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Healthcare

Texas Health Resources Agrees To HMO Marketplace Contract With Blue Cross Blue Shield Of Texas

Blue Cross Blue Shield of Texas has announced that it’s reached an agreement with Texas Health Resources to make its two-dozen hospitals in-network for consumers who purchased a Blue Advantage HMO plan off the marketplace.
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Blue Cross Blue Shield of Texas has announced that it’s reached an agreement with Texas Health Resources to make its 25 hospitals in-network for consumers who purchased a Blue Advantage HMO plan on the marketplace.

Included in the deal are all of Texas Health Resources’ hospitals and outpatient clinics as well as all the practitioners enrolled in the Texas Health Physicians Group, the companies say. This is the only way Obamacare shoppers can find THR facilities in the Affordable Care Act marketplace plans. In prepared statements, Texas Health Resources CEO Barclay Berdan said the inclusion in the HMO plan would broaden the network and provide care coordination to a new population.

“The plan puts the coordination of a patient’s care in the hands of a primary care physician, who manages care, to see that each person gets the right care they need and coordinates with other providers in the network,” he said. “The aim is to provide people with the right care, at the right time, in the right place, by the right caregiver. We think this will improve the reliability, affordability, and quality of care North Texans receive.”

Blue Cross Blue Shield of Texas, the state’s largest insurer, offers about a dozen Blue Advantage marketplace plans. Their deductibles range from $500 (the gold plans) to $6,750 (the bronze plans). The silver plans, the most popular, carry deductibles of $3,500. Premiums—before any possible federal subsidies—are between $200 and $400 a month, though those can drop by hundreds of dollars depending on income once the discounts are taken into account.

As it goes in an HMO, the primary care physician will steer the patient to specialists or other providers from a network chosen by the insurer. Blue Cross Blue Shield took a $400 million hit during the last enrollment period, paying out that much more than it took in for premiums. So this time around, the company cut its PPO offerings, which included a broader network of providers that the patient could choose.

Some major North Texas providers were left on the sidelines, including Baylor Scott & White Health and UT Southwestern. Texas Health Resources will only be available via these Advantage plans. Outside of Presbyterian Dallas, the plan will not at this time include either of UT Southwestern’s hospitals despite the plan to link them with Presby in a joint operating agreement, said UTSW spokeswoman Lori Stahl. That decision was announced in October as part of the two’s forthcoming alliance, known as Southwestern Health Resources.

Zale Lipshy University Hospital, William P. Clements Jr. University Hospital, and Texas Health Presbyterian Dallas will be operated under a single management structure. Texas Health and Blue Cross Blue Shield of Texas have a history of partnerships. The two organizations launched an accountable care organization in 2013 that became one of the nation’s earliest and largest value-based care initiatives.

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