In Texas, that remains to be seen. Based on the state’s past experience,
“we know a general standard doesn’t work,” which is why lawmakers inter- vened in the first place to command new, more specific rules, Mr. Spangler says. “The legislature told TDI what to do. Now it’s the department’s job to fig- ure out how to do it.” TDI contends the current rules repre- sent a “high standard” and its “best ef- forts to protect consumers and meet leg- islative mandates within the confines of TDI’s authority,” the biennial report says. “Still, the approach arguably represents a ‘slippery slope’ of governmental interven- tion in contractual relationships between private parties. Accordingly, TDI’s rule on network adequacy will not be fully implemented until after the Texas Legis- lature adjourns to allow the only entity with policymaking authority over all par- ties to provide additional guidance.” Dr. Hinchey agrees the department does not have the authority to get in the middle of physician-insurer negotiations. “But that’s not what these rules are about. And they [insurance regulators] do have the authority to make sure that if health plans are going to sell these products, they have an adequate network in place.”
talks of jointly establishing an ACO. In December, the multispecialty group practice Kelsey Seybold Clinic in Hous- ton received ACO accreditation by the National Committee for Quality Assur- ance.
In some ways, Scott & White already operated like an ACO, the system’s medical director for innovation W. Roy Smythe, MD, says. “We felt like we were good at integrated care. But we also felt we had to get better at continuity of care, and this would give us a structured pro- gram and a very good partner to work with to provide better access to more patients.”
The CMS approval means the Well
Network can participate in Medicare’s Shared Savings Program and keep a por- tion of any savings it generates by meet- ing established quality and cost targets. Dr. Smythe says the network will
focus largely on transitions of care and end-of-life care — two areas that drive a large portion of Medicare costs — using initiatives to better integrate electronic medical records, implement pharmaco- logical counseling, and enhance postdis- charge follow-up. Texas Health Resources says its new
Scott & White forms Medicare ACO
More accountable care organizations (ACO) are dotting the Texas health care landscape. Temple-based Scott & White Clinic became the latest health system to im- plement the model to help its Medicare patients get more coordinated, efficient care. The partnership with Walgreens pharmacies, now called the Scott & White Walgreens Well Network, was one of 106 new ACOs approved by the Cen- ters for Medicare & Medicaid Services (CMS) in January. A North Texas hospital system, Texas Health Resources, and Blue Cross and Blue Shield of Texas also announced
ACO model will focus on three key areas: quality of care, patient experience and satisfaction, and cost efficiency. Some of the strategies include early identifi- cation of disease and illness; use of ad- vanced technology; implementation of alternative payment arrangements; and reduced cost trends. BCBSTX Chief Medical Officer Eduar- do Sanchez, MD, said the alliance means a move from payment for fee-for-service “to fee-for-value” and better use of clini- cal data to drive medical care decision making. The ACO trend is a clear indicator
of where health care delivery is headed, and it comes with significant invest- ments, Dr. Smythe says. “Provider organizations have begun to understand that the old model of only providing excellent acute care is not good enough. Health care is interven- ing so patients don’t have to get acute care. It’s not easy, but it’s where the ball should be moving.”
Study: PPACA delivers raises to Texas primary care physicians
Texas is among more than a dozen states that will see Medicaid primary care rates rise by more than 50 percent under fed- eral health care reform provisions sched- uled for this year, according to a recent study by the Kaiser Commission on Med- icaid and the Uninsured (
www.kff.org/ medicaid/
8398.cfm). The Patient Protection and Afford-
able Care Act (PPACA) increased Med- icaid payments to certain primary care physicians — pediatricians, family phy- sicians, general internists, and related subspecialists — to Medicare parity for evaluation and management and vac-
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March 2013 TEXAS MEDICINE 25
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