EmployersEmployer Resources
Jan 9, 2024
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Blue KC Is Focused On Value-Based Care

At Blue Cross and Blue Shield of Kansas City (Blue KC), we recognize that change is necessary in the healthcare field to continually serve our members in the most effective ways possible. These changes have driven us to further invest in value-based care practices across our network.

Value-based care programs offer monetary incentives to healthcare providers for quality outcomes rather than volume of service. In turn, these efforts result in better quality care at lower costs for our members. Two of our most effective value-based care programs include our Blue KC Primary Care First program and offering Blue KC health plans that give members of all ages exclusive access to Spira Care Centers for their advanced primacy care needs.

Incentivizing Quality Care with Medical Homes

Over 10 years ago we introduced our Primary Care Medical Home (PCMH) program. Our Medical Home program was designed following a value-based model to effectively manage healthcare spending while providing high-quality healthcare to patients. To achieve this goal, we have incentivized providers based on high-quality healthcare to patients — not on the volume of patients seen. Our Medical Home program has evolved to include the launch of the Blue KC Primary Care First program in 2022, with measures of cost, quality, and utilization outcomes with an added focus of social determinants of health screening and interventions. Blue KC is proud to be a leader in this field and a partner with CMS in Primary Care First.

Our Primary Care First program currently comprises over 1,550 primary care providers practicing at more than 200 different locations throughout the greater Kansas City metropolitan area and surrounding areas. These dedicated providers care for more than 370,000 Kansas Citians. We continue to see that our members who receive care through a Primary Care First provider continually outperform members not attributed to a Primary Care First provider. Each year, members under the care of Blue KC Primary Care First providers exhibit a lower total cost of care, higher compliance with important preventive care such as colorectal cancer screening and are more likely to have their blood sugar under control if have diabetes.  

We continue to work toward a future where the quality of care is always the top priority for healthcare providers. But our Primary Care First program is not the only Blue KC initiative spearheading our efforts to streamline value-based care and continually evolve.

Redefining Primary Care with Spira Care

In the years after the Medical Home program’s inception, we continued to work toward a future where value-based care is the default care patients receive. This led to the creation of Spira Care in 2018.

Spira Care was designed around what we know our members want from their health plan — human interaction and human connection within their healthcare experiences. This model exists as a combined primary care and insurance offering that gives eligible Blue KC members simple, seamless access to primary care. At its core, Spira Care simplifies the healthcare experience. It is integrated primary care built on the promise of a stress-free member experience that addresses cost and access and enables stronger relationships with primary care providers.

In addition to its core goal of simplification, Spira Care addresses four of the key challenges that exist in the current healthcare landscape: experience, simplicity, quality, and cost.

To better meet patients’ expectations when it comes to their healthcare experience, all Spira Care locations offer extended hours, telehealth, and a wealth of options for alternative forms of communication. To simplify health plans, there are no copays, no deductibles and low or no additional cost for any services provided at Spira Care Centers. Of course, quality of care is top of mind at all Spira Care Centers. The Care Team approach streamlines the coordination of care for each patient, keeping care intuitive and personal. Lastly, Spira Care is designed to create savings for members and employers by combining patient-centered primary care with the high-performance BlueSelect Plus network.

Currently, there are nine Spira Care Centers in Missouri and Kansas open to Blue KC members enrolled in plans with Spira Care. The Crossroads, Independence, Lee’s Summit, Liberty, Olathe, Overland Park, Shawnee, Tiffany Springs, and Wyandotte are all home to a Spira Care Center and doctor-led Care Teams including integrated behavioral health. To experience Spira Care from the comfort of your home, take a virtual tour of a Care Center.

Looking Toward the Future of Value-Based Care

Our goal with these programs is to not only to meet the needs of our members, but to exceed them. We want to continue to exist at the forefront of positive change within the healthcare industry as we move it forward to better serve our members through value-based care.

Blue KC members enrolled in a health plan with Spira Care have exclusive access to Spira Care Centers for primary care services. For costs and further details of the coverage, including exclusions, any reductions or limitations and the terms under which the policy may be continued in force, see your insurance producer or write Blue KC.

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