Blue Cross and Blue Shield, Texas Health Resources Form ACO

Doug Hawthorne, Texas Health Resources

Blue Cross and Blue Shield of Texas (BCBSTX) and Texas Health Resources (THR) have formed a new strategic alliance to deliver improved, sustainable patient care and help manage costs through Texas Health’s accountable care organization.

This ACO, one of the nation’s largest of its kind, will be available to patients served by the THR’s 25 hospitals. THR has 5,500 physicians with active staff privileges.

The new ACO is designed to improve patient health and reduce unnecessary hospital admissions, readmissions, ER visits, and duplication of services for patients with chronic diseases, leading to lower cost trends, the companies said.

“By innovatively collaborating with Texas Health, this new ACO will help improve the quality of care and lower the cost of medical care for BCBSTX members and Texas Health patients, ultimately providing better value and improved outcomes for our members,” said Bert Marshall, President, Blue Cross and Blue Shield of Texas.

“This alliance is an extension of BCBSTX’s commitment to enabling innovative, value-based care delivery models such as Extended Medical Home, Intensive Medical Home and Bridges to Excellence, all of which are designed to reward physicians for managing costs and quality of whole patient care and moving from the traditional fee-for-service approach to a fee-for-value payment model.”

“This agreement to establish an ACO is another example of the innovative approaches that we believe will lead to truly effective healthcare reform,” said Doug Hawthorne, CEO of Texas Health Resources.

The ACO is designed to improve outcomes in three key categories:  quality of care, patient experience and satisfaction, and cost efficiency. The companies said they would reach those goals by:

  • Early identification of disease and illness through effective management and coordination of patient care.
  • Use of advanced technology and support services to make more informed decisions, facilitate the patient and provider relationship and improve transitions in care.
  • Implementing a non-fee-for-service payment arrangement.
  • Lowering costs by coordination among payers and providers to enable the delivery of more affordable health care.

“Our agreement is a game changer. We will move reimbursement from fee for service to fee for value,” says Dr. Eduardo Sanchez, vice president and chief medical officer, BCBSTX.  “In addition, we will better harness clinical data to drive medical care decision-making, enhance patient safety, and improve quality of care – all in the name of better health and better outcomes for patients.”

The new alliance extends a previous agreement that allows more than 1.6 million Blue Cross members access to in-network health care services at THR’s 25 hospitals and 18 outpatient facilities in North Texas. The ACO will be available to the general and commercial populations, and other populations in Collin, Dallas, Denton, Ellis, Erath, Grayson, Hood, Johnson, Kaufman, Parker, Rockwall and Tarrant counties.

The Texas Health Resources ACO is the fifth local ACO, and the second to be announced in the past week. D Healthcare Daily reported on The Accountable Care Coalition of North Texas’ entry into DFW on Friday.

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