Reducing Costs Together

A conversation that started two years ago with Dr. Charles Ambrose, University of Central Missouri (UCM) President, and Ron Rowe, Blue KC Senior Vice President, Sales and Marketing, about ways payers, providers and employers can work together to bring down the escalating costs of healthcare, came to fruition in 2017.

The result is a groundbreaking agreement between UCM, Western Missouri Medical Center, Saint Luke’s Health System and Blue KC to establish a quality-driven, patient-centered and outcomes-focused health delivery strategy that stabilizes overall healthcare costs. An agreement that Dr. Ambrose calls a win for all involved.

Rowe said, "This was Dr. Ambrose’s vision. He came to us looking for ways to help UCM control costs for its employees. We had been talking to him about the success of the Blue KC Medical Home program, and he put two and two together and said, ‘Why don’t we offer a medical home on the UCM campus?’"

The idea to offer a medical home grew into something even bigger: an Integrated Community Care Model that would improve health and reduce healthcare costs for UCM employees.

Dr. Ambrose explained, "University healthcare costs were climbing at the rate of $1 million annually. We had put ourselves into a position where our cost curve was broken. We needed partners who would help us explore new opportunities to help reduce the financial impact on the institution and its employees and their families while providing high-quality patient care and wellness activities. Western Missouri Medical Center, Saint Luke’s Health System and Blue KC were willing to do that.

“Every dollar we save in this plan, we’re going to give back. As we start building savings, we’re going to find the appropriate way to give that back to employees by reducing their premium cost and incentivizing healthier behaviors,” said Dr. Ambrose.

Rowe adds, “The employees who choose to be a part of this now have a $0 copay when they go to their primary care physician. And ensuring more people have relationships with their primary care physician helps control the medical spend.”

While this agreement is unique in both the way it is being delivered and the partners involved, Integrated Community Care Models have proven to be successful in driving high-quality, cost-efficient care across the United States. But how does the model actually save money?

Dr. Gregg Laiben, Blue KC Vice President for Employer Health Solutions, explained, “Unit costs and utilization drive everything, and there’s lots of variation in costs from facility to facility. A knee replacement might cost $45,000 at one facility but only $22,000 at another, with both facilities having the same outcomes. If we can use data to help primary care physicians find the best care at the best price for their patients, we can lower cost and improve outcomes."

The Integrated Community Care Model will also drive down costs by giving patients the help they need to navigate a system that can be confusing.

“The healthcare system is one of the most complex things most of us will ever deal with. The primary care physician is the best person to help patients navigate that system, giving them answers when they have questions such as ‘What can I do to prevent a complication from occurring? How do I control my chronic condition so I don’t end up in the hospital? When is the appropriate time to go to the emergency room?’ Giving patients the ability to easily see a primary care doctor to answer their questions instead of going to the ER will save money, improve health and ultimately help people live healthier, happier lives,” said Dr. Laiben.

If a Partner Comes to Us with a Problem, we Come Back With A Solution

Blue KC has had a strong relationship with the City of Kansas City, Missouri, for decades. The City came to us recently for help. They wanted an integrated Workers’ Compensation Program for their employees.

"We greatly value Blue KC, not only as our health insurance provider but as our partner in health, which is why we knew they could deliver an outstanding program that met our employees’ unique needs,” said Louie Wright, Chair, KC Health Care Trust.

We understood that the City was in a unique position, with a special group of employees. The City of Kansas City, Missouri, is responsible for the care of dozens of first responders – such as firefighters, EMTs and paramedics – with physically demanding, high-risk jobs. So, we developed a new Workers’ Compensation Program to better meet the needs of their employees.

"We're a hometown company and we look out for our members. We knew a Workers’ Compensation Program for the City would benefit not only our client, but also the first responders who put their lives on the line for our community,” said Ron Rowe, Blue KC Senior Vice President of Sales and Marketing.

On May 1, 2017, Blue KC began administering the Workers’ Compensation Program for the city.

“Since its inception in May, the Workers’ Compensation Program has resulted in more than $3.6 million of savings to the City and improved services to the members,” said Wright. “In addition, through streamlined communication processes set up by Blue KC, injured workers can speak directly with a dedicated nurse when they call to report an injury; the nurse provides medical advice and helps direct the injured worker to the care they need. A dedicated inquiry line and team of local claim adjusters are available to answer any questions."

Under the program, the City’s injured workers receive favorable pricing with qualified providers who have experience treating work-related injuries.

Our partners trust us with the health and well-being of their employees; that’s not something we take lightly. So, when they come to us with a problem, we come back with a solution.

high-quality care doesn’t have to mean high-cost care

When it comes to the challenges of high-cost care scenarios, such as managing chronic diseases, sometimes you just have to think outside the box. With 20 percent of the population accounting for 80 percent of the healthcare dollars spent, Blue KC is always looking for new ways to help employers manage expenses while improving the health outcomes of their employees.

How? For starters, we have a clinical team that combines data analytics with advanced research care options. This results in innovative alternatives that improve patient outcomes and lower cost. One example is our work with Quest Diagnostics – a Blue KC provider and client. Dr. Steven Goldberg, Quest Diagnostics Vice President and Chief Health Officer, collaborated with our clinical team to implement several new programs aimed at improving overall health among the company’s employees and their families. The efforts have not only resulted in better health for the people of Quest Diagnostics, but also have helped moderate cost trends.

“I work closely with the clinical team at Blue KC to study claims trends so that I can better understand the medical needs of our employees,” said Dr. Goldberg. “In doing so, we’re finding insights that allow us to provide high-quality care while being smarter about our healthcare spend.”

The clinical team at Blue KC is made up of people like Shelly Chavez, a clinical account coordinator, who acts as a liaison between Blue KC and our partners. She responds to inquiries from across the continuum of care – including members, customer service representatives, physicians and employers. Shelly can see when high-cost claims come through that are related to a particular diagnosis or prognosis. She can then reach out to members to ensure that they are receiving the care they need and identify cost savings opportunities.

“I’m here to find creative ways to help members get the right care and help lower the costs for all stakeholders. If we can help employers and employees better understand their care options and cost savings opportunities, it’s a win-win for all parties,” said Chavez.

Shelly created a potential savings of about $1 million per year over 2018 and 2019

Last year, a Blue KC member needed infusions that cost roughly $270,000. Shelly reviewed the claims, did some research, and found a free drug program that the member qualified for. The member was able to receive scheduled infusions and start a maintenance phase, with no charge for the drug and medical expenses of less than $10,000 per visit. Shelly's ability to pinpoint this care option created a potential savings of about $1 million per year for 2018 and 2019. This savings will result in a lower cost for both the employer and the employee.

With Blue KC and labor unions, the feelings are mutual

Blue KC’s labor partners have been looking to us to help them navigate the ever-changing healthcare landscape for the past 20, 30, even 50 years. And as a local health insurer in Kansas City, we believe we have a better understanding than other insurers of this community, its people and their healthcare needs.

Mo-Kan Sheet Metal Workers Welfare Fund has been a customer for nearly 20 years. "One reason we’re so loyal to Blue KC is because of the local account team, who truly understands our unique needs," said Greg Chastain, Sheet Metal Workers Local Union No. 2 Business Manager. "They know us, they know our history, they know this region. And they’re always available to answer our questions."

Our union labor partners rely on us to guide them through all the changes in the healthcare industry and to continue delivering quality healthcare at affordable prices. “We’ve worked closely with our partners, their business managers and even their trustees to come up with creative ways to continue providing plans that are affordable but still offer extensive, wide-ranging benefits,” said Garry Kemp, Blue KC board member and former Executive Vice President and Business Manager of the Greater Kansas City Building and Construction Trades Council.

Another key to successful long-term partnerships is having common interests. Both Blue KC and our labor partners are dedicated to the local community. "We choose to partner with the hometown team, and we have for nearly 30 years," said Alise Martiny, Secretary-Business Manager for the Building and Construction Trades Council. "Not only does Blue KC offer a great product, but they believe in giving back to the Kansas City community like we do, and that’s important to us."