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

Battling the Sickest ZIP Code in Dallas

A study performed by the Dallas-Fort Worth Hospital Council found that 75216 in southern Dallas is the unhealthiest ZIP code in the city. In an effort to address social factors that determine a majority of health outcomes in any community, the council looked a number of chronic diseases such as asthma, obesity, heart disease and depression, and found that area has the highest rate of nearly every disease that was measured. The analysis was done in order to help organizations such as the American Heart Association target certain areas with their health outreach, which was discussed during Dallas Startup Week… 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

Autonomous Vehicles and Drones May Help Address Rural Healthcare Disparities

Autonomous vehicles, drones, and tele-enabled ambulance services are being considered to address rural health disparities by a partnership between Blue Cross and Blue Shield of Texas and Texas A&M Health Science Center. The joint project will research innovative care delivery strategies and other rural health issues. BCBS of Texas is contributing $10 million to the Health Science Center as a part of the Affordability Cures program to reduce healthcare costs, address health disparities and improve social determinants of health. Projects will look at engaging vulnerabilities and improving access to healthcare, which will include the use of autonomous vehicles, drones, and… 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

Lawsuit Forces Blue Cross Blue Shield of Texas to Pay $75,000 to Deaf Applicant

A federal judge signed a decree requiring Richardson-based Blue Cross Blue Shield of Texas to pay a deaf woman $75,000 and other relief for violating the Americans with Disabilities Act, as first reported in the Dallas Morning News. The U.S. Equal Employment Opportunity Commission announced the results of its lawsuit against BCBS of Texas this week. According to the lawsuit, a deaf woman named Sheryl Meador applied online to be a claims examiner, and was asked to complete an assessment with an audio portion. The assessment did not have accommodations for hearing-impaired applicants, and Meador was unable to complete it. The… Full Story

Blue Cross Blue Shield of Texas Parent Company More Than Tripled Profits to $4.1B in 2018

Health Care Services Corporation, the parent company for Blue Cross Blue Shield of Texas, did not pay federal taxes in 2018 and netted $4.1 billion, receiving a $1.7 billion tax refund last year, according to financial statements. In 2017, the company had a net income of $1.3 billion, an increase of over 315 percent for this year. The tax overhaul passed by Congress and increasing profitability of health insurance played a large role in the increase, according to Axios. Profits don’t include fees from self-insured employers pay to HCSC, and the Affordable Care Act Marketplace was a big winner for HCSC.… Full Story

The Do’s and Don’ts of Corporate Wellness

Leadership buy-in, authentic employee participation, and building a culture of health are all keys to successful corporate wellness, benefitting the a company’s bottom line as well the health of its employees. These points and more were discussed earlier this month at the North Texas Corporate Wellness Forum organized by the American Cancer Society. The forum consisted of Becky Hall, Senior Manager of Health and Welfare Benefits and Wellness Programs at Oncor Electric Delivery, Dr. Paul Hain, Chief Medical Officer and Divisional Senior Vice President of Market Delivery at Blue Cross Blue Shield of Texas, and Levin Gunter, Lead Benefits Consultant at… Full Story

Blue Cross Teaming Up With 11 Texas Institutions to Address Healthcare Costs

Richardson-based Blue Cross and Blue Shield of Texas will be teaming up with 11 universities to address the root causes of high cost of health care. The research institutions and insurer will be working on projects that focus on behavioral health, vaccine adherence, and analyzing usage data to improve efficiency.  The collaboration is part of Blue Cross’ Affordability Cures initiative, and hopes to address care delivery, unequal distribution, and waste in the system. “Failure to address access and affordability of health care has real consequences. We need to challenge the status quo by bringing transformative research and ideas to the table,”… 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