Blue Cross Blue Shield of Texas and Cigna are both signed on to offer value-based contracts to more than 1,300 independent primary care doctors and specialists who have come together as part of a new clinically integrated network.
Called TXCIN, the collaborative includes about 680 family physicians and 670 specialists. It’s made up of four independent practice associations—Fort Worth’s TIOPA; Dallas’ Jefferson Physician Group and the Genesis Physicians Group; and Plano’s North Texas Ear Nose and Throat Associates (or NTENT)—500 primary care practices, and 600 specialty care practices. It includes some of the region’s largest specialty groups, including HeartPlace, Texas Colon & Rectal Surgeons, and Neurology Consultants of Dallas.
Dr. Jim Walton, a former president of the Dallas County Medical Association and the president and CEO of the nearly 1,500-member Genesis Physicians Group, will head the organization.
“Physicians who are making decisions to stay independent now have a really robust number of other independent physicians to work with in both primary and specialty care to achieve success in value-based contracts,” Walton said. “And they don’t have to stop being part of something they’re very comfortable with. They can balance this with their fee for service contracts.”
TXCIN is the latest example of independents fighting hard to have the same access to services and contracts that are available to their hospital-affiliated colleagues. Think of it as an indie answer to Southwestern Health Resources, the recently announced clinical integration between Texas Health’s primary care base and UT Southwestern Medical Center’s sizable specialists. As the Affordable Care Act fuels more data-driven, value-based models that manage the health of a population, independents are finding themselves increasingly fragmented. TXCIN is, in some ways, a reaction to this. For instance, they’ll be able to link patient information digitally to monitor a person and see what recent tests and procedures were done recently to reduce the risk of unnecessary testing.
“There’s not a lot of savings when you’re going to your primary care physician and you’re having wellness checks or going in for the sniffles, there’s little delta there in terms of getting real meaningful savings,” says Dr. Rick Snyder, a cardiologist with HeartPlace, the largest independent cardiology group in the state, which is also a part of TXCIN. “If you can get meaningful savings for heart failure cardiology, angina, stress testing—you can get some real savings there if you do it smartly and appropriately.”
Admission in TXCIN doesn’t mean the doctor has to leave his or her affiliated IPA or group—it simply gives them access to what will eventually be a variety of value-based contracts that reimburse for outcome and the elimination of waste rather than volume. On July 1, participating physicians will have access to contracts from Blue Cross Blue Shield of Texas and Cigna. Walton says the organization is progressing in discussions with UnitedHealthcare and should add a contract with them in the fall. Once that goes through, the network will include more than 125,000 patients across virtually all of North Texas—Dallas, Tarrant, Collin, and Denton counties.
“The growth was a strategic decision to cover more patients and more geography, which is what makes it attractive to the commercial payers,” Walton said.
The collaborative launches as the Centers for Medicare and Medicaid Services begin to roll out its payment reform program known as MACRA, which will ding providers for poor outcomes. The idea for TXCIN was born from conversations with Dr. John Moore, an ENT specialist, and Harriett Flowers, the CEO of RevelationMD, which offers software to physicians that allows the user to track the patient as they navigate the healthcare system. The web-based platform helps the doctor run data analyses to see areas of improvement to lower cost. The two envisioned a clinically integrated network of family doctors and specialists who could use the platform to find cost-savings.
“TXCIN’s choice of RevelationMD’s technology reflects the network’s commitment to communicating with one another to track patient care referrals, improve quality performance scores and reduce utilization and costs,” Flowers said.
It will have a 12 member governing board, five of whom are primary care physicians while seven are specialists. Walton will be the chair of the board and the president of the primary care division. Moore will be vice-chair and head the specialty division.