Parkland Names Executive Director of Its Community Health Plan

Parkland has named John W. Wendling as its Executive Director of the Parkland Community Health Plan, which is Parkland’s Medicaid Managed Care Organization. According to a release, Wendling has experience in managed care, the integration of services, accountable care organization development, and patient-centered medical home models. Parkland’s Community Health Plan started in 1999 as an effort to provide insurance services for children, teens, pregnant women and adults. The programs cover doctor visits, checkups, immunizations, and more. There are more than 3,000 doctors and 25 hospitals in network, which include Parkland and Children’s Medical Center. Wendling has 30 years of experience… Full Story

How Are Hospitals Posting Their Prices, and Is It Helpful?

The Public Health Act was enacted as part of the Affordable Care Act, which requires hospitals to make a public list of the hospital’s standard charges starting this year, but the posted price doesn’t tell the full story. Insurance, a person’s health, and the negotiated rate between insurers and providers complicates the out-of-pocket payment, the posted prices might not mean much to the average consumer. President and CEO of the DFW Hospital Council W. Stephen Love says the council’s member hospitals support transparency, but warn to proceed with caution. “We support transparency and want people to make informed decisions,” he says.… Full Story

When Your Insurance Company Can Predict Your Illness

Imagine getting a notification telling you to refill your emergency asthma inhaler because a dust storm is on its way to your area, preventing a visit to the emergency room. Or a robot in a nursing home that can interact with lonely patients and put a call in to the nursing station if something seems off. How about if a health insurer knew which patients did not have a vehicle and partnered with a ride share company to provide transportation to an appointment? These are just some of the ways in which NTT Data Services is using artificial intelligence, big… Full Story

Tenet and Cigna Reach an Agreement After 11 Months of Negotiations

Dallas-based Tenet Healthcare has reached a multi-year agreement with insurer Cigna, according to a statement on Cigna’s “Save Our Healthcare” website. It says “Cigna commercial customers will have uninterrupted, in-network access to Tenet Healthcare facilities and affiliated providers.” Tenet facilities will remain in-network for Cigna customers as well as Medicare patients insured by a Cigna-HealthSpring Medicare Advantage plan. Healthcare Finance reports that Cigna customers would have lost in-network access to Tenet facilities if an agreement had not been reached by the beginning of 2019, and that the 11-month negotiation was over payment rates. Ron Rittenmeyer, Tenet’s Executive Chairman and Chief… Full Story

Hospitals Now Have to Post Their Prices, But is That a Good Thing?

A federal law that requires hospitals to post their prices went into effect yesterday, moving toward the transparency that consumers are likely to say they desire. But the complicated system of who pays for healthcare may lead to more confusion. The new law requires hospitals to post their price for standard charges, but because insurance companies negotiate with providers on the price they will pay for an operation, many say the “price” that is posted will be meaningless. In addition, each consumer’s insurance plan will impact what the person actually pays for a procedure. In addition, patient health can cause… Full Story

Just How Much Does a Knee Replacement Cost in North Texas?

One of healthcare’s greatest challenges is determining exactly how much an operation is going to cost. While a patient’s unique body and medical history can make it difficult for providers to predict the exact price, consumers are applying pressure to make healthcare more like retail, with open and transparent pricing. We acquired some research from healthcare consultants Holmes Murphy about how different hospital systems price for a major joint replacement. According to Holmes Murphy, $40 billion is spent in Dallas-Fort Worth every year on healthcare. In order to combat costs, they were employed by regional municipalities to form the North… Full Story

Judge Dismisses Blue Cross Lawsuit Over Low Reimbursement Rates

A federal judge has dismissed a lawsuit against Blue Cross Blue Shield of Texas by 49 physician groups that claim the insurer is not paying enough for emergency medical care. The groups argue the there are 250,000 claims where Blue Cross’ reimbursement rate for out-of-network providers violates Texas insurance laws and regulations. In an emergency, patients are brought to the nearest hospital, which might not always be in network. “As out-of-network providers, the Provider Entities are not contractually bound to accept discounted rates of payment for the emergency medical services they provide to BCBSTX Members and instead expect to receive… Full Story

Catalyst and UnitedHealthcare’s ACO Saved $28 million Over the Last Two Years

Catalyst Health Network and UnitedHealthcare’s accountable care organization knocked $28 million off of North Texas healthcare costs over the last two years for UnitedHealthcare’s 78,000 plan participants. The ACO was established in 2015 with a goal of changing the way providers are reimbursed. The organization is moving away from the traditional fee-for-service model and into a system where providers are paid based on results and patient satisfaction. The savings have come from catching disease early through screenings, keeping referrals in-network, reducing emergency room visits, and more. In the last year, the ACO saw ER visits decrease by 4 percent, in-network… Full Story

Dr. Paul Hain promoted to Chief Medical Officer of Blue Cross Blue Shield of Texas

Dr. Paul Hain has been promoted to be Chief Medical Officer and divisional senior vice president market delivery for Blue Cross Blue Shield of Texas after previously serving as president of North Texas Market Strategy for the insurer. Hain is no stranger to D CEO Healthcare, and isn’t afraid to ruffle feathers. He speaks at medical conferences and panel discussions all over the region, and has spoken passionately about why medical costs are the way they are. In his new position, he will oversee public relations, community investments, government relations, and lobbying efforts. His other roles will include executive sponsor… Full Story

Report: Texas Hospitals are Becoming Less Profitable

Hospital profits have been on the rise for years, but 2017 saw dividends down for healthcare providers in Texas, according the the Texas Health Market Review. Fewer insured individuals and HMOs that lost money were partly to blame for the losses. Allan Baumgarten has been publishing the reviews since 1998, analyzing hospital systems and insurers across Texas and other states. He looks at the impact of the Affordable Care Act and other factors that contribute to the direction of the market. He noted that young people are less likely to care about a relationship with a physician than in past… Full Story