Ensuring health care for rural Texans
An update on the status of the Rural Community Health System of Texas

by Thomas E. Mueller, M.D.
President and Chairman of the Board,
Rural Community Health System of Texas

What was once a dream is now on the brink of reality. The Rural Community Health System of Texas, a health system established for the benefit of rural Texans and governed by rural doctors, rural hospital administrators and rural community leaders, will begin a pilot project in the panhandle early next year under the state’s Medicaid program.

RCHS was created as a result of the passage of enabling legislation in the 75th legislative session, which was modified in the 76th and 77th legislative sessions with the final bill, SB 1394 providing for the creation of a statewide rural network using the EPO model on a voluntary basis and authorizing a pilot program for Medicaid managed care. This model provides for fee-for-service reimbursement and no financial risk to the physicians, hospitals and ancillary providers. The Medicaid EPO model emphasizes wellness, preventive care and patient education with a focus on health care access and care coordination. There will also be a 24-hour nurse line so patients can access qualified health professionals to answer medical questions. The Medicaid recipients that choose the RCHS EPO option will receive an insurance card from the insurance carrier and the carrier will pay claims. This will be a voluntary program and will only be in those areas of the state that are not currently included in the state’s Medicaid managed care roll out areas.

There are five initial target expansion areas and the network development in the panhandle has begun as the first pilot area. The panhandle was selected for the first pilot expansion because of the existence of an organized community based network, Coalition of Health Services, Inc., which requested the first opportunity to participate in the pilot. Network development began with the hiring of RCHS provider representatives in July and contact with all providers in the 27 counties is ongoing. Each provider representative has an assigned territory. Letters of agreement are being provided to obtain expression of interest in participation and the actual physician participation agreements will be provided in October. The credentialing process has begun and the provider network credentialing process will follow the Texas Department of Insurance credentialing guidelines with use of the common application form. The contracted network should be finalized for the panhandle pilot counties by the end of November, so the provider directory can be published.

Provider relations representatives are from the panhandle area and are full-time employees with a local office. These representatives will be the initial contact for questions or assistance and will be responsible for the ongoing product training and education for the physician offices. Local as well as toll-free phone lines have been established and the local representatives are providing the participating physicians with their cellular phone numbers in an attempt to increase availability within their territory.

Once the network is established in the panhandle, the RCHS will initiate development of other pilot areas around the state. Local offices for RCHS will be established in each region as we move into these areas and local provider relation representatives will be hired. This will ensure a local focus and the RCHS commitment that health care decisions will remain local.

Dr. Barbara Freemen, a rural family physician, has developed the care coordination program and will serve as the medical director for the RCHS Medicaid EPO program. Local medical society meetings are currently being scheduled so the RCHS Medicaid EPO pilot as well as the care coordination plan can be presented in greater detail.

The final documents have been submitted to the appropriate state agencies for approval of the Medicaid EPO Pilot and the expectation is to have approval by years end. The target date for enrollment of the Medicaid population in the pilot area is January and February with an effective date of March 1, 2003.

This is a very exciting time for rural Texas, as we have the ability to keep health care local, health care decisions local and keep the natural referral patterns in place. The RCHS network is our network, rural providers and rural Texans, and with all our efforts this may well serve as the model for rural health care across the United States.

We will, over the course of the next several weeks, be conducting meetings and providing additional information to the various medical societies within the panhandle, as well as the medical societies within the other pilot areas.

This is just the beginning. We are currently developing our statewide network to attract insurance carriers specializing in products for small business, as well as individual products that will enhance the rural health care infrastructure and bring affordable health insurance to rural Texas. We will begin looking at products specific to communities and will have the ability to negotiate on behalf of our local providers. We welcome your questions, comments and suggestions, as this is our RCHS network. Together we can keep health care decisions local and improve health care for rural Texans.

We need your support and participation in the RCHS network to make this happen. For additional information, to schedule a presentation to your medical society or obtain a letter of agreement, please contact our executive director, Hal Patton, at (512) 328-RCHS or (877) 328-RCHS or e-mail at hpatton@rchstx.org. Additional information can be obtained on the RCHS Web site at www.rchstx.org. With your help, we can make a difference in health care for rural Texas and rural Texans.