Direct Primary Care Now Offered Through Baylor Scott and White ACO

Baylor Scott and White Health is joining the direct primary care movement with a new model in several North Texas clinics this year. The model will allow employers to customize the provider network and make a regular contribution to membership fees, making pricing transparent to control costs and avoid hospitalizations. As in other DPC relationships, members are charged a monthly fee that covers office visits and lab tests. Insurance is still needed for hospitalizations and other services, but because primary care needs are taken care of, patients might be more likely to choose high deductible plans with low premiums. The… Full Story

American Specialty Health Moves to AllianceTexas

AllianceTexas’ newest tenant is benefits management services company American Specialty Health. Hillwood’s 26,000 master planned community planned has leased 164,000 square feet of Class A office space from building owner Griffin Capital Essential Asset REIT. “We are pleased to welcome American Specialty Health to AllianceTexas’ ever-growing office community,” said Steve Aldrich, senior vice president of Hillwood via release. “Our region has an extensive and impressive list of top-tier health companies and with its cutting-edge healthcare services and new employment opportunities, ASH enhances that list in North Texas.” ASH gives guidance in musculoskeletal health solutions, fitness, exercise programs, and more to employer… Full Story

BCBS of Texas Ordered to Pay $21 Million for “Willful Conduct of Fraud”

A Texas judge has ordered Richardson’s Blue Cross Blue Shield of Texas to pay more than $21 million to Knox County Hospital in unpaid insurance claims because of “acts to be willful conduct of fraud,” according to the Times Record News in Wichita Fallas. Bobby Burnett, the presiding judge of the 50th District Court of Texas, also placed a temporary restraining order against BCBS, according to a release from Knox County Hospital District. The restraining order says it was placed because BCBS willfully secured funds that did not belong to them, they engaged in slanderous activities, breached duty of care, and… Full Story

CareFlite Cut Prescription Spending by 40 Percent – Here’s How

CareFlite is used to saving lives in the most dire of situations, but the Grand Prairie nonprofit has also been saving on their healthcare spend. By focusing on prescription drugs, the company has saved hundreds of thousands each year on prescriptions alone. Prescriptions can represent 18 to 23 percent of total healthcare spending for companies, even though only a few years ago the took up only 10 percent of healthcare spending. In 2016, CareFlite spent $863,000 on prescriptions alone for its 660 employees. But three years ago, partially-insured CareFlite moved to an independent pharmacy benefit manager with the help of… Full Story

Holmes Murphy Grants $30,000 to Four North Texas Nonprofits

The Holmes Murphy Foundation Grant Program has selected its inaugural recipients, which selected area nonprofits that align with the foundations pillars of At-Risk Youth Education, Health and Human Services, and Arts and Culture. The foundation has cumulatively awarded $30,000 to the following organizations: Cristo Rey Dallas, Austin Street Center, Children’s Medical Center of Dallas, and Community Partners of Dallas for grants this year. “Holmes Murphy is incredibly honored to have the opportunity to give to four organizations that help uplift the Dallas community,” said Chris Boyd, Senior Vice President of Employee Benefits at Holmes Murphy via release. “This year’s recipients… Full Story

Father and Son Sentenced in Blue Cross Blue Shield and American Airlines Hearing Aid Fraud

A hearing aid scam targeting American Airlines employees has landed a father and son in federal prison for 15 years, AP reports. Prosecutors say the men made false claims on behalf of the airline employees for unneeded hearing aids that were sometimes never delivered, AP reports. Many of the fraudulent hearing tests lasted less than five minutes and were done in a break room at DFW International Airport. Terry Lynn Anderson, 69, was sentenced to eight years in prison and ordered to pay 13.7 million to Richardson-based Blue Cross Blue Shield of Texas. His son Rocky Freeland Anderson, 38, was sentenced to… Full Story

Expert: How Reference Pricing and Consumerism Reduce Healthcare Costs

Reference pricing leverages a shopping model with an allowance component to give employees an incentive for comparing providers for particular procedures by shifting any costs above a target price to the patient. It’s a consumerism approach that encourages employees to become informed about their healthcare especially with respect to costs.  The Employee Benefits Research Institute estimates industry-wide savings of $9.4 billion or 1.6% of total aggregate US healthcare spend, so it has the potential to lower healthcare costs for the country. Blue Cross Blue Shield developed the shopping model in 2011 for the California Public Employees Retirement System (CalPers) and… Full Story

UnitedHealth Brief: Hospitals Will Cost Payers $250 Billion Over the Next Decade

Healthcare is expected to cost the country $6 trillion by 2027, an increase from $3.5 trillion in 2017, according to the Centers for Medicare & Medicaid Services – but it can be difficult to pinpoint the source of the swelling. Hospitals complain about low reimbursement rates from insurance companies while insurance companies point to rising hospital costs. Consumer behavior and social determinants of health are huge factors that are even more difficult to address. The most troubling piece of the puzzle is that despite the cost increases, overall quality in the United States (and Texas in particular) have not risen… Full Story

Would an Anthem-HCSC Merger Impact North Texas?

With the departure of two top leaders at Illinois-based Health Care Services Corporation, which owns Blue Cross Blue Shield of Texas, some have speculated about a merger between Anthem, which operates BCBS programs in New York, California, and other states, and HCSC. “We live in interesting times and conventional strategy and timid tactics have gone by the wayside,”writes Britt Berrett, former President of Texas Health Presbyterian Hospital Dallas and current UT Dallas professor. “The future will be filled with bold and innovative ideas. HCSC will most definitely pursue a more aggressive and innovative path and Anthem may be part of their… Full Story

CEO Perspective: How Self-Insurance Slashed Our Healthcare Spending

By self-insuring our healthcare benefits, our small company is able to save 20 to 30 percent annually on healthcare costs. Our firm consists of 63 employees, most of whom rely on us for their healthcare insurance. Outside of payroll expense, healthcare insurance was our second largest expense as a company. From 2014 to 2018, our health insurance premiums increased 67 percent (or 17 percent on average per year).  The cost of our single employee’s PPO election increased from $380 to $805 per month and our High Deductible Plan increased from $409 to $627 per month.  The only reason the high… Full Story