The move follows an ambition among US health insurers to combine health cover with healthcare services through partnerships and acquisitions, creating a value-based health insurance model
Blue Cross and Blue Shield of Texas (BCBSTX), the Lone Star State’s largest health insurance provider, will extend access to its healthcare services in Dallas and Houston after teaming up with Sanitas USA.
The partnership will bring ten new medical centres to both counties, with each offering primary care, urgent care, lab and diagnostic imaging services, care co-ordination, and wellness and disease management programmes.
The new centres will open on 1 January 2020.
They will accommodate Blue Cross and Blue Shield policyholders, as well as self-pay patients and seniors with traditional Medicare coverage – government-subsidised health insurance for over-65s.
Dan McCoy, managing director of BCBSTX, said: “Our partnership with Sanitas is another example of collaborating with healthcare providers to deliver the best possible care and support to our members.
“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.”
Joseba Grajales, president of Keralty Group, the parent company of Sanitas USA, added: “We are excited to begin our journey with Blue Cross and Blue Shield of Texas and look forward to working closely together to bring more value to their members and communities.
“Our approach to care is centred on our patients and their families, giving them more time with the doctor and the convenience of a one-stop medical centre for their everyday health care needs.”
Blue Cross and Blue Shield of Texas moves towards value-led health insurance
Health insurance providers across the US are adapting their approach to customer care from the traditional fee-for-service model to paying medical care providers based on the quality of care patients receive.
This involves a delivery system that rewards practices and staff for improving quality, as well as cutting the cost of the services provided – an approach known as value-based care.
In a joint announcement of the partnership, BCBSTX and Sanitas said: “It will also focus on creating a new, value-based care delivery model—one that takes an integrated, holistic approach to patients’ health.
“This means, in part, increasing the availability of primary care services to diverse communities to address the gaps and fragmentation in care that create barriers to people staying well.”
The initiative has been spurred on by US President Donald Trump’s ambition to deregulate the health insurance market and allow insurance companies to compete with policies subsidised by the Patient Protection and Affordable Care Act (PPACA) – usually referred to as just the Affordable Care Act (ACA).
Health insurers across the US have been partnering with, or acquiring healthcare practices in order to more closely monitor the services they provide and build their value into the health insurance proposition.
The largest health insurer in the US, United Health Group, has been extending access to healthcare for its customers, with its subsidiary OptumCare becoming the largest employer of doctors in the US in June 2018.
Likewise, Blue Cross and Blue Shield Association licensee Anthem has been moving toward a value-based healthcare insurance model through a partnership with Ohio-based healthcare provider TriHealth, and more recently with pharmaceuticals provider CVS Pharmacy.
This latest move from BCBSTX indicates a similar ambition to merge the insurance and healthcare provision processes to form a single proposition with increased access for policyholders.