5 Things Texas: Tenant & BPCI, Carrie de Moor, Medicaid & CHIP

There are 23 days until election day.  And, 96 days until the start of the legislative session.  Just think about how many questions about the future of our politics, of our country, and of Texas will be answered between now and then. And, that’ll be just the beginning.

Until then, here are 5 Things We’re Watching in Texas health care and health policy for the month of October.

DJ 5 Things SignatureWith help from Marjie High
and Emily Boerger.

 

 

1.  Creating places for constructive disagreement in health care

Regardless of what you thought about the outcome of the last few weeks’ Supreme Court hearings, it’s fair to say we’ve gone through an ugly time in our national politics.  Tom Friedman argues “We’ve moved from ‘partisanship,’ which still allowed for political compromises in the end, ‘to tribalism,’ which does not.”

Luckily, for the most part, Texas politics has stayed more respectable and reasonable than the national discourse.  That’s a credit to elected, civic, and media leaders, across the political spectrum.  But moving forward, it’s clear things are getting worse, not better.  So, creating spaces for constructive disagreement, where we leave the engagement with a better understanding of one another, is something we must do with intention.  If we don’t create those spaces, they won’t happen on their own.

2.  Baylor Scott & White Health, Memorial Hermann Health System set to combine

Baylor Scott & White Health and Memorial Hermann Health System have signed a letter of intent to merge into a combined system. Two of the largest non-profit health systems in Texas, the merger will result in one of the nation’s biggest health systemsoverall.

Leadership contends the merger is focused creating a “model for integrated, consumer-centric, and cost-effective care.” However, as large mergers increase in the industry, it’s increasingly common that the market leverage created from consolidation actually results in the opposite outcome.


 

3. HHSC report on Medicaid and CHIP managed care programs

Texas HHSC recently published a review of its Medicaid and Children’s Health Insurance Program managed care contracts requested by the legislature in 2017. The report comes on the heals of a series of special hearings by HHSC called by Rep. Richard Raymond after the Dallas Morning News published “Pain&Profit”, an expose criticizing Medicaid managed care for cutting corners to save costs.

The report assessed the performance of the current delivery system, contract review and oversight, rate setting processes, and MCO administrative costs. Some key recommendations include further MCO incentives to develop more value-based payment models, increasing transparency with more required disclosures, modifying reporting requirements to ease administrative burden, and auto-enrolling participants to strengthen the risk pool.

 

4.  Video: Carrie de Moor, Code 3 Emergency Partners

Dr. Carrie de Moor is the CEO of Code 3 Emergency Partners. Based in Frisco, TX, Code 3 owns and operates Freestanding Emergency Rooms and Urgent Care facilities in 7 locations around the state. She joins us in this edition of “What They’re Watching” to discuss holding insurance companies accountable.

“What I’m going to be watching for is who’s holding the insurance companies and the MCOs accountable for what they’re doing and how they’re administering benefit plans. I think that’s important for all employers to watch, and emergency care plays a big role in that because we have an unfunded mandate with EMTALA [Emergency Medical Treatment and Labor Act]. We have to see all people. So with that there’s a lot of room for things to go wrong where they think they can take advantage of us instead of contracting fairly.”

5. Tenant Hospitals joins CMS bundled-payment cost saving initiative

Tenant Hospitals, is joining CMS’s new Bundled Payments for Care Improvement Advanced (BPCI Advance) program designed to encouraging efficiency and care coordination by bundling payments for “episodes” of care.  BPCI Advanced builds on the original BPCI program, but BPCI eliminated downside risk and included incentive bonuses to attract participants which ultimately cost CMS $285 million according to a recently released evaluation.

The Advance program re-incorporates downside risk, penalizing participants up to 20 percent of cost overages rather than creating incentives for savings. The move comes as Tenant continues efforts to reduce costs after still sluggish second quarter earnings in wake of lay-offs and restructuring earlier this year.