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State News

Texas

Texas has a unique law that directs Texas insurers to publish PPO plan out-of-network service data by network hospital for specific hospital-based physician types, including emergency room doctors.  Moreover, the Texas Department of Insurance (TDI) mediates between healthcare providers and insurers when patients are faced with a surprise medical bill that meets certain criteria. 

Texas has a voluntary claims data collection effort through the University of Texas Center for Healthcare Data. They collect medical and pharmacy claims that account for 65% of the Texas population.

Texas also has many challenges in the healthcare value space. For one, Texas has an uninsurance rate that is nearly double the national average. The state is unique in that responsibility for the healthcare of indigent persons falls to the counties. Several counties in Texas have leveraged this role to support health reforms.

Another challenge is that patients living in rural areas often face healthcare deserts. These areas tend to have high hospital closure rates and physician shortages.

Texas ranked 48 out of 47 states plus DC, with a score of 17.9 out of 80 possible points in the Hub's 2021 Healthcare Affordability State Policy Scorecard.


Texas | Apr 21, 2024 | News Story | Equity

Study Finds Hispanic and Black Residents in Texas Have Poorer Health Than Those in Other States

A report shows that Hispanic and Black Texans experience greater inequities in health care
compared to Hispanic and Black people living in other states, according to the Metro News.
According to The Commonwealth Fund 2024 State Health Disparities Report, Texas ranked 44th
out of 47th in health care system performance for Hispanic people, and ranked 32nd out of 39
states calculated for health system performance for Black residents. The researchers noted that
the U.S. Hispanic population is highly diverse, and health care access and outcomes can vary,
particularly by immigration status.


Texas | Apr 1, 2024 | Report | Health Costs

Texas has Fifth Highest Health Care Costs in the Nation

Texas has the fifth highest health care costs in the nation, reports to Houston Culture Map. The
report, from Forbes Advisor, found Texas’ average annual premiums for plus-one health
coverage ($4,626) and family coverage ($7,051) through employer-provided policies were the
4th highest in the nation. In addition, 16 percent of Texas adults chose not to see a doctor in the
past 12 months due to the cost of health care.


Texas | Jan 2, 2024 | Report | Affordability

Large Share of Texans Cannot Afford Mental Health Care

A state-by-state report has found that Texans with mental health needs struggle to find and
afford treatment, reports KERA News. According to the report from insurance company
Milliman, 88 percent of Texans live in a county without enough mental health providers, and the
average cost of an out-of-pocket therapy session in the state was at least $160, or $68 even
with insurance if the provider is out-of-network.


Texas | Oct 9, 2023 | Report | Consolidation

Texans Concerned About Health Care Consolidation and Increasing Prices

A survey has found that Texas respondents are concerned about consolidation in the health
care industry, reports D Magazine. The survey from Texas 2036 found that 30 percent of
respondents were concerned about health care prices and 87 percent are concerned about
health care consolidation. In addition, more than half supported greater antitrust enforcement by
the government to address consolidation, and more than half wanted prohibitions on hospitals
and insurance companies from owning physician groups and pharmacies.


Texas | Sep 6, 2023 | Report | Price Transparency

Texas Medical Bill Transparency Law Requires Itemized Bills for Patients

In an effort to prevent medical debt and improve transparency, Texas hospitals are now
required to provide itemized bills to patients, reports Becker's Hospital Review. Beginning
September 1, 2023, hospitals must give patients an itemized bill, including plain language
descriptions of each charge and the payment amount, before sending them to collections.


Texas | Aug 29, 2023 | News Story | Drug Costs

Texas Enacts Canadian Drug Importation Program

Texas has created a Wholesale Prescription Drug Importation Program, reports the Texas
Tribune
. Under House Bill 25, the state can contract with Canadian drug wholesalers to import
prescription drugs to Texans at lower prices than U.S. wholesalers. Although the law goes into
effect September 1, the federal government has yet to approve and implement the programs
that will allow importation—it is unclear when or if the state will be able to import any
prescription drugs.


Texas | Jun 21, 2023 | News Story |  Consolidation

Texas Eliminates Anti-Competitive Contracting Practices in Health Plans

Texas has passed a law prohibiting anti-steering and anti-tiering plans effective 2024, reported by ALM Benefits Pro. Anti-tiering provisions compel insurers to place favored providers in higher tiers even if they don’t meet cost or quality standards, and anti-steering provisions restrict insurer’s ability to direct patients to higher value care from competing providers, respectively. Under HB 711, employers will be allowed to steer workers toward higher-performing health centers and tier hospitals based on performance.


Texas | Jun 13, 2023 | News Story | Drug Costs

Texas Limits Use of Copay Accumulators

Texas have passed laws limiting the use of copay accumulators, reported by the Lupus Foundation of America. Copay accumulators prevent third-party financial assistance from counting toward a patient's deductible and out-of-pocket maximum, which can increase patient costs and limit access to care. Texas's HB 999 ensure that financial assistance can be used toward a patient's deductible and other cost-sharing requirements.


Texas | Sep 24, 2021 | News Story | Rural Healthcare

Texas Expands Pediatric Telehealth Services to Four Rural Hospitals

Texas is expanding telehealth services for children through a grant of more than $530,000 to rural health clinics, according to State of Reform. The grants will help four hospitals expand or implement telehealth pediatric services through video chats and phone calls. The funding is part of a grant program to establish and administer a tele-connectivity resource program for children’s health in rural Texas.


Texas | Sep 1, 2021 | News Story | Price Transparency Affordability

New Texas Laws Target Price Transparency; Surprise Medical Bills

Texas has recently enacted laws improving hospital price transparency and evaluating ambulance surprise billing, according to AARP. SB 1137 mirrors federal price transparency requirements but levies harsher penalties for non-compliance. SB 790 requires the state to study ambulance surprise medical billing and allows counties and municipalities to outlaw balance billing for claims by counties or municipalities.


Texas | Jan 15, 2021 | News Story

Healthcare Safety Net Extension for Uninsured Texans

The Texas Health and Human Services Commission (HHSC) received federal approval for a 10-year extension through September 2030 for its Texas Healthcare Transformation and Quality Improvement Section 1115 demonstration waiver, according to The Texas Tribune. The federal funding agreement reimburses hospitals for the uncompensated care they provide to patients without health insurance. It also pays for innovative healthcare projects that serve low-income earners in Texas, often for mental health services.


Texas | Jan 12, 2021 | Report | Equity

Altarum Releases New Estimate of the Cost of Health Disparities in Texas, Including Impacts of COVID-19

Racial and ethnic disparities are costing Texas $2.7 billion in excess medical care spending annually, $5 billion in lost productivity annually and $22.6 billion in life years lost, according to a new report from Altarum. In Texas, as is the case with the rest of the country, social determinants of health, including access to healthcare, vary considerably by race and ethnicity. Not surprisingly, there are also large disparities in health status, disease prevalence and premature death by race and ethnicity. In weighing the value of investments to improve health, it is important to understand that disparities in health impose a substantial human cost and a significant economic burden to the Texas economy. The authors assert that economic burden numbers will increase by 22 percent as the Texas population grows larger and more diverse.


Texas | Jul 28, 2020 | News Story | Surprise Medical Bills

State Says Complaints Down 95 Percent Due to New Surprise Medical Bill Law

Complaints made to the State of Texas about surprise medical bills are down more than 95 percent since a new law took effect this past January, according to News 4 San Antonio. However, authors note that only 20 percent of Texans are protected by the surprise medical bill law because it applies to insurance regulated by the state. Under the new law, medical providers and insurance companies can go to arbitration to settle price disputes.


Texas | May 27, 2020 | News Story | Consumer Voices

Two Law Firms Dominate Medical Debt Suits in Texas

From 2018 to 2020, Dallas-based DeLoney Law Group filed 81 percent of medical debt collection lawsuits in the state, totaling $14.8 million in judgments, according to a review of the Texas online court system by researchers from Johns Hopkins University. Patients interviewed by researchers stated that they were only given last-minute notifications about their hearings—a predatory litigation strategy, MedPage Today states. Though wage garnishment is prohibited by the Texas Debt Collection Act, debt collectors can still file a writ of execution or a writ of garnishment that allows them to go after any bank funds, property or income that is not a wage, according to the report. The hospitals that filed the most lawsuits were small, for-profit community hospitals.


Texas | Apr 23, 2020 | News Story | Social Determinants of Health

Texas Will Let Food Stamp Recipients Have Groceries Delivered

Food stamp recipients in Texas will be allowed to use their benefits to order groceries online and have them delivered to their door, according to The Dallas Morning News. Food stamps help about 1.4 million eligible low-income households in Texas with benefits worth nearly $5 billion a year. However, the state is still awaiting word from the U.S. Department of Agriculture’s Food and Nutrition Service on its recent request to let people in the Supplemental Nutrition Assistance Program use their Lone Star Cards to buy carryout or delivered food from restaurants.


Texas | Feb 9, 2020 | News Story | Health Costs Affordability

Will Voters Revolt Over Healthcare Prices? Texans Have Plenty of Reason to Push for Change

Texas ranked low on healthcare affordability in a 2020 scorecard from Altarum, in part because it is “among the most expensive states, with private payer prices well above the national median.” Almost half of Texans had problems with out-of-pocket expenses and one third had trouble paying medical bills. Another report also found that Texas ranked last on access and affordability, according to Dallas News. The state legislature, and specifically its committee appointed to study healthcare costs, has an opportunity to identify state-based strategies that would address residents’ affordability and access needs. 


Texas | Jan 2, 2020 | News Story | Surprise Medical Bills

What You Need to Know About Texas' New Surprise Medical Billing Law

A Texas law that aims to protect patients from surprise medical bills has taken effect, according to The Texas Tribune. The legislation aims to remove patients from billing disputes between health insurance plans and healthcare providers. The protections apply to Texans with state-regulated health plans, which includes most state employees and public school teachers, people who purchase insurance through the ACA marketplace and some people who receive health insurance through their private employers. The new law bans balance billing for emergency care. In nonemergency situations, there is an exception that allows providers to charge balance bills to patients who intentionally seek out-of-network providers.  


Texas | Nov 20, 2019 | News Story | Rural Healthcare

The Rural Healthcare Crisis, Mapped

In 2018, Texas had about 54 primary care physicians per 100,000 people—one of the lowest ratios in the country, far below the national ratio of 76 per 100,000. More than a quarter of Texans live in an underserved county, according to the Texas Observer. As a result, Texans often have to travel for hours to get care, which ultimately leads to poorer outcomes and higher mortality. 


Texas | Oct 11, 2019 | News Story | Health Costs Affordability

Healthcare Providers Band Together to Create Comprehensive Care Centers

In an effort to make healthcare more affordable, Blue Cross Blue Shield and Sanitas Medical Center will offer a full-service clinic to provide primary care, urgent care, lab and diagnostic imaging services, care coordination and wellness and disease management programs in one location, according to Chron. They hope the primary-care driven, value-based model will reduce costs by providing affordable access to preventable care, thereby preventing the need for more serious treatment down the line. The key, the organizations believe, is working together to improve healthcare as a whole.


Texas | Sep 3, 2019 | News Story | Affordability

Medicaid Expansion in Texas: Potential Economic and Employment Implications

Low-income adults in Texas were much more likely to be uninsured and to experience financial barriers to care than their counterparts in the three states that expanded Medicaid, according to a new analysis from the Commonwealth Fund. Moreover, most low-income Texans support Medicaid expansion, which could extend coverage to 1.2 million uninsured individuals and increase affordability. The report includes a discussion of potential expansion effects on hospitals and the state’s economy. Studies show that Medicaid expansion reduces the share of uncompensated hospital care, which totaled $6.8 billion in Texas in 2016. Expansion has also been associated with fewer rural hospital closures (80 percent of which happen in nonexpansion states), where these entities account for 14 percent of total employment on average. Since 2013, 19 rural hospitals in Texas have closed due to financial difficulties. 


Texas | Jul 16, 2019 | News Story | Health Costs

For Value-Based Care, a Texas Health System Puts Cost and Risk Data at the Point of Care

To address the health system’s need to provide cost data at the point of care, Houston Methodist is piloting a program, Smart Ribbon, that provides real-time, patient-specific cost and risk data regarding medications, labs, radiology and observational status within the clinical workflow, according to Healthcare IT News. This information automatically appears and hovers over clinicians’ screens as they work within patients’ charts in the EHR. Since the pilot, Houston Methodist Sugar Land has reported approximately $717,000 in attributable cost savings with an average incremental cost reduction of $105 per admission. This early financial success was also accompanied by clinical efficiencies because Smart Ribbon is integrated with Epic EHR and VigiLanz pharmacy surveillance and antimicrobial stewardship products, and features a Controlled Substances app, thereby reducing provider clicks and cognitive burden associated with searching for data on opioid and antibiotic use.


Texas | Jun 18, 2019 | News Story | Surprise Medical Bills

Texas is Latest State to Attack Surprise Medical Bills

Texas has passed a law shielding patients from getting a huge bill when their insurance company and medical provider can’t agree on payment, according to Kaiser Health News. Under the new law, insurance companies and medical providers can enter into arbitration to negotiate a payment, removing patients from the middle of payment negotiations. Last year, a Kaiser Family Foundation poll found that 67 percent of people worry about unexpected medical bills — a larger share than those who say they worry about prescription drug costs or basic necessities such as rent, food and gas. Commonwealth Fund’s most recent report on the issue found about half of states offer some legal protections from surprise bills, but only six states had laws that provide “comprehensive” consumer protections similar to those just passed in Texas.


Texas | May 19, 2019 | News Story | Health Costs

Don’t Just Blame Hospitals and Docs for High Health Spending. Texas Keeps Dropping the Ball

Healthcare spending in Texas grew 18.5 percent between 2013 and 2017 and many factors contribute to that growth, according to Dallas NewsTexas ranked 37th last year in the overall health of its residents, according to America’s Health Rankings. Texas ranked near the bottom on many measures—it has many more adults with diabetes and obesity, and far fewer primary care doctors and mental health providers for the population. Additionally, 17 percent of the population in Texas has no health insurance—the largest in the nation. The state is one of 14 not expanding Medicaid, but experts assert that coverage is the biggest determinant of health outcomes. “Once people land in the hospital, they’ll spend a lot of money,” Lynn Quincy, director of the Healthcare Value Hub at Altarum, said. “Anything that keeps them healthy often costs less at the end of the day.”


Texas | Mar 26, 2019 | News Story | Rural Healthcare

West Texas Senator Seeks Solution to Rural Hospital Crisis

A new bill proposed in the Texas Senate would direct the state health commissioner to develop a method to ensure that rural hospitals get full Medicaid reimbursement, according to an editorial in the Orange Leader. Since 2013, 21 rural hospitals have closed in Texas. Legislators believe that a major reason for these closures is an underpayment for Medicaid reimbursements. Over three million people live in the state’s 170 rural community—a population that tends to be older, poorer and less healthy than urban communities. About 50 percent of infants in the state are delivered to patients covered by Medicaid and in rural regions that rate is about 70 percent—demonstrating a need for rural hospitals. Though a budget provision requiring reimbursement for the full allowable cost of a service for Medicaid patients exists, managed care organizations omitted the budget provision after they began administering the Medicaid program in 2012. Legislators emphasized the need for coordination between agencies to agree on what rural hospitals are owed to avoid future hospital closures.


Texas | Feb 25, 2019 | News Story | Consumer Voices

'Pain & Profit' Investigation Spurs Sweeping Bipartisan Fix for Texas' Medicaid Managed Care Mess

Lawmakers from both parties are rolling out a package of bills to overhaul the Texas Medicaid system, introducing protections for vulnerable patients who are denied treatments, increasing state oversight and signaling a crackdown on healthcare corporations that get richer by providing less care, according to Dallas News. One such bill would address the state’s broken medical appeals system. In light of limited state oversight that allowed managed care companies to refuse medically needed services and force families with sick or disabled children to pursue endless appeals, other bills would allow parents of children with disabilities to opt out a managed care program called STAR Kids and receive traditional Medicaid. The omnibus bill some lawmakers call the "Managed Care Accountability Bill,” would overhaul the state’s system for fining managed care companies when they fail to properly serve patients, empower the health commission’s Office of the Inspector General to assist in financial review of managed care companies and beef up the state’s tracking of company refusals to provide care. 


Texas | Feb 12, 2019 | News Story | Surprise Medical Bills Consumer Voices

Thousands of Texans Were Shocked by Surprise Medical Bills. Their Requests for Help Overwhelmed the State

A large backlog in patients seeking government help left state regulators unable to provide timely support to thousands of Texans who requested mediation from the short-staffed Texas Department of Insurance, according to the Texas Tribune. The overwhelmed state mediation program highlights the widespread problem of surprise emergency medical bills after the Texas Legislature gave state regulators increased authority to force insurers and providers to the negotiating table. The demand for the mediation program has increased from just 43 requests in 2013 to 4,519 in 2018, accounting for $8.8 million in qualifying surprise bills. Though the agency is able to get insurance companies to agree to pay more, lowering the amount a consumer owes, the department does not keep track of how much the consumer pays at the end of the mediation process.  Agency officials said they have already made strides to improve internal processes to prevent another backlog from choking the system.


Texas | Feb 6, 2019 | News Story | Consolidation

Baylor and Memorial Are Breaking Up. Here's Why the Failed Hospital Merger May Be for the Best

Baylor Scott & White Health of Dallas and Memorial Hermann of Houston have discontinued merger discussions, which may be in the best interest of patients, according to Dallas News. Baylor and Memorial operate some of the leading hospitals in Texas and their combined revenue approaches $15 billion a year. Together, they would have had over 73,000 employees, nearly 14,000 affiliated and employed physicians, and 68 hospitals stretching from Dallas to Austin to Houston. Mergers can give health systems increased negotiating power, however they often don’t provide savings or higher quality. Experts have found that mergers tend to lead to rising prices and profits, and benefits rarely get to patients or employers. 


Texas | Dec 17, 2018 | News Story | Health Costs Affordability

Health Suffers Deep in the Troubled Heart of Texas

A new analysis from the Urban Institute revealed that Texas has both the largest number and highest percentage of uninsured residents under age 65 in the country. Additionally, patients often struggle to pay their bills, according to Kaiser Health News. Part of the problem may be “entrepreneurial healthcare practices” like freestanding emergency rooms, doctor-owned hospitals and balance billing. At last count, 214 freestanding ERs, which are generally highly profitable, have popped up across the state, in addition to hundreds of urgent care clinics and surgery centers. Employers are also continuing to eliminate subsides for employee premiums and shifting to high-deductible health plans. Without policy changes, Texas’ working poor and uninsured will find it difficult to access quality care.


Texas | Oct 11, 2018 | News Story | Surprise Medical Bills

Texas Fines Humana for Out-of-Network Anesthesiology Bills

Humana will pay Texas a $700,000 fine for failing to maintain an adequate number of in-network anesthesiologists at its contracted hospitals in four counties, according to Modern Healthcare. After patients receiving out-of-network bills for anesthesiology services contacted the insurer about balance bills, Humana has agreed to hold enrollees responsible only for the in-network charges and not for the balance bills. Texas has lagged in addressing the surprise billing issue after becoming one of the first states to establish a mediation system for resolving these billing disputes in 2009, which has only been accessed by 3,824 people since its inception. More than 300 Texas hospitals did not have a single emergency physician who was in-network with at least one of three major carriers, Humana, Blue Cross Blue Shield and UnitedHealth Group. Lawmakers have proposed legislation that would require insurers and providers to resolve out-of-network bills while shielding consumers. 


Texas | Aug 2, 2018 | News Story

Nail Salon Workers Helped Us Turn the Idea of Community-Centered Health Into Reality

After seeing firsthand the repeated health problems faced by nail salon workers, leadership at the HOPE Clinic and the Episcopal Health Foundation tried to find out why. According to an article in STAT, researchers visited nail salons across the Houston area and interviewed almost 400 workers about their physical and mental health, exposure to chemicals, access to healthcare, workplace safety, and more. The survey showed that a large number of salons use potentially hazardous chemicals and workers suffered from repeated health problems. As a result of the survey, HOPE clinic created a curriculum focusing on health education in nail salon schools. 


Texas | Jul 25, 2018 | News Story | Rural Healthcare

Rural Texas is Struggling to Keep Doctors. One University Wants to Change That by Opening a Medical School

Huntsville-based Sam Houston State University thinks it can address Texas’ critical shortage of doctors in rural parts of the state. According to an article in The Texas Tribune, the school seeks to open a college of osteopathic medicine to recruit students from rural areas. An official at the proposed school emphasized that patient-centered care is one of the main tenets of osteopathic medicine. The school is still waiting for approval from the Higher Education Coordinating Board.  


Texas | Jul 16, 2018 | Report | Health Costs

Many Texans are Skipping Needed Healthcare Because of the Cost

More than half (55 percent) of Texas residents say it is difficult for them and their family to afford healthcare, and roughly six in ten say someone in their household has postponed or skipped medical care in the past year because of the cost. According to new survey data from the Kaiser Family Foundation, problems with healthcare affordability are much more commonly reported among Texans with lower incomes, those with health problems and the uninsured. In addition to general difficulty affording care, about four in ten Texans (38 percent) say they or someone in their household had problems paying medical bills in the past 12 months. 


Texas | Jul 5, 2018 | News Story

Texas Clinics Busting Traditional Silos of Mental and Physical Health Care

Integral Care in Austin offers patients a holistic approach, with access to physical health care and a program to manage chronic disease, on top of regular psychiatric care, according to Kaiser Health News. After a 2007 survey conducted by the Agency for Healthcare Research and Quality indicated that 1 in 8 emergency department visits were related to a mental health or substance abuse diagnosis, the federal government has turned to coordinated care to help relieve the problem. In Texas, 64 of the state’s 73 federally qualified health centers offer some mental health services compared to just 36 a decade ago, according to data from the Health Resources and Services Administration. However, challenges recruiting mental health professionals remain. 


Texas | Jun 14, 2018 | Report

Texas Residents' Views on State and National Health Policy Priorities

Roughly two-thirds of Texans say the state government is currently not doing enough to make sure low-income adults can get the healthcare they need, and the same share says the state should expand its Medicaid program, according to a Kaiser Family Foundation survey. One of 17 states that did not expand Medicaid under the Affordable Care Act, Texas has the largest number of uninsured residents among U.S. states (21 percent of adults between the ages 19-64). An almost equal number of respondents said top priority should be given to lowering what individuals pay for care (61 percent), reducing maternal mortality (59 percent), lowering prescription drug costs (56 percent), increasing access to health insurance (55 percent), and increasing funding for mental health programs (54 percent).


Texas | Jun 1, 2018 | News Story

Texas Blues Insurer Delays New ER Payment Policy

Blue Cross and Blue Shield of Texas agreed to delay a new payment policy aimed at reducing its emergency department (ED) claims costs while Texas insurance regulators review the policy. According to an article in Modern Healthcare, under the policy, the health plan's retail and HMO plan members who visit an out-of-network ED, for conditions that are not serious or life-threatening, would potentially be required to foot the entire bill. The policy would apply to about 500,000 of the insurers' members. Blue Cross Blue Shield developed the policy in response to the number of its members going to the ED for the sake of convenience for conditions like head lice, immunizations and school physicals. 


Texas | May 3, 2018 | News Story | Surprise Medical Bills

Texas Ruling on $11,000 ER Bill May Have Long-Lasting Effects, Experts Say

The healthcare industry is closely watching a recent decision by the Texas Supreme Court that some say could have broader implications on how hospitals and health insurers negotiate reimbursement rates, according to an article in Dallas News. The court sided with an uninsured woman who was billed $11,037 after an emergency department visit. The justices said that in order to prove her bill was “reasonable” compared with what an insured patient would be billed, the medical center would need to the court with details about the discounted rates it had with health insurers--data that’s generally claimed to be proprietary and confidential.


Texas | Feb 5, 2018 | News Story

In Texas Health System, Bundled Payments Saved More Than $5K per Joint Replacement

Medicare spending for joint replacements have increased by about 5 percent in recent years, but bundled payments could be a way to reverse that trend, according to an article in Healthcare Analytics News. In the Baptist Health System in San Antonio, Texas, participation in a series of CMS bundle programs cut the costs by more than 20 percent over the course of 7 years. From 2008 to 2015, the system participated in a pair of initiatives: the Acute Care Episodes and the Bundled Payments for Care Improvement program. Nearly 4,000 joint replacement of the lower extremity were documented with average savings of more than $5,000. In 3,738 cases without complications costs fell from an average of $26,785 per episode to $21,208; in the 204 patients who experienced complications the average dropped from $38,537 to $33,216.  


Texas | Jan 29, 2018 | News Story

The ‘Frequent Flier’ Program That Grounded a Hospital’s Soaring Costs

An article in Politico describes how a hospital in Dallas started a program to help the undeserved population. Parkland Center for Clinical Innovation (or PCCI) was a joint effort with community partners such as homeless shelters and food pantries to build a network of what was hoped would eventually be hundreds of community-based social services around Dallas County, with Parkland Memorial at the center of it. A sophisticated software platform would enable the hospital to easily refer homeless people discharged from its emergency department to shelters and pantries, and to let social workers at those places see what their clients were doing: whether they were filling their prescriptions, or getting healthy food, or had a place to sleep, or money for the bus. It would be so much cheaper to meet those needs outside the medical system than to pay for the consequences inside it. Two years into the program, evidence is mounting that PCCI is working.


Texas | Jan 10, 2018 | News Story

Houston accomplishes big health-care win with housing for homeless

Having the city pay someone's rent might seem like a costly way to address homelessness. But add health care to the mix and the equation starts to look different: Health care and housing experts have long known that keeping someone off the streets is often the most straightforward way to keep him or her out of the emergency room, one of the most expensive places to get health care. According to an article in Politico, a program called Integrated Care for the Chronically Homeless, is a four-year effort by the city of Houston to solve that this issue. But for the program to grow beyond a localized short-term project into a permanent statewide program, its proponents will have to convince Texas’ conservative lawmakers that the framework will save the state money in the long run. They have until 2019, when the state Legislature next convenes, to convince lawmakers to let the state’s Medicaid program, which covers health care costs for the homeless, to spend some of those funds on housing support instead.


Texas | Nov 11, 2017 | News Story

Redesigning Hospitals with Patient Experience in Mind

The clinics at UT Health Austin all have an atrium, a cafe and a library with an outdoor deck. The main concourses are dotted with furnished alcoves. But according to Modern Healthcare, the one thing they don't have: designated waiting rooms. That's because patients can either go straight to their rooms, if available, or if they arrive early, to any of those decidedly non-institutional spaces, where in the future they'll be buzzed via a smartphone app. The clinics' design may be among the more futuristic in the country, but it points to a practice sweeping all sorts of healthcare systems: using technology to facilitate a better patient experience, rather than emphasizing cosmetic changes such as waterfalls and chandeliers. Whether it's better heating, ventilation and air conditioning, large screens in patient rooms, or comfortable places to wait for an appointment, design and technology are playing a big role in patient care—and not just in the strictly medical aspects of it but in the environmental and emotional aspects as well.


Texas | Oct 26, 2017 | News Story

Transforming Healthcare to Incentivize Value and Quality over Volume

According to a news article in the San Antonio Business Journal, Blue Cross and Blue Shield of Texas discussed how they will be implementing a value-based care model. The first step in providing value-based care is giving physicians access to the resources and tools they need to better manage patient interactions as well as their financial operations. This allows physicians to focus more on treating patients and delivering the highest possible quality of care. Blue Cross will be partnering with The Texas Medical Association to support individual doctors by providing them with tools that help improve their practices and patient interactions, as well as their understanding of the cost of tests and of different facilities.


Texas | Oct 26, 2017 | News Story | Drug Costs

Pfizer Loses Lawsuit Against Texas Agency that Provided Drug Cost Data to Senators

According to an article in Dallas News, Texas legislators are entitled to details about how pharmaceutical giant Pfizer priced drugs offered through the state's expansive Medicaid program after a judge’s ruling. State lawmakers have been seeking methods to offset soaring costs and generate hundreds of millions in savings from Medicaid programs.


Texas | Aug 28, 2017 | News Story

How Does Texas Fare in the Commonwealth Fund Scorecard on State Health System Performance?

A report from the Episcopal Health Foundation found that 23 percent of Texas adults and 10 percent of children in the state still lack health insurance. The report's authors blame Texas' decision not to expand Medicaid and its restrictive eligibility standards for the state's high uninsured rate. They also say that the state's Hispanic population is hardest hit, with 60 percent of Hispanic children and half of Hispanic adults lacking a medical home and no usual source of care.


Texas | Apr 1, 2017 | News Story | Health Costs

Retired Texas Teachers' Healthcare Premiums Projected to Double

By September 2017, retired teachers in Texas may be paying double or even triple for their healthcare premiums, according to KTXS. There is a projected $1.3-$1.5 billion shortfall in the Texas retirement system, attributed to increasing drug costs, emergency department costs, chronic conditions and a growing retiree population.


Texas | Mar 13, 2017 | News Story | Health Costs

Lawmakers Take Aim at Healthcare Costs in Push to Protect Consumers

Amid the flurry of last-minute bills submitted before the end of the current legislative session are a number that target healthcare pricing practices and aim to create more transparency around costs, according to the Laredo Morning Times. The legislation targets freestanding emergency rooms that have proliferated in Texas since 2009, many of which are out-of-network for most insurance plans, and improving the availability of information about healthcare costs in an effort to bring charges down and create a more transparent market for medical services.


Texas | Feb 22, 2017 | News Story | Surprise Medical Bills

Surprise Medical Bills Hit Huge Numbers of Texans

A staggering number of Texas patients who go to in-network emergency departments still get hit with out-of-network fees, according to WFAA. A study by the Center for Public Policy Priorities found 40 in-network hospital emergency departments (EDs) where patients with Blue Cross Blue Shield, Humana or UnitedHealthcare are almost guaranteed to get a surprise medical bill, since 95 percent of their doctors are out of network. The report also identified 23 in-network hospital EDs at which surprise billing rarely happens.


Texas | Dec 1, 2016 | Report

Economic Impacts of Health Disparities in Texas

Health disparities for people of color in Texas cost families, employers, insurers and government an estimated $1.7 billion in excess medical spending and $2.9 billion in lost productivity, according to a report from the Episcopal Health Foundation and Methodist Healthcare Ministries. If current conditions remain, additional medical spending will increase to $3 billion per year by 2050. Notable racial disparities include: health status, rates of diabetes, infant mortality and uninsured rates. As of March 2016, nearly one-third of nonelderly adult Hispanics in Texas remained uninsured, along with 14 percent of Blacks and 10 percent of Whites. Recent studies of individuals who are newly insured have shown that those who gain coverage receive more care and experience better physical and mental health and improved financial stability. The study was conducted by Altarum, in partnership with George Washington University and Johns Hopkins University.


Texas | Nov 18, 2016 | News Story | Drug Costs Price Transparency

Pfizer Sues Texas Agency Over Drug Price Disclosure

The Texas Health and Human Services Commission is being sued after providing drug pricing data to two Texas Senate committee heads, according to Modern Healthcare. The Texas Attorney General claims the disclosure was required under Texas law, yet Pfizer insists the action violated federal law.


Texas | Sep 7, 2016 | News Story

The Affordable Care Act’s Effects on the Formation, Expansion, and Operation of Physician-Owned Hospitals

Physician-owned hospitals in Texas experienced significant pre-ACA increases in the formation, physician ownership and physical capacity of physician-owned hospitals in anticipation of changing policies, according to Health Affairs. After ACA implementation, hospitals generated revenue by leveraging their assets; for example, increasing the number of staffed beds and surgeries performed per operating room. Researchers also found that ACA restrictions effectively eliminated the formation of new physician-owned hospitals.


Texas | Aug 29, 2016 | News Story

Words to Live By: Baylor Scott and White to Text High-Risk Patients

In an attempt to better reach high-risk patients, Texas providers have started connecting with patients via text message, according to the Dallas Morning News. The initiative, in addition to the transportation programs already in place, is expected to decrease no-show rates for office visits.


Texas | Aug 3, 2016 | News Story

Bundled Payments Generate $6.1 Million for Texas Hospital Group on Joint Replacements

A Texas hospital group generated an average savings of $284 per joint replacement in a demonstration that features a bundled payment for joint replacements, according to The Commonwealth Fund.  Physician were guaranteed Medicare payment rates and offered bonuses of up to 25 percent. Program success relied on physician engagement, which was achieved through establishing individual and group gainsharing thresholds supported by transparency for physician level cost and quality data.


Texas | Jun 10, 2016 | News Story

The Texas Medical Association Begins to Unveil Balance Billing Strategy

The Texas Medical Association’s Task Force on Balance Billing has begun to pressure insurers to broaden their networks to cut down on balance billing. Insurers have been increasingly limiting their network sizes to manage losses. As a result, physicians are less effectively negotiating rates with insurers.


Texas | Jun 10, 2016 | News Story

Texas Hospital Association Releases Standardized Codes, Encourages Adoption

New standardized emergency codes released by the Texas Hospital Association are intended to boost safety, reduce errors, encourage transparency, meet national recommendations, and reduce confusion for providers practicing at many locations.The codes are voluntary for individual hospitals to implement.


Texas | Mar 15, 2016 | News Story

Nearly Half of ACA Sign-ups in Texas Are New

The Houston Chronicle: Of the 1.3 million Texans who signed up for health insurance in the Affordable Care Act’s 2016 enrollment period, nearly half were new customers, a good sign in the nation’s least insured state.


Texas | Aug 25, 2015 | News Story

Texas is Worst in Health Insurance, Third Worst in Healthcare Quality

A National Healthcare Quality and Disparities Report by the Agency for Healthcare Research and Quality identified Texas as a poorly performing state based on 200 criteria, according to The Dallas Observer. Texas falls significantly below the national average in such categories as patient safety, healthy living, HIV/AIDS, and nursing homes.


Texas | Jul 17, 2015 | News Story

Report: Healthcare Price Transparency in Texas Gets an “F”

A report by the Health Care Incentives Improvement Institute has scored Texas as an F for the third time in a row, according to Healthcare Daily. There has been little movement to improve the failing grade, a few bills failed in 2013 and no transparency bills were filed in 2015. The Texas Hospital Association provides chargemaster prices on txpricepoint.org; however, the tool is likely to be useful to consumers who rarely pay chargemaster price as a result of insurance-provider negotiations.


Texas | May 4, 2015 | News Story

Survey: 42% of Texans support single payer

The Houston Chronicle: Not only do the vast majority of Texans think having insurance is important for them and their families, seven in 10 also want health coverage for everyone else.

And they are willing to dig into their pockets to pay for it.


Texas | Apr 13, 2015 | News Story

Texas Medical Panel Votes to Limit Telemedicine Practices in State

New York Times: Taking a stand against the rapidly expanding use of telemedicine, the Texas Medical Board voted Friday to sharply restrict the practice in the state, siding with organizations representing doctors over the objections of industry representatives who said the new rules would reduce access to medical care at a time of increasing demand.


Texas | Feb 19, 2015 | News Story

Legislation Introduced to Protect Patients from Surprise Medical Bills

A partnership of statewide consumer and healthcare advocacy groups today applauded the filing of legislation in the Texas House of Representatives to protect patients from getting surprise medical bills after health emergencies.


Texas | Feb 19, 2015 | News Story | Surprise Medical Bills

Texas Consumer Groups Applaud Legislation to Stop Surprise Emergency Medical Bills

Statewide consumer and healthcare advocacy groups applauded the filing of HB 1638 legislation in the Texas House of Representatives to protect patients from receiving surprise medical bills from services at emergency rooms. Leaders of AARP, Consumers Union, National Multiple Sclerosis Society, Center for Public Policy Priorities, and the American Cancer Society Cancer Action Network are calling on lawmakers to hold hearings on HB 1638 and to pass the measure.


Texas | Sep 15, 2014 | Report

Surprise Medical Bills Take Advantage of Texans

New regulations that took effect in July 2013 direct Texas insurers to – for the first time – publish PPO plan out-of-network service data by network hospital for specific hospital-based physician types, including emergency room doctors.

Specifically insurers must publish the percentage of dollars billed as out-of-network by emergency room physicians within each in-network hospital as well as identify any in-network hospitals that have no in-network emergency room physicians at their hospital. An analysis of that data found that for the three largest insurers, between 21% and 56% of in-network hospitals had no in-network ER docs -increasing the likelihood of getting a surprise balance bill from those hospitals.

Texas | Aug 28, 2014 | News Story

Texas Patients Shifting from ER to Urgent Care Centers

New York Times: An increasing number of Texans are choosing to use urgent care centers that are popping up in strip malls and shopping districts—and is problematic for Texas hospitals. Hospitals say they are competing with the clinics for the same pool of insured Texans, at a time when they are also getting less money to cover the cost of treating uninsured patients.


Texas | Jun 1, 2009 | News Story | Health Costs

The Cost Conundrum: What a Texas Town Can Teach Us about Healthcare

Atul Gawande, a physician who visited McAllen, Texas, discovered a broken healthcare system as described in The New Yorker. Overutilization, rather than population health and quality, seemed to explain the vast amount of spending, making the city one of the most expensive healthcare markets in the country.