Managed Care

TDI Proposes HMO Rule Rewrite - 12/01/2016

Whenever a state agency undertakes a wholesale overhaul of a set of regulations important to physicians and patients, TMA examines the proposal extremely carefully. That's why a TMA staff team spent weeks studying the Texas Department of Insurance's (TDI's) Oct. 7 proposed repeal and rewrite of the entire regulatory chapter on HMOs.

TMA PracticeEdge Moving Forward With Five ACOs, CCM, GPO - 06/23/2016

After review from its Board of Managers, TMA PracticeEdge now has plans to help five groups of TMA physicians implement accountable care organizations (ACOs). In addition to two previously announced ACO projects in Houston and Central Texas, TMA PracticeEdge is poised to move ahead with three more. The five projects include more than 170 physicians and cover 26,000 patient lives.

Adverse Impact on Quality of Care - 06/13/2016

A majority of physicians (71 percent) tell TMA in our latest survey that in the past year there was at least one instance in their practice when the quality of patient care was impacted adversely by the operating policies or utilization controls of a private health plan. The most frequently cited causes were limited networks (83 percent), formulary limitations (80 percent), coverage limitations or denials (73 percent), and treatment delays (57 percent).

UniCare Leaves Texas and Endorses BCBSTX - 05/13/2016

UniCare leaves Texas and endorses BCBSTX.

Some Health Plans Pay Then Take it Away - 05/06/2016

Some health insurers look for reasons to rescind a patient’s health insurance so they can avoid paying his or her medical bills. They cancel the policy and take back all payments made under the patient's policy. TMA wants to protect Texas patients from this ploy.

Spend Patients’ Dollars on Health Care, Not Elsewhere - 05/06/2016

Physicians believe health insurers must be more accountable and more transparent about how they spend patients’ premium dollars. TMA suggests a consistent reporting formula for the so-called medical loss ratio so patients shopping for health insurance could easily compare the performance of health plans.

TMA Physicians and Legislators: “Patients Have a Right to Know” - 05/06/2016

“We believe our patients have the right to know what’s covered in their insurance,” said Josie R. Williams, MD, TMA’s president. “Our patients also have the right to know which doctors and hospitals are in their network, how much extra they will have to pay for the health care services they receive, and why they have to keep paying more for health insurance.”

TMA Says Patients Need Easy-to-Read Health Insurance Labels - 05/06/2016

TMA is working with state legislators to require insurers to simplify health plans and make them as easy to understand as reading what’s in a can of soup.