A New Old Model That Could Change How Employees Receive Primary Care

Is it possible to get quality primary care without worrying about deductibles, copays, or dealing with the insurance company? An old model is being revamped to simplify primary care and change the incentives. In the fee-for-service model where many primary care physicians are owned by large hospital systems, the incentives for the doctors may be skewed away from patient care and cost. More tests, procedures, and appointments mean more revenue for the doctor or hospital system, and if they are part of a large system, physicians have added pressure to refer their patients to specialists and surgeons in that network,… Full Story

AARP, Business, and Insurer Groups Join Fight to Fix Surprise Medical Bills

Texas advocacy, business, insurer, and public policy groups are teaming up to help fix surprise medical bills. These bills, also known as balance billing, often occur in emergency situations when a patient visits an emergency room and is unable to choose all the doctors they see, resulting in out-of-network care even for an in-network hospital. The resulting bill can be much larger than expected, and there have been moves made in the Texas Legislature to create a mediation system that helps providers and health plans to come together and figure out a fair payment. Despite the current mediation process, which… Full Story

How Much Money Are North Texas Health Plans Making?

The latest version of Allan Baumgarten’s Texas Health Market Review came out this year, revealing enrollment, profit, and marketshare for Texas’ Health Plans for 2017. Some plans appear to be raking in the cash, while others are losing millions of dollars. First, let’s look at what the review says about insured rates in Texas, which has the greatest percentage of uninsured people in the nation. According to the report, Texas’ uninsured rate decreased from 21.9 percent in 2013 to 17.3 percent in 2017, though it ticked up from 16.9 percent since 2015. Texas is one of 14 states that hasn’t adopted… Full Story

Expert Opinion: Simplifying Health Plans and Controlling Costs

The year was 2003, and a Fortune 500 company in Austin was looking to be the first employer with over 10,000 covered employees to launch a consumer driven health plan (CDHP). The savings the company realized from the federally mandated high deductibles would be redistributed in the form of Health Savings Account (HSA) dollars, so employees and their dependents could be better stewards of their own money. Coming out of an HMO era with low copays, the promise was that healthcare consumers needed “skin in the game” to impact the rising cost of healthcare.  As famed economist Milton Friedman’s once… Full Story

Southwestern Health Resources Network is No. 1 in the U.S.

The Centers for Medicare & Medicaid Services gave the local Southwestern Health Resources Accountable Care Network a quality score of 100 percent after saving $30 million in 2017. The savings made it the top organization in CMS’ Next Generation Accountable Care Organization model. All 44 ACOs participating in CMS’ most high-risk model saved around $208 million in gross savings according to data from CMS. SHR is a joint effort from Texas Health Resources and UT Southwestern Medical Center whose network includes 30 hospitals and 4,000 physicians. The accountable care network manages nearly 69,000 Medicare beneficiaries in the region, and as CMS… Full Story

Blue Cross Insurance Data Reveals Texas’ Freestanding Emergency Department Charges

New research shows what many have already discovered: freestanding emergency departments may charge more than urgent care centers to fewer patients who have similar conditions. The study looked at three urgent care centers that were converted to FSEDs in Texas using insurance claims from Blue Cross Blue Shield of Texas, based in Richardson. They show that patient volume went down between 29.5 and 94.8 percent, but reimbursement per patient increased between 970 and 1,369 percent. The study showed no significant difference in the age, gender, or conditions of patients managed by both the UCCs and FSEDs. Researchers did find a… Full Story

Market vs. Government: Two Ways Inevitable Recession May Change Healthcare

The United States spends 3.7 trillion dollars a year on healthcare, more than all but three nations’ entire gross national product. UT Dallas and UT Southwestern professor John McCracken, speaking at the North Dallas Chamber of Commerce’s Healthcare Conference, says that economic recession could be what forces the U.S. to change its healthcare spending habits. McCracken noted that the U.S. debt is 108 percent of its gross national product, and with the unfunded pension liabilities, it creates a precarious situation for the economy where a recession could force a massive change. “Time is running out, and there is  potential for… Full Story

Holmes Murphy Looks to Expand to Houston and Central Texas With Healthcare Exec

Holmes Murphy will be expanding its reach to Houston and Central Texas with the addition of Vice President and Market Leader for South and Central Texas, Employee Benefits, Travis Brashear. The Dallas-based firm hopes to expand its employee benefits division into the new regions with the hire. Brashear has 22 years of experience in benefits, and arrived in Texas in 2004 as the Market Leader for the South and Central Texas and Louisiana divisions of CIGNA HealthCare. While there, the lawyer helped developed one of the first accredited accountable care organizations. After that, he consulted as practice leader for Willis Towers… Full Story

Tenet and Humana Reach Agreement as Tenet Plans to Offshore More Than 1,000 Jobs

Dallas-based Tenet Healthcare Corporation and Humana Inc. signed a multi-year agreement to ensure Humana members will have in-network access to Tenet providers. The contract runs through May 2023. The deal follows a similar agreement between Tenet and Cigna signed shortly after the new year that followed months of negotiations. Founded in 1961 as a nursing home facility, Humana now has over 16 million medical plan members nationwide and had over $53 billion in revenue in 2017. The company also has 3.5 million Medicare Advantage members, 5 million Medicare prescription drug members. Tenet Healthcare operates 68 hospitals with 20,000 licensed beds, 21… Full Story

Community Organizations Awarded $1.8 Million from BCBS of Texas

Blue Cross Blue Shield of Texas has awarded $1.8 Million to community based organizations to fight and and manage chronic kidney disease and chronic obstructive pulmonary disease. Richardson-based BCBS of Texas has awarded more than $10 million Healthy Kids, Healthy Families grants to focus on the two diseases. The two diseases often go hand in hand, and research has shown that COPD increases the risk of mortality for patients with CKD by 41 percent, especially among women and children. “We launched this strategy understanding that this was an opportunity to impact two chronic diseases that are impacting the lives of… Full Story