Blue Cross Blue Shield of Texas and Southwestern Health Resources Reach New Contract
Blue Cross Blue Shield of Texas and Southwestern Health Resources settled their dispute just hours before the contract expired, providing relief to approximately 230,000 Blue Cross members in North Texas who were nearly left without their in-network doctor.
The resolution came on the day the contract expired, similar to other disputes between SWHR and BCBSTX resolved in 2016 and 2018. The terms of the multi-year contract are confidential.
Last week, Blue Cross emailed brokers saying SWHR was asking for a $900 million refund increase over the next 32 months, which Blue Cross said was not in line with what it said. other health systems had requested in recent contracts.
The new agreement will keep UT Southwestern and Texas health resource providers in the network for members of BCBSTX Par Plan, Blue Choice PPO, Blue Essentials, Medicaid, Medicare Advantage (PPO), Medicare Advantage (HMO) and Blue Advantage HMO.
“We appreciate the care SWHR provides to our members,” BCBSTX president Jim Springfield said in a statement. “We stood up for our members and were able to reach an agreement in their best interests. The agreement reflects our mutual commitment to our members, clients and SWHR patients having access to affordable, high-quality care. As an industry leader in customer-owned health insurance in Texas for over 90 years, we are excited to continue our long-standing relationship with SWHR.
Large provider networks almost always resolve disputes with health plans. However, the Houston-area Memorial Hermann Health System in Houston was unable to resolve its dispute with Blue Cross in March, leaving those providers out of the network for Blue Cross members for 10 days.
Just days ago, divisional senior vice president of healthcare delivery for Blue Cross Blue Shield of Texas, Shara McClure, said the two sides were still in discussion but very far apart just days before the end. Despite the countdown, both sides remained hopeful.
“This agreement provides BCBSTX members with continued access to providers in the Southwestern Health Resources network, which includes physicians and facilities at UT Southwestern and Texas Health Resources, allowing us to provide our highest quality care to hundreds of thousands of patients who give us the privilege of their trust and confidence,” THR, UTSW and SWHR said in a joint statement.
Dallas-Fort Worth is already one of the nation’s most expensive major metro areas for health care and has one of the highest medical debts in the business. Many health systems in the region, including Texas Health Resources and Children’s Health (which employs doctors from UTSW), are more cost effective than average for fortune 500 businesses in the region. Still, UTSW’s William P. Clements Jr. University Hospital has been named DFW’s top facility for several years by US news and world report.
“We hope we can get along, and we’re working on it,” McClure told me last week. Apparently the effort paid off.
Will is the editor of CEO magazine and editor of D CEO Healthcare. He wrote about health care…