ACOs Bring Unique Challenges to the Dallas-Fort Worth Market

By Kindred Healthcare

The presence of not one, not two, but three Accountable Care Organizations (ACOs) makes the Dallas-Fort Worth market a truly unique place with distinctive challenges, according to two leaders who know it well, Audra Early, Executive Director for Kindred’s Hospital Division in the Dallas-Fort Worth Market, and Julie Anderson, District Director of Sales and Business Development for the Nursing Center Division in the Rocky Mountain/ Texas District.

“We have three ACOs in Dallas-Fort Worth and they are all operating differently,” Early said.

Plus ACO is a 50/50 partnership between Texas Health Resources (THR) and North Texas Specialty Physicians, a group of 900 doctors, Early said. THR came to the partnership with a group of 500 physicians, so the ACO now features a total of 1,400 physicians. It is a pioneer ACO and they are taking an innovative approach, she said. Plus currently covers 20,000 lives and is adding 50,000 more, making it a dynamic force in the market.

Plus’ post-acute strategy is characterized by joint ventures; currently they have two joint ventures  in play, one with a rehabilitation provider and another with a homecare and hospice provider, neither of which are Kindred-owned.


 (left to right): Audra Early and Julie Anderson (left to right): Audra Early and Julie Anderson


“They have taken a preferred provider strategy,” Early said.

Kindred, she said, has been successful in getting some of its long-term acute care hospitals and transitional care centers on their referral list, all based on proximity.

“Our TCC is in closest proximity to their largest hospital,” Early said, and this set the stage nicely.

The second ACO is a shared savings plan called Methodist Health System.

“They have knitted together 269 physicians who were all independently practicing,” Early said. Of those, 110 are primary care providers and the rest are specialists.

Methodist’s philosophy is that they want to work with other providers who have skill sets they don’t, making a Kindred collaboration potentially realistic.

Finally, Baylor is operating an ACO under the philosophy of owning everything they operate.

“Their approach to post-acute is they want to own it,” said Early.

Baylor has also approached managed care organizations and arranged deals for managing a population of its Medicare Advantage patients.

The challenge here, said the speakers, is this will further shrink Kindred’s Medicare Advantage population.

The growth in the existence and influence of ACOs in the Dallas-Fort Worth market could be a harbinger of the future healthcare landscape. The shift toward physician alignment with large groups and health systems restricts doctors further from following patients into the post-acute environment due to pressure to focus on the acute care patient.

Kindred leaders in Dallas-Fort Worth say they are experienced in meeting challenges. They encountered a situation in Grapevine where physicians at the acute care hospitals were owners of an LTAC and, not surprisingly, referring patients there exclusively. Aggressive relationship-building by Kindred leadership has led to some referrals to the Kindred long-term acute care hospital in Arlington. A success, indeed.

(left to right): Audra Early and Julie Anderson