"Part of our approach is to see if we can do an alliance with those primary care docs," he says. "The first thing you have to think through is the cultural. Many are 2–4 person practices, while we're a large organization that works in several counties."
Seton, part of nonprofit healthcare giant Ascension Health, is already well-situated for integrating care, but like any hospital-centric organization, one of its biggest risks is disruption to its primary care network. One of the only components it doesn't have is a full service commercial health plan, but it's working out some of the kinks through its Medicaid HMO risk product.
"We are really in the process of becoming a healthcare system," he says. "We want to deemphasize the hospital system. The future is how you coordinate with partners, so that care gets delivered to the right place at the right time. We want to move away from episodic [and toward] more managed care."
Many systems think they are moving in that direction by employing a large portion of their medical staffs, but Seton is partially prevented from doing that outright because Texas is one of a few states that prevents hospitals from directly employing physicians through its corporate practice of medicine law—at least according to many interpretations of it.
Many find those laws to be outdated, and there are differing opinions on whether the law prevents hospitals and health systems from legally employing physicians, but for now, the law isn't keeping Seton from the strategic imperatives its leadership thinks are most important.
"That doesn't mean Seton won't discuss and acquire physician practices if we need to, but that's not where we are today," says Garza.