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Texas doctors band together to fight for independence


When physician groups in the Dallas-Fort Worth area started to feel the pressure of value-based contracts, they realized quickly that banding together was the best way to maintain autonomy while staying competitive in a changing market.

When physician groups in the Dallas-Fort Worth area started to feel the pressure of value-based contracts, they realized quickly that banding together was the best way to maintain autonomy while staying competitive in a changing market.

Their solution was a physician-led clinically integrated network, and what started as an alliance of a couple hundred independent physicians has ballooned to more than 500 primary care and 600 specialists caring for more than 75,000 patients under the TXCIN (pronounced “Texan”) moniker. At its July 1 launch, TXCIN was associated with 1,135 practices.

Membership is open to all physicians in North Texas.. By signing up, members agree to use a common technology platform that pulls data from electronic health records and other systems into a common format, tracks data and helps the group improve care across the organization. Performance metrics, physician coordination and a commitment to improving care across the network are requirements for all members, but the technology platform integrates with existing systems, and improving patient outcomes generates more interest from insurance providers looking for the most cost-effective delivery model.

While members must follow the network’s rules, physicians remain independent. “Doctors get to choose which contracts to get into,” says Jim Walton, DO, MBA, president and CEO of TXCIN. “There is peer review, but we are governed by independent physicians who had to make similar decisions to participate in value-based contracting like our members.”

The group focuses on cost reductions using tools and clinical guidelines but does not participate in rate negotiations or reimbursements – meaning it does not require regulatory review. Physicians from all types of practices are eligible to join.

John Robert Bret, MD, a cardiologist with HeartPlace and member of TXCIN, says the integration of independent physicians is a natural evolution. “There’s a battle for healthcare dollars, and if there is not a large enough army behind you, it can be difficult to compete,” says Bret. “Joining a group like TXCIN is not an absolute for survival, but it makes us relevant in the marketplace.”

Next: Importance of involving specialists


Payers agree. The group has contracts with Blue Cross Blue Shield and Cigna, and is looking to add United Healthcare later this year. “I think insurers see working with independent physicians as an opportunity for real cost savings,” says Bret. “They can work with physicians who don’t have to answer to anyone.”

Physicians in TXCIN gain access to insurance networks but don’t have to change the way they practice. Doctors use the same infrastructure they’ve always used, with processes like billing, collections and other internal processes remaining the same. “This is different than other models where, when you become part of their system, you have to play by their rules,” says Bret. “None of my rules have changed. I manage my practice the way I want to; we are just sharing information across all platforms in an unbiased manner, and I think you’ll see true cost savings.”

The shared data in the system will identify best practices to help doctors provide more efficient care while reducing costs–which is vital with MACRA requirements set to affect physician pay. The system also helps identify the most effective physicians within the group, directing specialist referrals to the best-performing doctors within TXCIN.

Walton says it was important to involve specialists as part of TXCIN, because they often control a lot of a consumer’s healthcare spending. “Consumers often self-refer to specialists, and because there is a shortage of primary care doctors in our area, the specialists become de facto primary care providers,” says Walton. “They carry an enormous influence in the spending of healthcare dollars, so it makes sense to bring them into the conversation at the same time as the primary care physicians.”

The long-term goal of the organization is to provide doctors not only with the information and performance measures they need to improve their clinical guidelines, but to provide patients with the data they need to make informed decisions regarding the best ways to spend their healthcare dollars.

Next: As the marketplace changes


“As the marketplace moves toward health plans where the consumer is responsible for spending, we’re focused on being the most efficient, so when a consumer makes a decision, he or she knows they are not getting unnecessary tests, just the best treatment,” says Walton.

TXCIN illustrates that independent physicians can come together in a neutral organization with common values that all doctors can agree to, while still maintaining their independence. Walton says the group’s goal is to provide physicians with an option for transitioning to value-based care that doesn’t take away their independence or make them feel threatened by changes in healthcare contracts.

“This is one of the more exciting opportunities we’ve been exposed to,” says Bret. “This gives us the opportunity to make a difference, which is really all we want. It gives us the opportunity to bring meaningful cost reduction to the market while maintaining quality care.”

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