Five million Texans don’t have health insurance – the most of any state. Texas also has the highest uninsured rate in the country, at over 17%. Many don’t have insurance because they can’t afford it, or their employers don’t provide it. Insurers say coverage is expensive because health care is expensive. But what if the insurer is also the health care provider? That’s something with which Blue Cross Blue Shield of Texas is experimenting.
“They want to partner with somebody who provides low-cost, high quality care, especially on preventive care,” Schnurman says. “They call that [the] cornerstone of getting more value when it comes to health care spending.”
These new health care clinics won’t be urgent care centers or freestanding emergency rooms, though Schnurman says those types of facilities were inspiration for Blue Cross. In fact, he says those businesses have hurt Blue Cross’ bottom line in recent years because many people were going to them for routine care – for ailments that could have be treated by a primary care doctor at much less expense. He says the new health care centers will be like a “medical home.”
“They will start with extended hours, including the weekend. They hope to eventually go to 24-hour service,” Schnurman says. “They will treat urgent care but they’re primarily aimed for primary care.”
There is a need for more clinics like these, especially among the uninsured. He says poor access to primary care is also prevalent among Texas’ Hispanic community and people with lower incomes.
“More than one in four Texans say that they don’t have any place to go if they get sick,” Schnurman says. “They either have no usual place, or they just go to the ER.”
Avoiding the emergency room matters because emergency care is much more costly to the patient and the insurer.
And Schnurman says the Blue Cross clinics would be open to everyone with Blue Cross insurance, and only those with the most restrictive, least expensive plans would face limits on where they can go for care.
“They’re choosing to incentivize you. They’re trying to say to you, It’ll cost you less to come here, so please do,” Schnurman says.
The idea is to keep prices low in order to get more people to use primary care more often, for things like vaccinations, pink eye, strep throat – all common things that can be cared for more easily and cheaply in a primary care clinic.
Blue Cross is planning to open 10 clinics in the Houston and Dallas areas. Schnurman says those clinics alone won’t change Texas health care, but they are part of a larger trend.
“The explosion of these retail clinics – the combination of convenience and, really, lower costs, is really attractive,” Schnurman says.
Blue Cross is following pharmacy giant, CVS – a leader in so-called retail health care.
“They’re creating 1,500 retail – what they call ‘health hubs’ inside their pharmacies,” Schnurman says.
Support for Texas Standard’s ”Spotlight on Health” project is provided by St. David’s Foundation.
Written by Caroline Covington.