And now America's Healthcare Advocate, Cary Hall.
Hello, America.
Welcome to America's Healthcare Advocate.
Show broadcasting coast to coast across USA.
Here on the HIA Radio Network, you can learn more about us going to our website.
AmericasHealthcareAdvocate.com.
Also your favorite podcast platform, SoundCloud, whatever it may be.
Spotify, Rumble, all of them.
We're on 16 of them and our YouTube channel, America's Healthcare Advocate.
My producer today, Mr.
Dave Thiessen, behind the cameras,
doing what he always does, bringing all these shows together.
They go up on our podcast platforms and our YouTube platform.
And Garner Cowdrey, who is behind the microphones here
in our beautiful Cumulus Studios.
If you need help, if you are, chronologically challenged
or you are looking for individual ACA, the lovely Carolee
Steele at RPS Benefits by Design, will be happy to help you.
You can reach her at 877-385-2224.
And if you're looking for employer sponsored
health insurance, Maria Ahlers is also happy to help you.
They have access to all the great plans out there, including those brand new
Blue Cross and Blue Shield plans are going to roll out this year.
And so in studio with me, Mr.
Barron Roberts from Blue Cross and Blue Shield of Kansas City. Welcome.
Thanks, Cary.
I haven't done a show like this, I think in probably six years.
And now I'm going to tell you why I just said that.
So here's what's going on in the ACA
marketplace that I warned you this was going to happen some months ago.
This is this is what we're looking at with carriers.
Celtic Insurance increased this year 24.4%,
Medica 29.2%.
UnitedHealth Insurance 10.7%.
You want to tell us what the Blue Cross
and Blue Shield increase is going to be this year? Yeah.
So in in Kansas we're looking at a -4.1%.
And in Missouri a negative six.
Did you hear what I just said.
I reversed that Cary.
That's all right. Yeah that's all right.
The point is they’re actually going to be a premium reduction.
Now the last time I did a radio broadcast where there was a decrease in premiums
was Ron Rowe, about eight years ago, if I remember correctly.
So it's been a while. All right.
And this is a great piece of news for everybody in the Kansas City metro.
So I'm going to repeat that.
So they're looking at Missouri at a -4.4%.
And in Kansas a -6.1%.
So there must have been a lot of work went into this.
If you're bucking the whole marketplace,
okay, all the national carriers, etc.,
and you're coming in at numbers that are good,
and then we're going to talk about
some of the specific plans you're going to offer.
They're going to be very different.
But how did you guys get to this.
Yeah we put a lot of work designing these new plans.
We gathered member feedback from across the community.
We gathered our broker partner feedback,
months and
months ago to put together plans that would fit,
the members of our community.
You know, it,
when we talk about the independent Blue Cross plans, like Blue
Cross of Kansas, Blue Cross of Nebraska, Blue Cross of Kansas City.
You know, there's the tagline that always comes to mind for me
when I look at that versus the big carriers.
The big Aetna’s, the big UnitedHealthcare's.
the Cygnus, and that is we're Main Street, not Wall Street.
And you're right down here on Main Street.
You know, you serve this market.
You've been here for how many years? Over 85 Years.
85 years in Kansas City.
And you're able to come to the people in this city and say,
we're going to cut premiums this year by 4.4% Missouri and 6% in Kansas.
That's pretty significant. Absolutely.
There's a lot going on in the ACA this year.
You know, there's enhanced subsidies that are going away or expected to go away
at the end of the year unless there's something that changes about that.
You'll have a $5, additional premium
applied to your bill if you don't go in and update your income.
It's a very active open enrollment this year.
And we would encourage everyone to go out and review their details
within their marketplace account to ensure that they are getting,
assessed the right premium for one, but also evaluate their options.
And as you mentioned, we're giving decreases this year.
We're going to be much more competitive.
Well, you’re going to be much more competitive.
And there's a tsunami coming.
I've been telling people this for the last four months.
Okay. I've done multiple shows on this.
There's a tsunami coming that, no longer are you going to be able to self affirm.
You're actually going to have to,
you know, have documentation that says you made ‘X’.
The automatically renewing subsidies are going from 400%
of the poverty level back to 150 to 200, which is where they were
before we had the expansion in 2021.
Well, that's going away now.
So there's going to be massive market disruption in the marketplace.
Between 90 and 93% of Americans
today on the ACA, have the enhanced subsidies.
So 90 to 93% are going to be affected by these changes.
That's huge.
All right.
And so what BlueCross has done is they've stepped up to the plate
and said, we're going to buck the market trend.
You guys are taking a risk here.
There's no guarantee.
You know this is going to work out for you guys in a year from now.
You're not going to be going, oh, Lord, you know, but the fact that you're willing
to make that commitment to this community after 80 years of serving
this community says a lot about Blue Cross and Blue Shield of Kansas City.
You know, most certainly.
And we've done a lot of things to to get there.
What we're looking at different care management programs.
In addition to that, we're rolling out a brand new network in 2026.
Will help us get to the pricing point that, members are looking for.
Yeah.
And that new network
you’re going to have,
we'll talk about that when we get into the next segment of the show.
And then obviously, Spira Care and how that's going to fit into
the equation is really interesting because we're seeing a lot of initiatives
now for, primary care, direct primary care,
getting away from the hospital models, the other models,
which is kind of funny because how long Spira Care have been in existence.
Yeah, since 2018. Okay.
So I mean you the compliment Danette Wilson.
Okay.
For having,
you know, the vision to say we're going to do something really different.
I remember when everybody was like, this is never going to work.
Well here we are in 2026.
And guess what.
Not only is it working, it's working phenomenally well.
Yeah. Very well.
Our members are reporting, 96% customer effort
score at Spira Care, which is a true testament
to the experience that they get there, the accessibility,
and and being able to get to a provider that, keeps costs low.
Let's give folks the dates when they can when this is all going to start with OEPs.
For ACA, you'll have a shopping period or shopping window towards the tail
end of October, so you can go out and see what
the different prices and plans that are available.
And then open enrollment starts November 1st
up until December 15th for a 1/1 effective date.
And then if you're enrolling for a 2/1 effective date,
that enrollment can come in after December 15th up to January 15th.
And that's it.
That's it.
Okay.
So here's my admonition to all of you out there in the audience.
All you folks like to procrastinate.
This is one year where you better not procrastinate.
Okay.
You know, I'm going to give you the phone number,
and I'm going to suggest you that you probably you ought to start
making some calls and start talking to people and get ahead of this thing.
So you can call the folks down at Blue Cross.
They can they can chat with you.
They can set up a time to talk to you after OEP, whatever you want to do.
But you need to get ahead of this because once this tsunami hits,
you guys are going to get buried.
You're the only plan in town that’s offering decrease,
you're going to get hammered.
We're going to get a lot of calls. For sure. Yes, you are.
And there's going to be a lot that has to happen here.
So the phone number is 833-467-2145.
833-467-2145.
And the website is bluekc.com. Yes. Yep.
All right.
So if you want information you can go up to the website.
But I would strongly suggest
you start making arrangements to have these conversations now.
So you're not caught at the last minute.
Because as I said it's going to be a tsunami.
There are a lot of changes coming.
A lot of folks are going to be affected by these changes.
We come back to the break.
We'll talk some more about this and how and the new plans
and the new network and all that they’re doing,
and then we'll switch gears when we get to the third segment,
and we'll start talking about what's going to happen
to the small employer, because small employers on ACA
type plans are also going to get hit with very significant increases.
What is Blue Cross doing to address that, and how are they addressing that
so they can help the small employer in the marketplace?
Stay tuned.
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 USA. We've got more.
Stay right there.
That phone number once again.
833-467-2145.
Stay right there. We'll be right back after the break.
Welcome back.
You're listening to America's Healthcare Advocate show, broadcasting coast
to coast across the USA here on the HIA Radio Network.
Once again, you can find out
more about us by going to the website AmericasHealthcareAdvocate.com.
You have an email. You want to send me a note?
Please do so.
Go to the website. I'm happy to help you. Any way I can.
I want a shout out to WNRP, AM 1620
and FM 95.3 Pensacola, Florida.
Happy to have those folks on board as part of America's Healthcare Advocate
family broadcasting down there every Saturday at 8:00 in the morning.
And we love Pensacola, Florida, by the way.
So, all right, let's switch gears now.
And we kind of gave people a little tease there.
This new plan, which I'm hearing a lot.
In fact, we just had the folks
from RPS Benefits by Design up here, and they were talking about it.
And you guys have had a big broker meeting the other day,
and there's some pretty excited brokers out there to learn about this new plan
that's coming in play, and what a difference
it's going to make people. So let's talk about it. Yeah.
What's it going to be called. Yep.
It is going to be called the Simply Blue Plan.
Simply Blue. All right.
And we'll
actually have three one in each metallic category.
So gold, silver and bronze.
We're pretty excited about it.
At the
smaller rollouts that we've done so far, brokers are getting excited about it.
We had a group up here this morning. It's pretty excited about it.
Yeah.
So, the price point on that, that will be our lowest price plan
that we have available.
It'll be offered in the Johnson County, Wyandotte County and Jackson County
metro area. Okay.
And it'll be a part of what we call the Blue Metro Network.
Okay.
That'll consist of Saint Joseph,
Saint Mary's University Health and Providence.
And it also includes University Health Lakewood as well.
Lakewood and then downtown.
Yep. Okay.
Then Providence Hospital over in Kansas City, Kansas.
That was the other one.
Saint Mary's down south. In Blue Spring.
and Saint Joseph.
So it’s a narrow network.
But the price point is going to be.
Much better.
You know what people are going to have to do is be willing
to accept a narrower network in order to get that price point.
The good news is you're giving them an option.
Absolutely.
They're not going to see with the other carriers so
you're addressing the issue by getting creative
and giving them an option so that somebody,
you know, if they do lose their subsidy and they need coverage,
at least they can keep they can still stay in Blue Cross. The.
Whole nine yards.
Okay.
Now is Spira Care accessible on those plans.
So each one of those plans will have access to all nine Spira Care centers.
That's huge. Yeah. All right.
So now you just took primary care out of the equation
from the standpoint did they have to drive to a facility.
They've got one of the nine Spira Care centers.
So you're connecting the two now.
So all of their primary care, behavioral health,
all the other things that go with that will be in Spira Care.
Yeah, they'll have access to that.
And, access to Spira Care is much faster than a traditional primary care.
23 days to a typical wait to get in to see a primary care doctor.
Then you get 7.5 minutes.
That's the average time you get with your primary care.
Little different. In Spira Care.
Talk about. That. Yeah, yeah. So in Spira Care.
You can get in and get your original orientation
visit set up much earlier than traditional PCP office visits.
And then on top of that for sick care or a little bit more urgent type care.
You can get in to see Spira
within a few days, if not the same day, depending on the circumstance.
To me, when you're balancing that narrow network piece
for cost effectiveness and but you're not saying to them, well,
you're going to go find a new primary care provider.
No, you can come to Spira Care and we'll take care of you here.
We've got nine clinics around the Kansas City metro,
so you're giving them an option where they've got primary care, taken care of.
Whatever they need is right there.
If they need major medical, they can go to one of the hospitals
and get major medical.
Absolutely.
And hit on one more thing there Cary.
Care at Spira Care is at no cost to members.
So they've got easy access, affordable access.
They'll have a great experience there and care is at no cost for Spira
Care members. Yeah.
So there's your there's your key takeaways right there.
And you heard him say in the last segment, 96% of the people coming away
from Spira Care are telling them they're doing a good job.
All right. So if you're not going to
make co-pays.
You're not going to have to pay out-of-pocket costs for this.
When you think about marrying that up with the plan, it's
going to save you a significant amount of money.
That sounds like a pretty win win deal to me.
Yeah, absolutely.
That is, taking total cost of care down for members and families for sure.
So rolls out. Win.
This will roll out, January 1st is a new product.
Open enrollment starts 11/1.
Great. Start looking for that plan starting 11/1.
And if they want to call
and just have a consultation with somebody and talk about that plan,
they don't have to wait to open enrollment to make a phone call to say
this isn't Medicare. Right? Okay. Right.
Yeah.
Where we got the thought police out there going, you can't call it.
You can't talk to anybody. Yep. They can. So this is a different deal.
This is ACA. So they can call anytime they want.
If they've heard about this plan it's called Simply Blue.
That's pretty easy right. Simply Blue.
And there are three plans.
There's there's the there's the gold.
There's the silver and there's the bronze.
So you've got three separate plans to offer.
I assume there's going to have different deductibles. Correct.
2000, 4000 and 6000.
And the premiums all vary depending on the plan. Okay.
So if you know, if you're if you're one of those folks
that's chronologically challenged, you're in your 50s,
you probably don't need a $2,000 deductible
because you’re not running to the E.R., the urgent care and all the other things
you're going to have to do with the household children.
So you could go to a $5,000 deductible.
Can that be tied to an HSA?
So actually new for 2026,
bronze and catastrophic plans will be eligible for HSA, compatibility.
Okay. So that's huge. Yeah.
And the thing about the HSA is that I always try to get people's
heads is it money going in is tax deductible.
So you made 100 grand. You're going to pay taxes on 100 grand.
No you're not.
You're going to take 6300 off that.
It’s your money you're putting into your account.
Oh and by the way, when you take it out it's tax free.
So if you went to the higher deductible plan
and you had to go have a surgical procedure,
you've already got your deductible there to pay to get it done.
Correct.
And if you don't use it, you don't lose it.
Unlike, Like an HRA or something like that.
All right.
This plan is not a flex. It's not an HRA.
This money rolls over every year.
So you can continue to add to it So if you put all those pieces together
you got some answers here. Absolutely.
And that's that's really kind of what BlueCross
Kansas City has always been known for
is that you have the answers and you're serving this community.
And this is a great opportunity.
You know, once again, they're called Simply Blue.
I strongly suggest that you are the up on the website, yet.
No. They won't be up on the website until late October.
Okay, so. During the shopping season in. October, you can go up there.
They'll be up there if you just want to call
and have a conversation with him about this, you can do that.
833-467-2145.
By the way, there are 1 million people out there across the country
that are losing their coverage because Aetna’s pulling out of the market.
You folks probably ought to be the ones on the phones first.
Okay.
And looking for these plans and to see what they can do because,
come January 1st, all the Aetna plans are pulling the pin on ACA.
They're going to be gone.
And I and I read to you earlier what's going to happen with the other plans.
They're going to be significant increases across the board.
BlueKC continues to lead the way as the local hometown carrier.
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 USA.
Stay right there. We've got more in the next segment.
Welcome back.
You're listening to America's Healthcare Advocate show broadcasting
coast to coast across USA here on the HIA Radio Network.
My producer behind the microphones, Mr.
Garner Cowdery behind the cameras,
putting all these shows together as he does every week.
Dave Thiessen
in studio with me, Barron Roberts, BlueKC we're talking about the coming tsunami
That's what's going to happen, both on the individual side
and on the group side with anything associated with ACA.
And how is that going to play out for all of you out there in the audience?
So we've talked about
on the individual side and what Blue Cross is doing to lead the way.
They're actually going to have premium reductions on the individual side.
Right now we're going to switch gears here, and talk about
what are the answers to the employers out there, the small group
employer, the employer under the 100 lives.
What are the answers to them?
What is Blue Cross doing to address the issues
that they're going to deal with?
Because that's going to happen.
All right.
And if you're you know, you need to talk to your broker.
If you don't talk to your broker, call the folks at Blue Cross and Blue Shield
at 833-467-2145.
If you want to have a conversation before you get to the point where you've got
the renewal, now you're looking at a 20% increase that came from another carrier.
you might want to give them a call and have a chat.
All right. Let's talk about what you're going to do.
Alright,
how are you addressing this market and what are you doing to help employers
deal with these issues and the brokers out there that are
the ones representing your products?
Yeah, absolutely. Gary.
So we put a lot of work into the 2026 plan designs for small group.
Number one.
We went out and surveyed
our broker community and asked them, what are employers asking for?
We took those notes.
We took, feedback from our team, and we developed new plan designs
for 2026, to help reduce the overall,
premiums on the baseline for employers.
And you're confident this year's new rollouts,
what are they going to look like?
You know, we've already had a couple of smaller rollouts, our broker community
and our brokers that we've presented
in front of our pretty excited about these changes.
We've got updates to Blue Select Plus eligibility, more members,
will become eligible
to enroll in Blue Select Plus, Blue Select Plus has Spira Care.
We have brand new plan options.
Some of them have higher deductibles, new plan designs.
Some of them have no deductible on medical, whatsoever with fixed co-pays.
So that's going to open up a lot of opportunity there.
Run that by me one more time.
No deductible on medical.
And so we’ll have just co-pays on primary care office visits, specialist visits.
And some of those plans have just co-pays on inpatient as well.
That's going to be remarkable.
Yeah.
That's going to be that going to be a game changer for people.
Let's go back to Blue Select Plus you talked about some things.
So what are some of the things going to happen there. Yeah.
So for Blue Select Plus, for many years now we've been getting questions
and really requests to expand our Blue Select Plus eligibility.
Right.
So you know members that live in Miami County or right outside Johnson County,
right outside Wyandotte County,
we have employer groups that are within those counties
today that have members that live just across the county.
Line, right.
That have not previously been eligible for Blue Select Plus or Blue Select
Plus with Spira Care. Right.
And so starting in 2026, we're actually opening up some eligibility
there and allowing those members to enroll in Blue Select Plus and Spira.
Wow. Yeah.
So I think they're going to be excited.
Those members that live in those counties will have, new plan options.
The Spira Care experience if they enroll in the Spira Care plan.
And those employers may be a little bit more open to offering,
that plan option as well.
Yeah.
And the beauty of that is we talked about Spira Care in the last segment.
We’ll touch on it again a little bit because the beauty of that
is that the employer can say here we're going to go to a higher deductible,
but all of your primary care, behavioral health, X-rays,
labs, all that is going to be handled by Spira Care.
All right.
And if you need to be referred out, they'll take care of doing that.
So you're taking away the biggest obstacle to care that people have.
That is I can't afford a $50 copay, okay.
Or a $75 copay to go to a specialist.
Okay.
But I can go to Spira Care and I don't have to pay anything.
So now you're marrying that to this plan, which keeps affordability in line
and also says to the employee, my employer really does care
because they put this plan in place so that I can go to Spira Care,
not just the employee, but the employees family as well
up there on the plan, right? Right.
and when you think about total cost of care savings, if you got a family of four
of going to the provider every year on top of reduced
premium, you're going to save a significant amount of money.
Yeah. And you know, I've got six grandchildren.
And I can assure you that my two daughters with those six children,
there is not a week goes by that there is not a visit at the urgent care, the E.R.
or some specialist doctor that they've got to go to
because there's a new issue we've got to deal with.
Okay.
So for families, to me, this just seems to make an awful lot of sense.
Yep. And those care centers also offer,
services that support pediatric care as well.
So if there's younger children there, they can help them as well.
Yeah. So we've got nine locations around the metro.
Where are. They?
Yeah, absolutely. Cary.
So, Tiffany, Liberty, Legends, Shawnee, Olathe,
Overland Park, Independence, Lee's Summit and Crossroads.
Well, you've got one almost everywhere in the city.
All over the city. Nine locations for Spira Care.
Anywhere in the city you have access to Spira Care.
So in other words, there's some places close to you.
Yeah. Okay.
You're not going to have to drive 45 minutes to an hour to get to a facility.
Right.
And the whole the whole concept of putting the Spira Care’s
all around the Kansas City community, if you look there, really circled
all within the 435 interstate.
So any member within the Kansas City community
should be able to get to a Spira Care within 10 to 15 minutes.
And this is the solution.
That as an employer, you really need to take a look at.
If you want to keep your employees happy, give them a benefit that’s going to mean
something to them and, give them access to the kind of care they need.
This is an opportunity to do that.
Talk a little bit
before we go to break about level funded, fully insured in the ACA.
Our Level Funded, option for 5 to 99
size employers, 5 to 9 enrolled employees.
That option is available for the small groups.
A lot of groups are finding those options to be
you know, a great product, an affordable product.
It is a very attractive and growing market in that space.
For ACA, that's 2 to 50.
2 to 50 enrolled employees.
And then for fully insured, underwritten, it's 51 to 99 enrolled employees.
So explain that because that that.
I'm an employer now I've got 75 employees.
So if I want to move to it and I and my workforce is trending below 45.
So now I know that you know that if they're trending
below 45, they're going to be a healthier bunch, right?
They ought to be.
We'll make an assumption that they're reasonably healthy.
Okay.
So having said that, when they go to that model,
they're going to be judged on that group as a group, not being judged
on this giant pool of people over here
with ACA, a lot of sick people and other people on it.
It gives them an opportunity
if they've got a pretty healthy group or
group that doesn't have a lot of major issues
where they can actually put a program together,
that really is kind of tailored to what they need, correct? Yep.
And in addition to all the planned changes, the new plans we have coming out,
we've also opened up our underwriting guidelines Cary.
Oh really? In addition to. That.
Well, that's a big deal. It is a huge deal.
Yeah okay.
So explain what that means because I'm sure the audience out there
what does that mean. They opened up their underwriting.
Yeah.
So, we're making it easier for employer groups to apply for coverage.
Those that have at least ten or more enrolled employees on the plan.
And so what I mean by that is we need a
we need a group census with at least ten or more enrolled on the plan.
We need that group app.
And we need a couple of other pieces of information and we can turn around
and quote that group on, level funded or fully insured?
51 and 99. You know, that's pretty amazing.
You've got a suite of products here.
Yeah. I'm kind of talking to the broker audience now a little bit.
You've got a suite of products here that are addressing
concerns in the marketplace, and I'm not seeing this anywhere else.
I'm not seeing it from the other carriers out there.
I'm seeing carriers pull out of the marketplace,
and I'm seeing articles in the Wall Street Journal, other places talking about
how difficult it's going to be for them to continue this year.
But you're seeing something completely different here by the hometown carrier.
And if you're the broker out there, you really need to engage in this.
If you haven't gotten to one of their seminars, the webinars
to learn about these products, you need to because you're going to be getting calls
from your clients, who are going to hear this show
and the commercials run during the week where we talk about these kind of things.
They're going to ask you,
why haven’t you been telling me about that new Blue Cross plan?
Okay.
Because they're going to be a host of new Blue Cross plans.
They're going to address,
what's going to happen in this marketplace.
And I'll repeat what I said earlier.
We're going to see a tsunami in changes this year on the ACA.
Small group side across the board.
Impacted by all the changes that are happening.
And it's important for you to get ahead of that.
833-467-2145 if you're an employer, okay?
And you just want to have a conversation, they're happy to do it.
833-467-2145
or the website bluekc.com, bluekc.com.
We'll be right back after the break to wrap it up, stay tuned.
You're listening to America's Healthcare Advocate
broadcasting here on the HIA Radio Network.
Coast to coast across the USA.
Don't go anywhere.
Welcome back.
You're listening to America's Healthcare Advocate show, broadcasting coast to coast
across the USA here on the HIA Radio Network.
You know,
I do these shows to get information out to all of you
about what's going to happen in the marketplace.
I got I have BlueKC up here today to tell us what they're doing
to address the concerns that people are going to have as we get closer to renewal
on the individual side and on the employer sponsored health care side.
They've got answers.
They've been here for 83 years, okay?
They've got answers. They're the hometown carrier.
They're the only carrier in this market that's actually reducing premiums
on the individual side.
So again, if you're a broker or if you're an employer or an individual
and you want information 833-467-2145 is the phone number.
They're happy to talk to you and get you set up for
what's going to come down the pike this year 833-467-2145.
And the website bluekc.com.
All right, let's go back to Spira Care a little bit
because this is such a unique value proposition.
Now, and, you know, it's funny, you don't have to wait
23 days to get in to see a doctor. Yeah.
And the visit is probably going to last longer than 7.5 minutes.
Right.
I know the average visit with Spira Care is about 30 minutes.
Okay. But it's it's a very different care model.
So talk a little bit about that
and why that is really something both employers individuals should consider. So
you know starting off with just the Spira Care story, we rolled it out in 2018.
Over time, we've added more care centers across the Kansas City community.
We're up to nine so far.
With that,
the idea was to ensure that every member within Kansas City
could have access to Spira Care easily and relatively close.
So each member can get to a Spira Care center
within 10 to 15 minutes at least, that was the design that we had in mind.
And it worked.
Yeah, yeah.
Members are you know, reporting a great experience there.
We grade ourselves on the customer effort score of our members
not only the Blue Cross members, but also our Spira Care members.
And for the those Spira Care members,
the customer effort score is 96%.
And just to put it in perspective,
you know, gold plans,
industry best is right around 72%.
So holy cow.
Are you serious? We're getting great.
Great feedback from members on the experience that they have at Spira Care.
And have you got the capacity to handle what's going to be coming down the pike?
Because I got a funny feeling, pal.
Your phones are going to be ringing. Yeah, yeah.
We do.
Each of our care centers have capacity to continue to grow and grow membership.
Some of the newer ones have even additional capacity
to have additional rooms in there that they can add on.
So, we're pretty confident our, the growth opportunities we have ahead for 2026.
So there is one component about Spira Care that I always thought was unique
because nobody else does this.
I mean, there are there are other models out there for direct primary care.
But your behavioral health, I mean, this is a big deal to Erin it's a big deal
to Jenny, you know, Christina Lively, all the C-suite people at Blue Cross.
Talk a little bit about that and the fact that,
you know, it's right there in the center.
You don't get referred out to go see somebody outside.
You can start right there in behavioral health.
And to me, this is important, especially for people with kids these days
that are dealing with issues, whether it's, you know, cyber bullying
or what's going on at school or just some of the talk a little bit
about that whole behavioral health piece and how that fits.
Because I think that separates Spira Care from everything else out there.
Yeah, yeah.
So, as you mentioned, it's very important at BlueKC
you know, our leadership team, all of our all of our team members,
to provide access to behavioral health services,
not only at Spira Care, but also through all of our apps
and all of our resources and mindful, we've got a ton of resources available.
But at Spira Care, we did integrate behavioral health care,
to ensure that members had access to that service.
And there is screenings that occur within the Spira Care centers to help understand
if members need that type of care and we help get them there.
Yeah.
And, you know, for the mother, you know, that’s
got 2 or 3 children and she's got one that's having a problem.
She doesn't have to worry about going someplace else.
She can go to Spira Care
and that child can be privately counseled, whatever they need to do.
And the whole thing works like it's supposed to.
Yeah.
So, in addition to that, there's no cost at Spira Care.
Well, that's that's a big piece, right?
Yeah, yeah, it's the, you know, all the co-pays are gone.
So, you know, that's critical to talk about some of the other services
that Spira Care offers.
You I know labs and X-rays are available in certain facilities.
How are you handling prescription drugs.
The rest of it.
Yeah.
So, each of our Spira Care plans have, prescription drug,
model plans that enable, low cost for prescriptions.
So tier one and tier two are co-pays, and then tier three,
typically have a level of coinsurance. But,
the Spira Care centers will refer out
those prescription drug needs to, local pharmacies that are in network
so members can get access to those prescriptions.
So that's all part of the plan.
They don't have to go deal with another plan or some other issue.
That's all going to be handled through the Spira Care facility.
It's all built in.
Okay.
That that that's pretty significant in terms of how that works.
Are you doing anything with urgent care after hours visits?
Yeah.
So some of the care centers
have not only they have after hours visits,
but some of them are open on the weekends as well in case.
That's new because that. Yeah.
Okay. That's that's.
Yeah.
So it's, you know, you have to call and make sure, you find out
which care center is open on the weekends because they are rotating.
So we always advise members to call and schedule appointments.
You know, if they,
if they need to get in at that point in time that they can do that.
And can they make appointment just a regular appointment.
They go online and make that appointment a line.
Definitely.
So what we always recommend is that for that very first appointment,
the consultation appointment to go ahead
and make that call, once you're in the system,
then you can make all of your regularly scheduled appointments on online.
So you go and you have that initial visit usually takes about 45 minutes
to an hour. Where they actually sit down right
and listen to what it's not 7.5 minutes, right?
Okay.
It's a real opportunity to sit down and talk to the provider
and let them hear about your health history and what you do.
Yeah.
And the Spira Care experience is a lot different than a traditional, experience
or the PCP office.
They have consultative rooms with comfortable seating in there.
With a table.
You can you can talk eye to eye with the provider that's there.
I mean, you're not doing this. Yeah.
The doctor's over here on the computer and you're here.
The doctor's over here filling in the computer screen.
Oh, you're 7.5 minutes is up next, right?
Yeah, it's a little different. Most of the time.
You spend less than 7.5 minutes sitting in the waiting room.
Yeah, I know.
You take it back.
So, the design, the features, the view, the experience is,
wonderfully different.
It is. Thank you for doing this today. Yeah.
We're going to get you back.
Okay. When the brand new group plans are released.
So we can tell the audience what's going on there. Yeah.
So if you're a broker, if you're an individual, if you're an employer,
there are changes coming, and these folks can help you through that.
They've got a product that can fit your budget and fit your needs.
I don't care what it is.
And you marry this up with the Spira Care model and you've got a value proposition.
It's hard to beat if you want information, if you want help.
877-467-2145.
You know, I've been a, my wife and I've been Blue Cross and Blue Shield
members for, I think, the last 35 years.
It's been a long time. Okay.
Local customer service.
They're good people and they do what they do really well.
So thanks again for coming up here again today.
And now I leave you with this thought from Doctor Martin Luther King.
Americans must learn to live together as brothers and sisters,
or we will surely perish together as fools.
Truer words are never spoken.
Thank you for listening to America's Healthcare Advocate
broadcasting here on the HIA Radio Network.
Coast to coast across the USA.