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She added that a “one-size-fits-all ap-


proach to health care is suffocating the states.”


Lt. Gov. David Dewhurst, also a sup- porter of the legislation, said at the time that “Texas’ innovative new health care initiatives will allow doctors and hospi- tals to work together, improving medical outcomes and reducing health care costs for both patients and taxpayers.” Ultimately, the legislature found that


licensed collaboratives “will increase pro-competitive effects as the ability to compete on the basis of quality of care will overcome any anti-competitive ef- fects.” However, lawmakers added that they do not sanction violations of federal antitrust laws. Ultimately, Texas authorized the an-


titrust exemption, taking shelter under the “state action doctrine.” Created by a U.S. Supreme Court decision, the legal standard essentially immunizes states and private participants from federal antitrust liability when they choose to regulate conduct that could be consid- ered anti-competitive under federal stan- dards, so long as states actively monitor the activity.


Indeed, TDI officials say HCCs must demonstrate compliance on an ongoing basis or face sanctions, including losing their license. Renewals occur annually, “and the law is explicit that the annual review has to have as much input and oversight as the initial review, so compli- ance monitoring will be fairly consistent year-round,” Mr. Hunt said. Dr. Lockhart acknowledges that the


bar may appear high, but not unreason- ably so. Compared with the federal ACO op-


tion, active state oversight not only gives physicians peace of mind that any col- laborative they join will not run afoul of antitrust law, he says, but also assures patients that their best interests are pri- ority and the exemptions are not abused for other gains. Mr. Spangler added that the reserve


requirements are a “lesson learned” from the earlier failures of many independent practice associations in the 1990s. Those collaborative-type organizations went bankrupt without a safety net, leaving patients without care and physicians without pay.


If new health care collaboratives “are going to take on performance risk, we want to be sure they can sustain any po- tential losses and that they are well man- aged. If they don’t take on risk, and they are looking to gain savings from other efficiencies, the financial requirements are lower. But this was the legislative compromise that was struck for the state to give HCCs protection from antitrust laws and other exceptions to market- place conduct rules,” Mr. Spangler said. TDI officials stressed that pursuing HCC licensure is an option, not a man- date. For those that do, officials scale the review process to the size and complex- ity of the organization. And those that win licensure will benefit from signifi- cant protections. In all, the rules provide what officials say is a middle ground that holds all


players accountable, while leaving the door open for innovation. “All of it is geared towards making


sure [patient] members in these collab- oratives have the opportunity to get the care they need, and to get quality care,” Ms. Diaz-Lara said. “And if we can im- prove quality and get patients care faster and better, we may not need as much of it.”


Blues launch campaign to reach uninsured, promote insurance exchange


Blue Cross and Blue Shield of Texas (BCBSTX) kicked off a statewide cam- paign in March geared toward getting uninsured Texans coverage through the online health insurance marketplace created by the Patient Protection and Af- fordable Care Act (PPACA). Enrollment in health plans offered


through the exchange is set to open Oct. 1, with coverage starting Jan. 1, 2014. The federal government will run the in- surance exchange in Texas, as state lead- ers disenchanted with the federal health reform law rebuffed the option of creat- ing a state-based program. The Blues’ “Be Covered” campaign aims to educate the uninsured about their options under the federal health care reform law.


The health plan set up a website,


Genetics to Genomics: The Future and Beyond!


June 22 Dallas June 29 Austin July 13 San Antonio


Register for the 2013 Genetics Conference: www.GeneticsConferences2013.com 512-474-2166 or


workshop@cardeaservices.org Sponsored by the Texas Department of State Health Services and Cardea 28 TEXAS MEDICINE June 2013


www.becoveredtexas.org, with informa- tion on key components of the legisla- tion and steps patients can take to evalu- ate plan options and take advantage of applicable tax credits and subsidies to purchase coverage.


BCBSTX pledged to participate in


the exchange, and company leaders acknowledged that the health plan stands to benefit from the campaign. But regardless where patients turn for coverage, “our goal is to make sure as many Texans as possible have access to health insurance,” said Dan McCoy, MD,


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