Bringing the Free Market to Dallas Healthcare

At the Free Market Medical Association conference earlier this spring, Johns Hopkins surgeon Dr. Martin Makary showed the crowd a chart about how prices for different items has changed since 1998. Housing, childcare, and wages were up significantly, while cars and clothing had remained mostly static. Toys, televisions, and cell phone service were much lower than 20 years ago. But the items with the largest jumps, around 200 percent more expensive than 20 years ago, are hospital services and college tuition. Makary, best-selling author of The Price We Pay about how employers and families can lower healthcare costs, went on to… Full Story

Join Us for D CEO’s Value-Based Care Healthcare Breakfast Panel

In many of today’s medical practices, patients and their insurers pay for the procedures and time spent treating their illness, regardless of the outcome. Whether or not the patient needed that blood test, brain scan, or knee scope, they are paying for it directly or indirectly. While it would be bad business to intentionally stack up unnecessary charges, even the most well-meaning providers are incentivized to provide more medical treatment than is actually necessary because of the fee-for-service model of healthcare. But with skyrocketing health costs adding pressure to the employers and taxpayers who pay for healthcare, new systems have… Full Story

“Providers Will Run Amok” – Dallas Does Too Many Surgeries

Half of all adults are impacted by musculoskeletal conditions, greater than the number of people impacted by chronic heart and lung conditions, according to the Centers for Disease Control. But because of mismanaged care, many of these injuries are costing patients, their employers, and taxpayers much more than they should. At a recent meeting of the Dallas-Fort Worth Business Group on Health, Dr. Scott Conard of Converging Health moderated a discussion about how to bring down MSK costs between Catalyst Health CEO Dr. Chris Crow, Vice President of Clinical Strategy at Airrosti Dr. Chris Cato, and Administration Services Manager for the… Full Story

Health Insurers To Pay Record Rebates After Individual Market Stabilizes

A new report from the Kaiser Family Foundation shows that insurers are more profitable than ever, and are expected to pay around $800 million in rebates to individual market consumers, a record since the passing of the Affordable Care Act. The insurers did not meet the ACA medical loss ration threshold, which requires 80 percent spending of premium revenues on healthcare claims or quality improvement activities. Though the early years of the ACA were often volatile and insurers reacted with increased premiums, by 2017 the individual market had stabilized, and premiums were expected to level out as well. But with… Full Story

How Much are Patients Paying to Deliver Babies in Dallas?

In the Dallas area, new moms will find a nearly $5000 range in price range to deliver their baby. As healthcare costs continue to rise, price transparency has become a key strategy for those trying to bring high prices and the stress they put on the system under control. Hospitals are now asked to post their prices online, but most are difficult to interpret and somewhat meaningless unless one knows how their insurance deductible and coinsurance will impact the final cost. The Robert Wood Johnson Foundation funded the Healthy Marketplace Index, where they analyzed negotiated rates between providers and insurance… Full Story

The ER Doc-Blue Cross Blue Shield Conflict is More Complicated Than It Seems

Emergency Department physicians being out of network is nothing new, but a new round of failed negotiations between a local emergency physician group and Blue Cross Blue Shield of Texas have both sides crying foul and pointing fingers. Blue Cross Blue Shield contacted members to describe how Texas Medicine Resources, a physician group hired by Texas Health Resources emergency rooms, has terminated its deal with BCBSTX, meaning the group is now out of network at 14 area hospitals for its Blue Choice PPO and Blue Essentials HMO members. A statement on BCBSTX’s “Stand With Texas” website calls the demands of the ER doctors “unreasonable,”… Full Story

The Potential Impact of Blue Cross Blue Shield’s Medical Centers

Last week, Blue Cross Blue Shield of Texas announced its entry into the provider space with 10 clinics opening near Dallas and Houston next year. The clinics will include primary care, urgent care, lab and diagnostic imaging services, care coordination, and wellness and disease management programs, and were framed as part of the insurer’s desire to advance value-based care in the medical space – but other providers see the clinics as direct competition. Value-based care is growing in popularity as the industry transitions away from fee-for service, where providers are paid based on the number of procedures or tests that… Full Story

Blue Cross Blue Shield Weighs in on Texas Affordable Care Act Ruling

Late last year, a Texas judge ruled the Affordable Care Act to be unconstitutional, but Blue Cross Blue Shield is siding with the act.  Because the tax on the individual mandate had been removed, Texas argued that the law is an unjust use of Congressional power. The Texas judge found the individual mandate to be an essential part of the ACA, so he ruled the entire act (not just the mandate), to be unconstitutional. If it wins on appeal, the ruling would remove coverage for millions of Americans who received insurance through the Medicare expansion and private insurance subsidies. The… Full Story

Can a Coalition of Local Cities Bring Price Transparency and Consistency to Healthcare?

Estimates say around $40 billion every year is spent on healthcare in Dallas-Fort Worth, and as prices continue to increase, all entities are looking for ways to bring down costs. A coalition of 30 cities and the greater DFW area came together in 2015 to form the North Texas Coalition to bring more transparency, sustainability, and predictability to the healthcare market. The coalition hopes to use strength in numbers to get bids directly from regional hospital systems for healthcare services. Some members of the coalition have seen dividends from this strategy. Fort Worth saved $19 million in healthcare spending in… Full Story

How Concentrated is the Texas Health Insurance Market?

According to data from the Government Accountability Office, the three largest private insurers held at least 80 percent of the large group health insurance market in 43 states. Overall, the three largest private health insurers held 80 percent of the employer market in 2015-2016, as first reported in Becker’s Health Review. Compiled from data submitted to the Centers of Medicare and Medicaid, the report reveals that Blue Cross Blue Shield parent company Health Care Services Corporation held 45.2 percent of the overall large group health insurance market in 2016, down from 49.2 percent in 2014. Texas’ three largest private insurers had… Full Story