The pairing between Texas Health Resources and UT Southwestern Medical Center will include a joint venture made up of three Dallas hospitals, a new physician network, and a population health initiative that includes a research institution and a services company—all of which will be overseen by four high-level executives from the institutions.
The network, announced last October, is called Southwestern Health Resources. On Thursday, the institutions announced the executive team and detailed how the network will operate. It’s clearly structured to try to leverage the strengths of each institution, particularly Texas Health’s huge primary care base and UT Southwestern’s advanced faculty of specialists. THR gets a broader service line, UT Southwestern can launch substantive research initiatives, and more patients get care within their networks.
The keys to its success will be data and connectivity. Participating physicians will use that information to keep North Texans healthy just as they’ll use it to better manage the symptoms of those with chronic conditions. It has a substantial base of practitioners and care sites: when it launches on April 1, more than 3,000 physicians will be on board across 27 hospitals, and 300 clinics. The only legal difference will be a joint operating company made up of the three Dallas hospitals that are owned between the two institutions. They will maintain separate ownership and brands but share in a single management structure. Texas Health CEO Barclay Berdan and UTSW President Dr. Daniel Podolsky will co-chair the board.
This network spreads 16 counties. The population health initiative has the goal of emboldening researchers to produce white papers and analyses to be shared with healthcare providers throughout the country. And when the separate institution’s existing contracts with insurance plans expire, it will renegotiate as a unit and bring to the table outcomes from thousands of patient encounters. If it is successful in-house, officials say a population health services company will be available to physicians outside the network should they want to contract its technology.
“We have ways to share some patient information electronically,” says Dr. John Warner, the CEO of UT Southwestern’s William P. Clements Jr. University Hospital. “But the best medical care really happens when physicians and other providers are able to communicate in real time with each other and make decisions, share decisions, change information, and really coordinate care.”
The four men running the show have long histories within their institutions. Warner, who was one of the most important C-level leaders in the construction and opening of the Clements Hospital in Dallas’ Medical District in 2014, will be the senior executive officer of the newly formed joint operating company. This network is neither a merger nor an acquisition, partly because UT Southwestern is a public institution and state dollars cannot flow to a private organization (Texas Health is a faith-based nonprofit). The JOC is the only reconfigured legal structure in the deal and links together UTSW’s Clements and Zale Lipshy University hospitals with Texas Health Presbyterian Hospital, THR’s only full service acute care facility in Dallas.
Bringing the hospitals under a single management structure is an effort to evade any sort of bias in the referrals, ensuring that none of the facilities will hog high-margin procedures or pass off low or no-margin ones elsewhere. The joint venture will combine all the hospital’s bottom lines and distribute the money evenly, said Dr. Bruce Meyer, UT Southwestern’s executive vice president for health affairs. Think of them as a miniature health system.
Dr. Daniel Varga, THR’s first chief clinical officer, will be in charge of the new physician network. It will launch with more than 3,000 primary care and specialty doctors from both institutions. Dr. Mack Mitchell will be the network’s chief medical officer. Texas Health will first add the 1,200 primary care physicians in its affiliated physician group as well as 600 advanced practitioners. UT Southwestern will bring on its roughly 1,800 faculty physicians—the vast majority of whom are specialists—and about 280 primary care doctors who practice in UTSW’s Clinically Affiliated Physicians group, or UTSCAP.
“It was clear that one of the easiest places to create a point of attachment was the network level,” Varga said Thursday afternoon from Presbyterian. UT Southwestern has “specialists that most health systems haven’t even thought about having and a breadth of specialty care that really isn’t present anywhere in the marketplace. We have a big primary care, community care program that would integrate very well with almost no real competition. It’s purely complementary.”
Varga is charged with maintaining relationships with other physician groups and recruiting additional primary care doctors to participate as it expands. While practitioners outside the systems won’t necessarily be made to practice exclusively within the network, Varga said they will be held to agreed-upon clinical outcomes and risk-based payment models.
But this network isn’t possible if it is not connected. Dr. Bruce Meyer, who is UT Southwestern’s executive vice president for Health System Affairs, will be in charge of the population health services company and its research institute. It will be his job to oversee that the infrastructure is in place for the type of seamless connectivity that Warner described at the top of this story. Both UTSW and THR use the Epic Electronic Health Record platform, which Meyer said gives them a head start. But each Epic system has its own kinks and quirks, and so Meyer is leading a team of developers who are syncing the two—making sure they have the same interface as to simplify the sharing of patient records between doctors with as few headaches as possible.
“We rapidly need to get docs onto a compatible electronic health record so that we can have a seamless flow of information across all parts of the platform,” he said. “Then as part of that, we want to be able to look at what are the care pathways and how do we embed that? How do we take best practices and spread those across the network?”
Meyer says both partners are identifying any duplicative services and determining whether to consolidate them to one hospital or retain them separately. Emergency and catheterization services will almost certainly remain at each of the hospitals to address the acute needs of patients who suffer a traumatic event. But less time-sensitive and elective procedures like joint replacement may be moved and housed in just one of the facilities. For instance, Zale Lipshy University Hospital has transitioned to a dedicated neuroscience facility, making it a natural option for the consolidation of related procedures.
Once Southwestern Health Resources is off and running, Meyer describes a massive yet scalable network. Administrators will be able to analyze data on a macro level to find strategies that are saving money at an individual care site to replicate it elsewhere. They’ll be able to zoom into a single patient, to automatically flag them in the system if they don’t fill a prescription or if a test shows something like high blood pressure, searching for evidence that they aren’t properly taking their medicine. If a patient has already had an MRI performed at one hospital but shows up to the ER at another, everyone involved in the care team will be able to pull up the patient’s first MRI without having to duplicate it.
“That’s the very low hanging fruit,” Meyer says.
All of this data—outcomes, cost reductions from duplicative services, percentage of generic prescriptions, et. al.—will be shared with population health researchers at UT Southwestern, who will author white papers based on findings within the system. This was a difficult, if not impossible, task for UT Southwestern before the pairing—Meyer says the majority of its patients are already sick before being admitted within its system. They’re there to see the world-renowned specialists (UT Southwestern’s Harold C. Simmons Cancer Center, for example, is one of just 44 in the country to be labeled “comprehensive” by the National Cancer Institute). To get a good baseline, the system needed the large cohort of healthy patients checking in with primary care doctors.
Now, none of these strategies are necessarily new to healthcare. The market has encouraged systems to grow larger, to retain a broader patient base and control the health outcomes of a population by harnessing data. To do this, some choose to merge, others acquire, and still others align or partner.
UT Southwestern, by the nature of being a public institution, was limited in those choices. Three years ago, it began shopping for a partner. It found a fit in Texas Health Resources, and the two developed an idea that allows each to sit at the table equally. Outside of the joint operating company, each institution will retain its own assets and manage its own budgets. But the potential, both say, is greater together than apart. They’ll increase the amount of patients they have separately in risk-based models such as the Medicare Shared Savings Program, which will see UT Southwestern linking its 20,000 enrolled patients with Texas Health’s 40,000.
Ideally, Southwestern Health Resources will be able to approach employers and health plans to show a bulbous, connected network that has outcomes that are good enough to zap any desire to offset the cost of employees seeking care out of network. With that, the thinking goes, it will save the healthcare system money in North Texas—and also give Texas Health and Southwestern more patients and doctors than they’d have alone.
“What we’re trying to create here is a long-term sustainable model for both organizations and something that really brings value to our community,” Meyer said. “I don’t want to say we’re inventing the wheel, but we’re doing something that I think is unusual.”