How A Blue Cross Plan Crossed The Innovation Chasm

13 March, 2018 / Articles
healthcare

Few industries face as many challenges today as does healthcare. The traditional, claims-processing insurance company is in an especially difficult position in this regard—they sit right in the middle of every important health care issue: rising costs, unhappy patients, the need to improve outcomes, and clinical team burnout.

Blue Cross and Blue Shield of Kansas City (Blue KC) is seeking to solve some of these problems by tackling them head-on.  They recently launched Spira Care, a consumer-driven primary care service concept that puts a premium on hyper-attentive patient service and making the health plan itself as invisible as possible.

Spira Care had its origins as an exploratory research and innovation project in early 2016. In less than 24 months, it turned into a working clinic taking care of patients. Recently, I sat down with two Blue KC executives and members of the Barkley team who worked with them to build this new brand. This is part 1 of a two-part interview.

Jeff Fromm: What was the genesis of the project?

Jason Spacek, Blue KC Chief Innovation Officer: We started with a very simple premise, “what if we could start all over as a health insurer?” We looked at the complexities of the industry and the multiple parties involved and began to explore whether a “fresh start” could be a viable option.  As we thought about this notion of “starting fresh,” we initially focused our attention on the Millennial segment, as they were coming of age as the future consumers of healthcare.  We thought that their needs and wants should be our focus if we were truly going to entertain the idea of beginning anew.

Jimmy Keown, Strategy Director, Barkley: Blue KC brought us into the picture early on—first to explore what characterized the “millennial healthcare experience.” We saw it as an assignment that would broaden our millennial knowledge in a vital category, but it was apparent from the outset that Blue Cross was thinking even bigger than that. This wasn’t just a research project, it was an innovation study based on getting inside a consumer mindset. When the project started, we envisioned building a “digital first” care brand. How it evolved was a lesson in learning about what people think they want versus what they really want.

Fromm: How did you approach this challenge?

Spacek: Very quickly we realized that reforming just the insurance experience was not enough.  Many of the challenges and frustrations consumers experience result from the fragmented experience they have with the many parts of the health care system and the unpleasant surprises they run into.  At the root of all of this is the idea that there is a fundamental misalignment of incentives between the insurer/member and the providers.  The provider’s incentives (revenue) come from providing more services while the insurer and member’s incentives (cost savings), come from having fewer done and for lower costs.

Greg Sweat, M.D., Blue KC Chief Medical Officer: To build on Jason’s point, we wanted to think completely differently than we ever had. So we explored the value of integrating a primary care experience into this reimagined insurance offering.  Our philosophy at Blue KC has long been focused on primary care as the gateway to the rest of the healthcare system.  We want primary care doctors to serve as “quarterbacks” for the members, helping to guide and manage their care throughout the complex system.  Given this, we began to investigate what a truly integrated primary care experience would look like with a clinical team whose incentives were aligned with the customer – to provide high quality care, support them through their entire health journey, and find the right opportunities to save money.

Fromm: What did you learn from ethnographic research?

Spacek: We started this process by interviewing 13 people in their homes.  They taught us a ton with their perceptions of the healthcare system and how it did or didn’t serve them well.  There are two stories in particular that stand out.  The first was from a single mother who had a 14-year-old daughter attempt suicide in the past year.  She showed us the giant Ziploc bag of prescriptions she was trying to manage for her daughter.  Many of them were from different doctors for different treatments.  I have no doubt that some of them were duplicative or even contradictory.  And behind each of those prescriptions was a doctor visit, medical advice, bills, and the huge stress that comes with all of it.  That image stayed with me and was a driving factor – how do we build a healthcare system that actually helps people in situations like this?

The second was from a young mom who was frustrated with how the system worked and the fact that no one seemed to communicate with each other.  She said what she would most desire is to have someone like an insurer play a more central role in her care, helping to coordinate her various needs, keeping track of things, and managing costs.  It was an early, critical validation that people had an interest in the same things we had been talking about internally.  It ultimately led to what became a new role for us, a Care Guide, who serves as that personal navigator for our Spira Care members.  That role exists to demystify the healthcare experience, inform people about their options and costs, answer questions and provide proactive outreach at key moments.

David Gutting, SVP/Intelligence at Barkley: In research like this, the search is always for that “nugget” of breakthrough insight. We certainly got that, but what’s more important is that this study reminded us that Blue Cross had an opportunity to simply reaffirm their true mission, providing more and better access to healthcare. It’s almost like the research wrote the strategy.

The science man and innovator, Fernando Fischmann, founder of Crystal Lagoons, recommends this article.

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