Thursday, November 21, 2013

Blue Cross and Blue Shield of Texas and Tenet Healthcare Corporation Collaborate on Statewide ACO to Improve Quality and Efficiency of Care

New commercial ACO agreement is among most innovative in the nation.

RICHARDSON, Texas and DALLAS, Nov. 12, 2013 /PRNewswire/ --Blue Cross and Blue Shield of Texas (BCBSTX) and Tenet Healthcare Corporation (Tenet) have agreed to collaborate to offer an innovative, statewide accountable care organization (ACO) model to deliver improved, sustainable patient care and help manage costs through Tenet's Integrated Care Networks. The collaboration is planned to be available to BCBSTX PPO commercial patients at any of Tenet's Texas hospitals with an Integrated Care Network beginning Jan. 1, 2015. The agreement may be expanded to include health insurance marketplace patients over the life of the agreement. Tenet's Texas Integrated Care Networks currently include South Texas Care Connect in San Antonio, Physician Performance Network of Houston and the Sierra Providence Physician Performance Network in El Paso.

The statewide ACO is targeted to include healthcare providers from all of Tenet's Texas markets and will advance the future of healthcare by transforming the way physicians coordinate and deliver patient care by reducing unnecessary hospital admissions, readmissions, ER visits and duplication of services for patients with chronic diseases, leading to lower costs.

"This collaboration with Tenet Healthcare reinforces both organizations' commitments to improving the quality and efficiency of healthcare services," said Jack Towsley, Divisional Senior Vice President, Texas Health Care Delivery, BCBSTX. "It also furthers Blue Cross and Blue Shield of Texas' efforts to establish innovative, value-based care delivery models designed to reward healthcare providers for managing costs and quality while realigning the focus from volume of services to the value of services."

"We are proud to partner with Blue Cross and Blue Shield of Texas on this strategic alliance, which represents the many innovative approaches to healthcare delivery that Tenet and Blue Cross and Blue Shield of Texas continue to provide to their communities and customers," said Clint Hailey, Chief Managed Care Officer for Tenet Healthcare. "Tenet has a long history of successful collaborations with physicians and payers, and this arrangement will capitalize on the physician-led organizations that have developed robust clinical programs to improve care delivery across the service continuum."

"In addition to shifting the way we have traditionally paid for services, the ACO model will allow us to use our time and resources to implement strategies to improve the overall patient experience," says Dr. Dan McCoy, Chief Medical Officer, BCBSTX. "Establishing this arrangement with Tenet will help BCBSTX to provide our members with both lower costs and improved quality of care."

This new model of healthcare delivery is designed to improve outcomes in three key categories: quality of care, patient experience and satisfaction and cost efficiency. It will reach those goals by pursuing the following strategies:

  • Early identification of disease and illness through effective management and coordination of patient care;
  • Use of advanced technology and support services to make more informed decisions and facilitate the patient and provider relationship and transitions in care;
  • Implementing an alternative or non-fee-for-service payment arrangement, and
  • Lowering cost trends by coordination among payers and providers, without limiting medically necessary services in order to enable the delivery of more affordable healthcare products.

Tenet Healthcare has been advancing the concept of better care coordination for more than a decade. Conifer Health's Value-based Care division will support this ACO project by identifying care improvement, efficiency and service opportunities. As one of the nation's largest employers, this endeavor furthers Tenet's commitment to the long-term health status of its communities.

HHS Says It Will Only Spend Up To $7 Billion In Order To Learn How To Save Money On Obamacare : Personal Liberty™

HHS Says It Will Only Spend Up To $7 Billion In Order To Lean How To Save Money On Obamacare : Personal Liberty™

The Department of Health and Human Services is seeking ways to cut Affordable Care Act spending while still providing quality healthcare to Americans— and a solicitation for bids on the Federal Business Opportunities website reveals that HHS is only willing to spend $7 billion to do so.
From the website:
The purpose is to develop a Research, Measurement, Assessment, Design, and Analysis (RMADA) IDIQ [Indefinite Delivery, Indefinite Quantity] to respond to expanded needs of the Patient Protection and Affordable Care ACT (ACA) and Health Care reform ACT (HCERA). The work awarded under the RMADA will involve the design, implementation and evaluation of a broad range of research and/or payment and service delivery models to test their potential for reducing expenditures for Medicare, Medicaid, CHIP, and uninsured beneficiaries while maintaining or improving quality of care.
Documents accompanying the solicitation inform possible contractors that the government intends to spend no more than $7 billion over the life of the contract.
The solicitation continues:
The need for analyses based on real time claims and utilization data is a unique factor that distinguishes today’s evaluation of models as opposed to prior demonstrations… Furthermore, because Innovation Center models often include collaboration among multiple payers and other entities, the current evaluation approaches will need to account for the need to gather, coordinate, and analyze private payer and other private data sources. In addition, evaluations involving other entities, such as payers, should plan to examine the role of CMS as a convener and how the model is received by both participating and non-participating affected parties.
Contractors have until January 14, 2014 to respond.

3 McAllen doctors, clinic to pay $5.5M for Medicaid fraud claim settlement -

3 McAllen doctors, clinic to pay $5.5M for Medicaid fraud claim settlement -

Nov. 21 -- MCALLEN -- Three local doctors and their clinic entered into a settlement with the Texas Attorney General's Office to avoid further proceedings tied to the state's action against them for Medicaid fraud. As part of the settlement, Carlos Mego , Pedro Mego , Subbaro Yarra and their clinic, Valley Heart Consultants , will have to pay $5.5 million in a five-installment plan beginning next month. The settlement doesn't affect the doctors' status as medical providers in the Texas Medicaid program, said Thomas Kelley , a spokesman with the AG's Office. The settlement was reached earlier this month, confirming the state's allegations that the cardiology practice improperly billed Medicaid patients for a series of unnecessary tests that were performed by unlicensed technicians and below the required standards of practice. Carlos Mego and Yarra were also named in a similar settlement for $27 million reached with the federal government in 2009 that named five other doctors and South Texas Health System in a scheme that resulted in more than $50 million in Medicare payments, Monitor archives show.