Don’t Mess with Texas


TexasLast week I wrote about the Trivergent MSO in Maryland, (“Canary in the Coal Mine”) and their  overarching structure which associates three distinct community hospital members.  Well, it appears I’ve discovered a trend in the form of the Texas Care Alliance (TCA), headquartered in Dallas.  According to their summary strategic plan, TCA was created in March 2013 as a “central organization” or, in IRS language, a 509(a)(3) Type 1 supporting organization.  I never heard of that either, but their collaboration is meant to leverage and support their strengths.  According to their website, it is  designed to build expertise in population health management, capitalize on economies of scale, and accelerate the rapid adoption of clinical and operational best practices.  I can certainly resonate with a mission that has population health in the lead position!

I was privileged to share the stage with  one of my best pals, Dr. Ian Morrison, a nationally regarded healthcare futurist, who acted as the kick-off speaker and moderator for a recent program in Dallas for TCA’s leaders.  In attendance were many of the board members from the constituent hospitals, clinical leaders, and most of the senior administrative leaders, who came together for a day and a half to discuss  how to operationalize the population health management agenda.

I was impressed by TCA’s commitment to value for its members.  A key membership value driver, which I used as the jumping off point for my presentation, is the ability to deliver “measurable, safe, quality comprehensive care to defined populations using evidence-based best practices.”    My role was to help the non-clinical board members appreciate just how tough it’s going to be to get disparate medical staffs, across an entire state the size of Texas, in multiple community hospitals, to standardize their approach to care.  I was heartened to learn that TCA has numerous clinical initiatives, including task forces and committees such as the Best Care committee, the Clinical Effectiveness task force, and the Practitioner Leadership Council.  The only way we can accomplish true clinical integration across a multi-hospital, non-owned membership system model, is through this type of physician engagement in the process.

Finally, I was very impressed by George Terrazas, the President  of TCA, who laid out a five year plan to implement population health with six key phases.  I can’t share all of the proprietary details, but George has it right!  They’re going to risk-stratify the patients, give feedback to doctors about their performance, focus on the benefit design for their own employees, and, in a word, implement all the key operational components that are prevalent in the marketplace.  A member-driven coalition sounds like a pretty good model for distilling the best that each system and each individual hospital has to offer.  In the end, you’d better  not “mess with Texas”!

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