Texas Blues: Insurer Makes Push into Primary Care

It’s getting tougher and tougher to distinguish between insurers and providers — and even more so after Blue Cross and Blue Shield of Texas became the latest payer to move into primary care.

Seizing greater control over where its members seek care, attempting to reduce costs and increase access, the Texas Blues along with its venture capital arm HCSC Ventures will team with medical care provider Sanitas USA to open 10 primary care medical centers in Dallas and Houston. The centers will open in January 2020, offer expanded evening and weekend hours and some will be open year-round. The centers will deliver primary and urgent care, lab and diagnostic imaging services and care coordination, along with wellness services and disease management programs.

Forbes reports the venture will evaluate future expansion in the five-state region where HCSC owns Blues plans on a “market-by-market basis.”

Humana has taken a similar path with its Covina brand, which now operates more than 230 primary care clinics. UnitedHealth Group has also been buying clinics and practices for years through its health services business Optum. And CVS’ move last year to acquire Aetna has many ramifications for primary care as the retailer plans to offer various health services to Aetna plan members and its other customers.

As payers move to become more integrated with primary care providers, they believe they can better manage quality and costs. An AHA Center for Health Innovation Market Insights report on Leading the Charge for Disruptive Innovation outlines moves hospitals and health systems should make to convert challenges like this to opportunities.