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George Terrazas


Texas Care Alliance

George serves as President of Texas Care Alliance, an organization comprised of 12 leading health care systems across the state of Texas. In this role, he works with member organizations to facilitate the individual and collective pursuit of the triple aim objectives – improving the experience of care, improving population health, and reducing the per capita costs of care.

HTA - Tell us about your personal/professional background?

I am originally from Fort Stockton, TX, a small town located in far West Texas with a population of about 8,000 people.  I attended the University of Texas at Austin for my undergraduate studies and Baylor University for graduate school, where I received a Master of Business Administration with a Specialization in Healthcare Administration.  I began my career at Baylor Health Care System in Dallas (now Baylor Scott & White Health) after being selected for  the Boone Powell Sr. Fellowship in healthcare administration.  Over the course of a year, this program provided an opportunity to explore the various functional units of a large integrated health system, and provided a great foundation for a career in healthcare administration. 

After completion of the fellowship, I served as a management consultant at Baylor Health Care System, managing various strategic business support projects on a corporate/system level.  Prior to my current role with Texas Care Alliance, I also had an opportunity to work with a boutique healthcare investment bank, which was a great experience and provided a critical skill set for much of what I do today within Texas Care Alliance. 
HTA - What impact has uncertainty about the future of the ACA had on the Texas Care Alliance?

The fundamental challenge for healthcare providers is readiness in an uncertain environment.  At a high level, the industry faces complex challenges due to unsustainable spending, significant regulatory uncertainty, a rapidly changing reimbursement landscape, a shift toward consumer centric strategies, and of course, a transition from fee-for-service to value-based care.  According to the Centers for Medicare & Medicaid Services (CMS), in 2016 U.S. health care spending grew 4.3 percent to $3.3 trillion or $10,348 per person. By some estimates, as much as 20-25% of that cost is considered wasteful spending, driven primarily by administrative complexity, clinical waste, ineffective use of information technology, and overutilization, among other factors.   

While the ACA is driving significant dialogue and activity in the value based healthcare space, much of the demand for lower-cost solutions and better value is driven by the market.  Consumers, employers, and insurers are actively seeking methods to lower their healthcare costs, which is a trend that will continue regardless of the future of the ACA.

TCA is working with our health system members to develop population health strategies and advance risk capability because we believe in the Triple Aim – improving population health, enhancing the patient experience of care, and lowering the per capita cost of care.  At a time when the only certainty is significant change, it will be important for leaders to continue to focus on delivering better-quality care at a lower cost.

HTA - Was it hard to convince other health care organizations about the importance of collaborating with each other?

For many of our TCA members, collaboration has been a key strategy as they, like other health systems across the country, explore the best route for navigating the changing landscape of healthcare.  As with other industries, the journey to stay competitive, valuable, and ultimately relevant to the market is a continuous process.  Healthcare leaders must continue to search for innovative ways to position their organization for long-term sustainability. 

For many organizations, such as those within TCA, this is achieved in part by a thoughtful approach to strategic partnerships.  These collaborative models are taking shape across the country as more health systems respond to industry challenges in their pursuit of financial and operational viability.   
HTA - A goal of your organization is to improve care and reduce costs. Do you have any evidence that you can share?

A key strategy for healthcare organizations looking to enter the population health space while managing appropriate levels of risk is a deliberate focus on the performance of their own employee health plans.  For our health system members, the well-being of our healthcare workforce and the communities we serve are intrinsically linked.  In addition, for those organizations that are self-funded, they are already at-risk for managing the health of their employee and dependent population.  At TCA, we’ve focused heavily on bench-marking employee health plan performance across the 12 health system organizations to identify opportunities for improvement in the areas of cost, quality, and utilization. 

Our largest member, Baylor Scott & White Health, through a series of deliberate interventions and strategies, has reduced hospital admissions by 22% and saved more than $50 million in total medical costs among their employee health plan population.
HTA - For your stakeholders, what have been some challenges and success stories in communicating to your clinical leader communities, the opportunities in digital health and value-based care?

Access to meaningful, relevant, and accurate data is one of the critical elements for success in value-based care.  It is also one of the most challenging areas for healthcare providers to manage, especially since healthcare is by nature a very fragmented industry.  For example, a past study of Medicare claims found that each year the typical Medicare beneficiary saw a median of two primary care physicians and five specialists, collectively working in four different practice settings.  Medicare patients with multiple chronic conditions saw as many as three primary care physicians and eight specialists in seven different settings. 

These complexities are a significant challenge for patients, providers, and the industry as a whole, but also a great opportunity to leverage new innovations in technology and data to improve care coordination.  As we look for new ways to improve and simplify care, these strategies must be driven by our clinician leaders across the industry who are at the forefront of the shift to value-based care.  Across TCA, each one of our organizations is currently pursuing their own value based care strategy in programs such as the Medicare Shared Savings Program (MSSP), the patient-centered medical home (PCMH), and models such as the Comprehensive Care for Joint Replacement (CJR) program, among others.  If there is a common message from our clinician leaders across TCA, it’s that participation in these various programs has underscored the importance of digital health and innovative technology that supports access to meaningful data for the improvement of quality, cost, and efficiency metrics and performance.
HTA - To what extent are Texas Care Alliance partners using new and emerging technologies to improve the delivery of care?

Throughout Texas Care Alliance, many of our health system members are leveraging emerging technologies to improve the delivery of care.  In some instances, member organizations are using emerging technologies to utilize social determinants of health and other behavioral health insights to provide a more comprehensive view of the patient population. 

These insights are then used to enhance effective patient outreach in order to enhance and improve health outcomes in the community.  Over time, by leveraging these technologies, the precision of risk identification and stratification will help our health organizations as they begin to take on more clinical and financial risk.
HTA - How do you learn? What are you reading?

There are several great resources for those interested in learning more about the healthcare industry – Modern Healthcare, Health Affairs, Healthcare Financial Management Association (HFMA), the Journal of Healthcare Management, Becker’s Hospital Review, the Journal of the American Medical Association (JAMA), New England Journal of Medicine (NEJM), and Kaiser Health News (KHN), to name a few.

HTA - Where do you see the Texas Care Alliance in 5-10 years?

Strategic partnerships of different types will continue to be the future of our healthcare system – this may range from mergers and acquisitions (M&As) to affiliations, joint ventures, clinical integration networks, and regional collaboratives, as well as arrangements with physician practices, urgent care and retail clinics, and pre-and post-acute care providers, community organizations, and payers. 

As these strategies evolve, the members of TCA will continue to search for innovative ways to deliver value to providers, patients, and the communities we serve.  As the shift to value continues, our goal is to position our hospital, health system, and clinicians for success by creating and maintaining future relevance and long-term sustainability through the creation of new and innovative value-based care delivery models.