Texas Blues insurer to open primary-care clinics

Taking a cue from other insurers that are attempting to gain more control over where their members seek care, Blue Cross and Blue Shield of Texas on Monday announced plans to open 10 primary-care medical centers in Dallas and Houston next year.

The clinics, which the Health Care Service Corp.-owned Blues insurer will open in partnership with medical center operator Sanitas USA, will provide a range of services beyond primary care, including urgent care, lab and diagnostic imaging, care coordination, and wellness and disease management programs. Sanitas also operates U.S. clinics with other Blues insurers, including Florida Blue and Horizon Blue Cross and Blue Shield of New Jersey.

The Texas Blues affiliate said the goal is address gaps in care by bringing more primary-care services to diverse communities.

"We believe that this partnership will advance primary-care services and is an effective approach to providing quality healthcare outcomes, improving member engagement and experience, and lowering costs for our members, including populations that may have difficulty accessing care," Dr. Dan McCoy, president of Blue Cross and Blue Shield of Texas, said in the announcement.

The move echoes steps other insurers have taken to rein in medical spending by encouraging patients to seek care at retail clinics and other lower-cost settings while steering clear of costly hospitals and emergency departments. Some insurers have gone as far as buying up medical practices to gain better control over where their members access care.

National insurer Humana, for example, owns or operates as a joint venture or alliance more than 230 primary-care clinics under its Conviva brand.

Florida Blue parent company Guidewell Health's partnership with Sanitas is what first brought the Colombia-based medical center operator to the United States. Through the partnership, Guidewell and Sanitas now have 23 clinics throughout Florida serving more than 200,000 patients, a Florida Blue spokeswoman said.

Florida Blue initially launched the clinics in 2015 to serve its highly-subsidized ACA exchange customers enrolled in a low-cost HMO plan called "myBlue," which serves 415,000 people. Between 2016 and late 2018, those myBlue members who sought care at Sanitas clinics had 32% lower inpatient admissions, 34% fewer outpatient visits and 20% fewer emergency room visits than myBlue members who saw other providers in South Florida, the spokeswoman explained.