MH: At the same time, you formed some ACOs with private insurers such as Blue Cross and Blue Shield of Texas. How is that working out?
Hawthorne: Very well. It opened up some new doors for us to relate to the payers in the Dallas-Fort Worth area to talk about how we can improve outcomes. These conversations were difficult to begin with. They got more comfortable with time. We talked about specifics in terms of paying for performance and outcomes. As a result, we have seen excellent outcome relationships with Blue Cross and Blue Shield and with Aetna, and we're currently working with the other major payers to see how we might expand the accountable care opportunity.
MH: Are you contemplating getting into the business of insurance?
Hawthorne: We've been there. In the early years before Texas Health Resources was formed, one of our founders, the Harris Methodist Health System, had a very large insurance product. We watched how that evolved as a provider-sponsored health plan and decided that we would rather not take on our own insurance group because we felt like there was some pretty hard competition between the provider side and the insurance side inside our own organization. So at this point that's not on our list. We will work with other organizations but not invest independently in our own health plan.
MH: Texas has the highest rate of uninsured of any state and yet it hasn't expanded Medicaid. How is that affecting your bottom line?
Hawthorne: It's hard to say how it's affecting our bottom line. What it is affecting is the relationships that we have with the people of Texas. Because we have a very significant Medicaid program already in Texas, we're concerned that we have divided a very needy population. We're seeing more people show up in our emergency rooms. But unfortunately, they wait too long to receive care. As a result, the amount of care necessary to get them back to good health is a lot more expensive than it would be had they had the coverage. So we're concerned about the fact that we didn't expand Medicaid in Texas. We are certainly advancing knowledge about this with the business community, which must be aligned with us to achieve the expansion. We're going to take the issue up again when the Legislature meets in 2015.
MH: Do you think it will have a better chance in the future?
Hawthorne: We may need to reframe it a little bit as some other states like Arkansas, Indiana and others have done. Medicaid is a lightning-rod word. How do we bring more people into this coverage beyond just acute care or women and children's services? How can we bring more prevention and wellness into the equation? So we will repackage it this time a little differently than we did in the first round.
MH: What's next for Doug Hawthorne?
Hawthorne: Retiring is not a word I can comprehend. So for Doug Hawthorne, it's refiring. How can I look at some of the things that have been on that bucket list for a while that I now can engage in? Healthcare will always be a part of my continuing life's work but perhaps in just a little different framework than the CEO seat. But I'm a communitarian, I want to see more things happen where we are extending ourselves out into the community to improve health for the people we serve. So there will be opportunities to do that in a variety of ways. I'll look back on this journey with wonderful memories and stories about the people who have provided health services to this community.