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Blue Cross and Blue Shield and Texas Health Resources Implement Innovative Reforms to Improve Quality of Care and Reduce Costs

Jan. 14, 2013

New Agreement Creates one of the Largest Commercial ACOs in the Nation.

Richardson and Arlington, TX — Blue Cross and Blue Shield of Texas (BCBSTX) and Texas Health Resources (Texas Health) announced today a new strategic alliance to deliver improved, sustainable patient care and help manage costs through Texas Health’s Accountable Care Organization (ACO). This ACO will be one of the largest of its kind in the nation, available to patients served by the 25 hospitals of Texas Health, which is one of the largest faith-based, nonprofit health systems in the United States, with more than 5,500 physicians with active staff privileges.

The new ACO will include healthcare providers who have realigned their focus from volume of services to the value of services and will advance the future of health care by transforming the way physicians coordinate and deliver patient care. The new enhanced delivery system is designed to improve patient health and reduce unnecessary hospital admissions, readmissions, ER visits and duplication of services for patients with chronic diseases, leading to lower cost trends.

"By innovatively collaborating with Texas Health, this new ACO will help improve the quality of care and lower the cost of medical care for BCBSTX members and Texas Health patients, ultimately providing better value and improved outcomes for our members," said Bert Marshall, President, Blue Cross and Blue Shield of Texas. "This alliance is an extension of BCBSTX’s commitment to enabling innovative, value-based care delivery models such as Extended Medical Home, Intensive Medical Home and Bridges to Excellence, all of which are designed to reward physicians for managing costs and quality of whole patient care and moving from the traditional fee-for-service approach to a fee-for-value payment model."

"This agreement to establish an ACO is another example of the innovative approaches that we believe will lead to truly effective healthcare reform," said Doug Hawthorne, CEO of Texas Health Resources. "Texas Health has been advancing the concept of putting more emphasis on keeping people healthy and out of the hospital and developing new programs like this ACO to help employers keep their employees healthy. By creating this ACO, Texas Health is delivering on our promise to collaborate with physicians, payers, employers and other health systems to align the efforts of all of us around what is best for the patient across the entire continuum of care."

This new model of health care delivery is designed to improve outcomes in three key categories: quality of care, patient experience and satisfaction, and cost efficiency. It will reach those goals by pursuing the following strategies:

  • Early identification of disease and illness through effective management and coordination of patient care
  • IUse of advanced technology and support services to make more informed decisions and facilitate the patient and provider relationship and transitions in care
  • Implementing an alternative or non-fee-for-service payment arrangement
  • Lowering cost trends by coordination among payers and providers, without limiting medically necessary services in order to enable the delivery of more affordable health care products.

"Our agreement is a game changer. We will move reimbursement from fee for service to fee for value," says Dr. Eduardo Sanchez, vice president and chief medical officer, BCBSTX. "In addition, we will better harness clinical data to drive medical care decision-making, enhance patient safety, and improve quality of care - all in the name of better health and better outcomes for patients."

The new alliance extends a previous agreement that allows more than 1.6 million Blue Cross members access to in-network health care services at Texas Health's 25 hospitals and 18 outpatient facilities in the North Texas area. The ACO will be available to the general and commercial (fully insured /self-funded) populations, and other populations in Collin, Dallas, Denton, Ellis, Erath, Grayson, Hood, Johnson, Kaufman, Parker, Rockwall and Tarrant counties.


About Texas Health Resources
Texas Health Resources is one of the largest faith-based, nonprofit health systems in the United States. The health system includes 25 acute care and short-stay hospitals that are owned, operated, joint-ventured or affiliated with Texas Health Resources. It includes the Texas Health Presbyterian, Texas Health Arlington Memorial and Texas Health Harris Methodist hospitals, Huguley Memorial Medical Center, Texas Health Physicians Group, outpatient facilities, behavioral health and home health, preventive and fitness services, and an organization for medical research and education.

For more information about Texas Health Resources, call 1-877-THR-WELL, or visit www.texashealth.org .


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