Blue Cross And Blue Shield Of Texas And Memorial Hermann Health System Announce Alliance To Improve Quality Of Care And Reduce Costs
New ACO Arrangement realigns focus to value of service with emphasis on improving health outcomes
September 5, 2013
HOUSTON – Blue Cross and Blue Shield of Texas (BCBSTX) and Memorial Hermann Accountable Care Organization (MHACO) announced a new strategic alliance today that will deliver improved, sustainable patient care while better managing health care costs, beginning mid-2014. An accountable care organization (ACO) is a collection of providers that have agreed to coordinate care across a continuum of heath care settings to improve the coordination and quality of care. The ACO model improves the patient’s health and experience while reducing costs through avoiding unnecessary hospital admissions, readmissions, emergency room (ER) visits and duplication of services. MHACO’s 1,900 primary care and specialty physicians focus on providing quality services that have the potential to improve their patients’ health and reduce the cost of care.
“By establishing this arrangement with MHACO, BCBSTX hopes to provide the Houston community with improved quality of care and lower costs; providing better value and improved outcomes for our members,” said Dr. Robert Morrow, Senior Medical Officer for BCBSTX. "This collaboration is an extension of BCBSTX’s commitment to enabling innovative, value-based care delivery models, which are designed to reward physicians for managing costs and quality of total patient care while moving from the traditional fee-for-service approach to a fee-for-value payment model.”
"Our relationship with Blue Cross Blue Shield of Texas around accountable care activities is consistent with Memorial Hermann’s commitment to quality outcomes and cost management,” said Chris Lloyd, CEO of MHACO. “The efforts we will undertake together will continue to advance the health of the populations we serve.”
This new model of health care 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 health care products.
"This is a paradigm shift in paying for medical services. The arrangement begins to move reimbursement away from fee for service to fee for value," said Shara McClure, BCBSTX Vice President for Network Management. "In addition, the arrangement enables MHACO to harness clinical data to help drive medical care decision-making, enhance patient safety and improve quality of care – all supporting the goals of better health and improved outcomes for BCBSTX members."
Dr. Keith Fernandez, Chief Medical Officer of MHACO, added, “Our combined population management efforts will allow us to more efficiently deliver health care in the greater Houston area and will continue to serve as a model for the rest of the country around health reform principles.”
The new alliance enhances a previous agreement that allows more than 1.1 million BCBSTX members access to in-network health care services at Memorial Hermann hospitals and outpatient facilities in the greater Houston area. MHACO will serve populations in Harris, Fort Bend and other surrounding counties.
About Blue Cross and Blue Shield of Texas
Blue Cross and Blue Shield of Texas -- the only statewide, customer-owned health insurer in Texas – is the largest provider of health benefits in the state, working with nearly 40,000 physicians and 400 hospitals to serve 4.8 million members in all 254 counties. Blue Cross and Blue Shield of Texas is a Division of Health Care Service Corporation (which operates Blue Cross and Blue Shield plans in Illinois, Montana, New Mexico, Oklahoma and Texas), the country’s largest customer-owned health insurer and fourth largest health insurer overall. Health Care Service Corporation is a Mutual Legal Reserve Company and an Independent Licensee of the Blue Cross and Blue Shield Association.
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About Memorial Hermann
An integrated health system, Memorial Hermann is known for world-class clinical expertise, patient-centered care, leading edge technology, and innovation. The system, with its exceptional medical staff and more than 20,000 employees, serves to advance health in Southeast Texas and the Greater Houston community. Memorial Hermann’s 12 hospitals include three hospitals in the Texas Medical Center, including the Texas Trauma Institute – a level I trauma center which houses the Life Flight® air ambulance – a hospital for children and a rehabilitation hospital, eight suburban hospitals, and a second rehabilitation hospital in Katy. The system also operates three Heart & Vascular Institutes, the Mischer Neuroscience Institute, two Ironman Sports Medicine Institute locations, cancer centers, imaging and surgery centers, sports medicine and rehabilitation centers, outpatient laboratories, a chemical dependency treatment center, a home health agency, a retirement community and a nursing home. As an Accountable Care Organization, the system also offers employers health solutions and health benefit plans through its wholly owned Memorial Hermann Health Solutions, Inc., and Memorial Hermann Insurance Company.
The Blue Cross and Blue Shield Association is a national federation of 37 independent, community-based and locally-operated Blue Cross and Blue Shield companies that collectively provide healthcare coverage for nearly 105 million members – one-in-three Americans. For more information on the Blue Cross and Blue Shield Association and its member companies, please visit bcbs.com. We encourage you to connect with us on Facebook, check out our videos on YouTube, follow us on Twitter and check out The BCBS Blog, for up-to-date information about BCBSA.