The venture capital arm of five Blue Cross and Blue Shield plans has partnered with global primary care provider Sanitas USA to open medical centers in Texas as a precursor to a U.S. multi-state rollout.
Initially, 10 “advanced primary care medical centers” will be opened in the Dallas and Houston markets via a joint venture of Sanitas, the majority owner, and Chicago-based HCSC Ventures, which holds a minority stake of less than 50%. HCSC Ventures is part of Health Care Service Corp., which owns Blue Cross and Blue Shield of Texas as well as Blues plans in Illinois, Oklahoma, New Mexico and Montana.
The Sanitas-HCSC venture will evaluate future expansion in the five-state region where Health Care Service owns Blues plans on a “market-by-market basis,” executives said. Financial terms of the relationship aren’t being disclosed, but those involved say Sanitas and HCSC Ventures will contribute capital to “fund the start-up of the medical centers and the joint venture will contract with Sanitas to operate the medical centers.”
The move comes as health insurance companies form closer ties with medical care providers. Health insurers are moving away from fee-for-service medicine to value-based models that pay medical care providers based on quality of care and health outcomes of patients. If providers and insurers are even more integrated, supporters of such arrangements believe quality and costs can be more closely monitored.
CVS Health, which operates pharmacies and retail clinics, bought the health insurer Aetna last year and for years now UnitedHealth Group has been buying up doctor practices and clinics through its Optum health services business. Closer ties between insurers and providers allows the combined entity to more closely monitor the delivery of care, those involved say.
“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,” Blue Cross and Blue Shield of Texas president Dr. Dan McCoy said.
The Texas Blue Cross plan is owned by Health Care Service Corp, which is the nation’s fourth largest health insurance company with nearly 16 million members enrolled in Blues plans in Texas, Illinois, Montana, Oklahoma and New Mexico. Sanitas is a multi-national healthcare company that is establishing more relationships with health insurers in the U.S.
“Our approach to care is centered on our patients and their families, giving them more time with the doctor and the convenience of a one-stop medical center for their everyday health care needs,” Joseba Grajales, president of Keralty Group, the parent company of Sanitas USA, said in a statement accompanying the announcement. “Our expansion to Texas will continue to build on our success in Florida, New Jersey and Connecticut, serving more than 200,000 patients in diverse communities.”
In Texas, the centers will offer primary care, urgent care, including laboratory and diagnostic imaging services. The facilities will be open beginning Jan. 1, 2020 and some of them will be open 365 days a year, Blue Cross and Blue Shield of Texas said.
The effort to make sure patients are getting care in the right place, in the right amount and at the right time is key to health insurers negotiating performance measures in value-based contracts with medical care providers.
“It will also focus on creating a new, value-based care delivery model—one that takes an integrated, holistic approach to patients’ health,” Blue Cross and Sanitas said in their statement announcing the partnership. “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 medical centers will be available “exclusively” to people enrolled in Blues plans though customers willing to pay out of pocket or for those who have traditional Medicare.
Date: April 11, 2019