The southwest's largest Blue Cross insurer is hoping to find value by working with independent physicians and the state medical association, as powerful health systems loom in the field of ACOs.
Blue Cross and Blue Shield of Texas, the second largest company in the Health Care Services Corporation BCBS family, is launching a new accountable care program with the Texas Medical Association.
BCBSTX and the Texas Medical Association describe the program, called TMA PracticeEdge. as a "first-of-its-kind joint effort" to "empower a strong base of independent physicians" through alternative payment models.
The TMA's membership includes some 48,000 Texas physicians, and more than 60 percent of the state's doctors are still independent. Among their peers in the southwest and nationally are waves of medical practices becoming a part of hospital systems, as doctors seek consistent pay and easier administrative burdens.
The TMA PracticeEdge program is aimed at bringing independent physicians a type of accountable care organization to join, as a way to adapt to the evolution in American healthcare and to reduce "growing data-entry burden" and free up time to spent with patients.
The program will offer consultations on reducing administrative burden, and help for practices to create care management teams focused on groups of patients with complex and chronic diseases.
"This represents a significant investment in our relationship with the TMA and Texas physicians, and will benefit our members, who value their relationships with their independent physicians," said Bert Marshall, president of BCBSTX.
Austin King, MD, president of the Texas Medical Association lauded BCBSTX as "the first health insurer to stand by independent Texas physicians in support of 21st century patient care."
Based in the north Dallas suburb of Richardson, BCBSTX is the state's largest insurer, covering about 20 percent of the population with 5 million members. When HCSC acquired BCBSTX in 1998, it became the second largest in what is now a family of five mutual Blue Cross insurers, led by the BCBS of Illinois.
BCBSTX contributes a significant chunk of HCSC's $22 billion in revenue, and despite challenges in the wake of the Great Recession, has also contributed to its net income of $684 million in 2013.
An AM Best's Rating report recently gave HCSC as a whole an A+ rating and a stable outlook, and noted that BCBSTX's operations have "significantly improved over the past few years with operating earnings growth in 2013, which is attributable to profitable premium growth and improved underwriting margins."
In the joint venture with the Texas Medical Association, BCBSTX is looking to create affordable and sustainable relationships with independent physicians, at a time when more and more Texas health systems are consolidating into large integrated networks of physicians, hospitals and clinics -- a trend also happening in many other regions, including HCSC's home base of Chicagoland.
"While most ACOs are constrained by a specific hospital system, TMA PracticeEdge will help connect physicians centered on the needs of their specific patients," BCBSTX and the TMA said in a release. "TMA PracticeEdge will offer participating physicians the means to provide coordinated collaborative care, including prevention and management of chronic disease."
If the TMA Practice Edge venture is successful in Texas, gaining traction by physicians and preventing the need for high-cost acute care, HCSC could apply a similar model elsewhere. The company could be well positioned to do so and even collaborate with other Chicago-based stakeholders, including the American Medical Association and Blue Cross Blue Shield Association.