Insurance & Benefits

The Potential Impact of Blue Cross Blue Shield’s Medical Centers

Last week, Blue Cross Blue Shield of Texas announced its entry into the provider space with 10 clinics opening near Dallas and Houston next year. The clinics will include primary care, urgent care, lab and diagnostic imaging services, care coordination, and wellness and disease management programs, and were framed as part of the insurer’s desire to advance value-based care in the medical space – but other providers see the clinics as direct competition.

Value-based care is growing in popularity as the industry transitions away from fee-for service, where providers are paid based on the number of procedures or tests that are performed. By focusing on value, providers are held accountable for the outcomes of their practice, which should lead to lower overall healthcare costs and reduce unnecessary medical care.

BCBSTX will be partnering with Sanitas USA, a branch of  the Spain-based provider that has several clinics in Florida, New Jersey, and Connecticut. The clinics will be in Irving, Las Colinas, Mesquite, and Richardson in Dallas County, and be exclusively for BCBSTX plan holders. “Our partnership with Sanitas is another example of collaborating with health care providers to deliver the best possible care and support to our members,” said Dan McCoy, M.D., president of BCBSTX via release. “We believe that this partnership will advance primary care services and is an effective approach to providing quality health care outcomes, improving member engagement and experience, and lowering costs for our members, including populations that may have difficulty accessing care.”

The healthcare industry is seeing segments expand into new territory in an attempt to consolidate marketshare and mitigate risk. BCBSTX is far from the first insurer to enter the provider marketplace. Optum, one of the largest physician groups in the country, is owned by UnitedHealthcare. Pharmacy behemoth CVS has opened clinics in their locations, and physicians are lobbying for a bill in the Texas legislature to be able to distribute common medications in their clinic. Employers have their own clinics and health systems have their own health plans.

But some area primary care providers in BCBSTX’s network don’t necessarily see the new clinics as something to be celebrated. Chris Crow is President of Catalyst Health Network, which is made up of independent primary care physicians who focus on value-based care. He says the new clinics are competing directly with physicians, and an intrusion into the provider space. “It’s a stay in your lane moment,” he says.

Crow is concerned that clinics that are owned by BCBSTX will receive better treatment than other offices. “The insurance company is choosing to directly compete with you, even though you contract with them to be in network. It might benefit those guys differently,” Crow says.

BCBSTX Chief Medical Officer Dr. Paul Hain, says locations for the clinics were chosen based on their analysis of areas where their members were having trouble accessing primary care and aren’t meant as competition. “We looked at where we are hearing about our members getting access in a timely manner. The reality is that we are always short of primary care doctors in Texas,” he says. “This is not an attempt to compete; it was an addition that was carefully thought out.”

The impending shortage of primary care doctors has been well documented, though the greatest shortages have been in rural and small town communities. When I searched primary care physicians through the BCBSTX Find a Doctor site, 40 family practice, internal medicine, and pediatric physicians were found in ZIP code 75038, which surrounds North Lake College in Las Colinas, one of the areas for a future Sanitas/BCBSTX clinic.

Crow wonders why BCBSTX didn’t decide to partner with a local primary care provider rather than an international company. “You would have wish they would have partnered with someone local,” he says. “None of them (local providers) received calls or were notified until two weeks before the announcement.”

Hain says that Sanitas was chosen because of their experience with value-based care in other states. While many local providers have some level of value-based care, Hain says they wanted to “move fast as possible to full value-based arrangement, with upside and downside risk on patients.” Sanitas was ready to deliver with that model, where they would be held accountable if they didn’t meet certain quality and cost standards.

While the Sanitas clinics will provide primary care for patients, they will only be in network for BCBSTX members, though Medicare and cash patients are also welcome. Because most families get their insurance through their employer, a job change that results in a new insurance company will mean those patients won’t be able to keep their Sanitas primacy care doctor.

“Life expectancy goes up if you have a primary care physician,” Crow says. “If the continuity of care is important, insurance or employer clinics based on where people work can be very disruptive to the relationship that is really important in your life.” Crow says they could have worked with local providers who were already providing care. “Wouldn’t that be a good place to start rather than opening up your own?”

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