provider and the patient to help reconcile some of that medication, because oftentimes when you come out of the hospital, you have a list of medications that they have prescribed that may be similar or different to the medications that a maybe a patient has been on.

00;26;57;07 - 00;27;14;14

Anna Finnegan

And so they're sort of confused of what do I take from the hospital to what I've been taking previously. Sometimes there's follow up appointments that are needed, care that is needed. To your point. So that's where our care guides come in, and that's where our staff comes in. So we will proactively reach out and and bring those patients in.

00;27;14;16 - 00;27;40;03

Anna Finnegan

We've also set up a program of call us first. So anyone who has questions about their health call us first. For non you know, life threatening emergencies, right. If you're having a heart attack you need to call 911. But if you have a wake up and not feeling well or you you're concerned about something, call us first. Our triage nurses will, ask you a series of questions, triage those symptoms, and if you need an appointment, work with you to get you scheduled the same day next day.

00;27;40;06 - 00;28;04;02

Cary Hall

So now I'm the employer, and I'm going to offer Blue Cross Blue Shield to my employees. But if I offer Spira Care to them, what I'm doing, there's two things that are happening. Number one, the satisfaction level of Spira Care is at is really superior. I've seen the surveys. It's really quite remarkable. Number two, you're helping the employer with cost control because it is sending them out to get a $3,000 MRI.

00;28;04;09 - 00;28;21;11

Cary Hall

You're sending it to a standalone to get the same MRI for $700. So those are the kinds of things that I think resonate, you know, not only with the employer but also with the employee, because the employee experience, as you talk about the member experience. Yes. Is what your focus is.

00;28;21;11 - 00;28;23;03

Anna Finnegan

Absolutely. It is. Absolutely.

00;28;23;03 - 00;28;24;14

Cary Hall

And that's what makes the difference.

00;28;24;14 - 00;28;25;14

Anna Finnegan

It's wonderful. Yes.

00;28;25;15 - 00;28;45;22

Cary Hall

We come back to the break. We're going to talk about a program that Anna mentioned. And I've talked with Ryan Lefebvre about this. You probably see him during the Royals games talking about it. We're going to talk about the offer of mental health care in Spira Care Behavioral Health. How they do it. Why it's different. Okay. You won't find this in other primary care clinics.

00;28;45;29 - 00;29;07;13

Cary Hall

And who can benefit from this. So stay tuned. We'll be right back after the break. You're listening to America's Healthcare Advocate broadcasting on the HIA Radio Network coast to coast across the USA. If you want to give Blue Cross Blue Shield a call (833) 467-2145. You want to learn about Spira Care. You want to do something your employees are going to really be happy with.

00;29;07;20 - 00;29;21;00

Cary Hall

Find out about Spira Care. You'll be surprised. Or you can go online BlueKC.com. We'll be right back after the break. Stay tuned. We've got more.

00;29;21;02 - 00;29;42;10

Cary Hall

Welcome back, you're listening to America's Healthcare Advocate show broadcasting coast to coast across the USA. All these shows are posted on our podcast platforms, 15 of them. So if there's a podcast platform out there, we're probably on it from Rumble, the Spotify, you name it, we’re on all of them and on our YouTube channel AmericasHealthcareAdvocate.com.

00;29;42;14 - 00;29;57;28

Cary Hall

So if you want to tell somebody about Spira Care and this program, they can go up and actually listen to the program. You don't have to be able to recite everything we talked about here. That's a great way to do this. My producer in studio, Mr. Garner Cowdrey and Dave Thiessen, always doing an excellent job in studio with me.

00;29;57;28 - 00;30;10;08

Cary Hall

Maggie Parker, Director of Large Group, Blue Cross and Blue Shield of Kansas City, and Anna Finnegan, VP of Spira Care. Spira Care’s clinics there. How many of them are there 11 we have nine. Nine? Nine of them. I keep trying to get more.

00;30;10;11 - 00;30;10;21

Anna Finnegan

Yes.

00;30;10;21 - 00;30;29;10

Cary Hall

Every time I have to tell you a quick story. So there's a local broker here. Years ago when this first opened and his name is David Hickman, and he had a large group when we were heading to Arkansas to meet with, some legislators in Arkansas about something, I can't remember what it was. And he was telling me about this group, and he was having trouble getting making it work and getting it.

00;30;29;10 - 00;30;46;14

Cary Hall

I said, well, why don't you take him over to Spira Care? So he did. He found out about the program, thought it was great. Did it. Calls me up two weeks later, he goes, I just enrolled the whole brokerage in Spira Care. So he's not only did he do it, but he enrolled his entire family, plus everybody in his brokerage in Spira Care.

00;30;46;14 - 00;31;05;26

Cary Hall

So his son goes to one of the Spira Care centers to get something done. And they couldn't do it there. They had to send him to another one and they gave him a gas card. Sure, he thought that was the greatest thing since sliced bread, that they gave him a gas card to get him from one Spira Care center to another. So when you talk about personalized care, that's what I'm talking about, okay.

00;31;06;00 - 00;31;23;17

Cary Hall

That's why it's different. And that's why I would urge you, if you're a broker or if you're an employer, to take a look at this, if you're if you're on an ACA plan, whatever the case may be, it's worth taking a look at what Spira Care has to offer. So there is a, crisis in this country on mental health.

00;31;23;17 - 00;31;43;25

Cary Hall

You know, Ryan Lefebvre has come on this show on multiple occasions. We've talked about this, his journey. You see him on the Royals broadcast. What are the unique features of Spira Care that I think is very, very different is you offer behavioral health. Yes. And it's right there. So, you know, so someone has a death in the family.

00;31;43;28 - 00;32;01;06

Cary Hall

You know, they need bereavement counseling. They're coming in. They're having now. They're having physical problems. They can go right across the hall, down the hall and see a behavioral health specialist. So talk about that, that I think that's one of the most unique offerings of Spira Care versus any other primary care clinic I've ever seen.

00;32;01;07 - 00;32;29;27

Anna Finnegan

No, absolutely. And I'm so glad you brought this up. So as I as I talk about Spira Care and we take care of patients from babies up to seniors, right? And everywhere in between. So we we take care of the whole family through all ages. The integration of behavioral health was very intentional from the very beginning, and it was all about we want to take care of the whole person and we know that your physical health and your mental health are intertwined.

00;32;29;29 - 00;32;58;24

Anna Finnegan

And whether you have a new diagnosis, whether you have a death in the family, a new life event, all of these things impact your physical well-being. Your physical well-being impacts your mental health. All of these things come together so the way sort of operationally it works is as you're having your appointment, maybe with your your provider and you're talking about what's going on, our providers will do warm handoffs right there to the, the the behavioral health consultant.

00;32;58;24 - 00;33;24;08

Anna Finnegan

They'll bring them into the room to meet with the patient. The behavioral health consultant will set up an appointment with that patient as a, as a follow up to make sure things are going well. They'll provide interventions. Okay. Let's talk through what's happening. And here's some some things we can do to help you navigate this event that's happening or the diagnosis you're dealing with or okay, there's new medications you have to take that that may impact your lifestyle.

00;33;24;12 - 00;33;52;00

Anna Finnegan

So let's talk about what that means. It's really important that we bring these things together. And it's not stigmatized. And that's so much of what we're we're dealing with is what Ryan's dealing with, he talks about. So how we bring that together is whether you're a young teenager who's dealing with things, if you're a dad, a parent, all of these things, we do it inside of Spira Care as part of that, just integrated care that we give every single day.

00;33;52;03 - 00;34;10;08

Cary Hall

You know, and we we're seeing, more and more young people dealing with mental health issues. A lot of that has to do with these damn things. Sure. And the amount of time kids spend on this, and then and social media and all the rest is to talk a little bit about, hey, you know, this is not just for adults.

00;34;10;08 - 00;34;23;16

Cary Hall

Yeah, you can bring children. A child doesn't really want to talk to their parents about it, right. But they will sit down and talk to somebody else about it. If and if they can talk a little about how that works and how they can help the parent deal with that issue.

00;34;23;16 - 00;34;54;04

Anna Finnegan

Right. So, you know, we encourage everybody, you know, the value of primary care is to come to us for your annual checkup for your annual wellness. And that's sometimes when these things come up. And we we are providers are good at asking those questions of the kids and kind of pulling those things out, asking them about some of those lifestyle questions about how much time do you spend, how are things going, what's what's life like, you know, all the all that stuff.

00;34;54;04 - 00;34;55;16

Anna Finnegan

I got two teenagers. I know what it's like.

00;34;55;18 - 00;34;58;01

Cary Hall

Yeah, I've got six grandchildren, trust me.

00;34;58;03 - 00;35;00;22

Anna Finnegan

Yeah, you get the spectrum. Some are talkers, some are.

00;35;00;27 - 00;35;03;12

Cary Hall

Good news is I can give them back at the end of the day.

00;35;03;12 - 00;35;17;17

Anna Finnegan

100%. You're lucky I can't. There you go, there you go. But it is. And and we have that support. And if a parent is concerned, you know, they can bring that up to the, to the provider and say, you know, I'm a little concerned about my kid. Can you know what can we do? I'm the parent help.

00;35;17;17 - 00;35;28;00

Anna Finnegan

Can you help us with us. And so we'll work with the parents and the kid. So it really is a team effort, to come together and come up with those strategies of support.

00;35;28;07 - 00;35;47;05

Cary Hall

So, you know, and here again, you know, the employer, the employee, the member, instead of having to go out and find, a psychiatrist, psychologist, behavioral health specialist and, and try to get in to see them and go through all of that and then pay for it out of pocket. You're part of Spira Care. That's all part of the program.

00;35;47;18 - 00;35;56;00

Anna Finnegan

Right. And if in this process, we find that we do need to connect you with maybe you do need some additional specialty care in that behavioral health space.

00;35;56;01 - 00;35;56;27

Cary Hall

You're going to get them in.

00;35;56;28 - 00;36;09;15

Anna Finnegan

We're going to help you. We're going to help connect you. Just like we would if you needed to go see a cardiologist. That's part of that value, that connection of care. We're not going to leave you hanging to go navigate on your own.

00;36;09;18 - 00;36;15;23

Cary Hall

So you started out back in the day with about 2500 members, and today it's over 70,000.

00;36;15;23 - 00;36;16;05

Anna Finnegan

Correct.

00;36;16;12 - 00;36;35;05

Cary Hall

It's pretty amazing. Yeah. That's says something. But you don't get 70,000 people in a program like this because they're not happy. You know when you've got 70,000 people in our program you're doing something right. Right. So what are the plans. Are there plans for more facilities or are we topped out now where.

00;36;35;12 - 00;36;44;08

Anna Finnegan

So we we have capacity in our care center. So we constantly monitor to make sure that we have access. Right. We want to be able to get patients in.

00;36;44;11 - 00;36;45;13

Cary Hall

So you don’t have to wait 30 days.

00;36;45;16 - 00;37;05;12

Anna Finnegan

Oh no. Absolutely not. If and that's part of we want to get you in for the care you need when you need it. So, we constantly monitor our metrics and access across the system, and we're constantly looking at and working with sales to find out, you know, where are our new groups coming in? Where is the membership? Where is the community growing across Kansas City?

00;37;05;19 - 00;37;15;10

Anna Finnegan

And so we'll continue to evaluate that as as time goes on. And if we need to, look at further expansion. Well, then I'll come back to your show and I'll tell you where we're headed.

00;37;15;10 - 00;37;16;08

Cary Hall

That would be that would be great.

00;37;16;09 - 00;37;19;16

Anna Finnegan

I you have you. Absolutely. I'll come back and I'll tell you where the next one is going to be.

00;37;19;17 - 00;37;36;02

Cary Hall

Thank you both for being here today. Great show, great information that was out there. I really appreciate you take the time. You know, I've been I've been a broker for, like I said, over almost 30 years now and I've been a Blue Cross and Blue Shield member about the same amount of time. I've never left Blue Cross the Blue Shield. The care in this town.

00;37;36;04 - 00;37;55;14

Cary Hall

The way they do things is significantly different than the other carriers and I. And if you're a broker, if you're an employer or you're an individual, I urge you to take a look at their products or what they offer of Spira Care, in particular is a great program. If you want information (833) 467-2145or blueKC.com is the website.

00;37;55;20 - 00;38;18;20

Cary Hall

And now I leave you with this thought from Doctor Martin Luther King. We must learn to live together as Americans, as brothers and sisters, so we will surely perish together as fools. Truer words are never spoken. Thank you for listening to America's Healthcare Advocate Show, broadcasting coast to coast across USA. Goodbye America.

00;38;18;22 - 00;38;25;14

Cary Hall