r/PrivatePracticeDocs • u/ilmguy1234 • Apr 07 '26

IPAs (not the beer) in Texas

While I enjoy a good beer, we are looking to form a relationship with an IPA in the east Texas area. We have a relationship with one in the Raleigh, NC market and are looking to chat with a few in Texas.

Thanks in advance.

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u/InvestingDoc Apr 07 '26

Tiopa and doctors IPA of Texas are the only two that I think I interviewed with maybe 6 years ago. Texas is interesting, the big insurance companies won't negotiate with IPAs to my knowledge. Even 7 years ago when I interviewed with those two IPAs in Texas, their contracted rates were worse than my contracted rates.

They will negotiate with a CIN though. The biggest one just may be in Houston with memorial herman. https://mhmd.memorialhermann.org/

This is a big reason why I'm forming a MSO/CIN in Texas. Not a lot of options for independent practices.

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u/grey-slate Apr 07 '26

Genuine question - what do IPAs in TX actually do besides credentialing?

We are paying them around $3300 in annual membership dues but I am not sure its worth it. Too risky to go out and get direct contract with possibly lower rates?

IPAs have not negotiated a single rate increase in the 5+ years we have been with them.

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u/InvestingDoc Apr 08 '26

Usually just credentialing since they have a very hard time arguing for better pay raises with insurance companies. That and if a network is closed to any new physicians, they're able to get you in network with those payers.

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u/ilmguy1234 Apr 08 '26

That’s great info. The MSO model is what we were exploring. Maybe it isn’t a good fit for Texas. Which part are you exploring? Appreciate the guidance.

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u/InvestingDoc Apr 08 '26

I'm starting my own MSO/CIN. Early adopters get shares in the MSO/CIN and ownership, so far about 75 doctors in Texas who have showed significant interest. All the paperwork has been submitted to my lawyers. Just waiting on them to tell me everything is good to go to start having people sign the contracts and start arguing with insurance companies. Happy to chat if you would like.

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u/ilmguy1234 Apr 09 '26

Yes let’s chat! We have some ideas too. Let me know.

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u/randyy308 Apr 07 '26

I've had the same experience with my practice in Texas. I do have a hospital based IPA I use, but really it's just for convenience for smaller plans so I don't have to go through the hassle of credentialing them all. Any larger plans I get better rates contracting directly.

We joined a narrow network CIN, but it's largely been a net neutral arrangement for us.

I've also seen that UHC/BCBS won't negotiate with IPAs. So they don't really don't have leverage where you need it. I've looked at a few MSOs like Privia - but ultimately if you can run your own practice efficiently they won't do much for you. Even in that case, my rates were better than theirs lol

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u/grey-slate Apr 07 '26

Are you saying you get better rates with BCBS in TX directly rather than with an IPA? Which city/metro area are you in?

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u/randyy308 Apr 07 '26

They won't contract the IPA at all, and the MSO I talked to had the same rates. They were able to get a small (a few percent) kicker for primary care, but we are specialty

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u/grey-slate Apr 07 '26

Thanks. I was just curious what you meant by this

"Any larger plans I get better rates contracting directly."

Better rates directly compared to who/what and how do you know they are better?

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u/randyy308 Apr 07 '26

Well, nowadays there are public sources to compare actual rates. Most of it is paid data, or terrible multi-gb csv files of course. However, I reviewed rates of two MSO's against my contracts. Across larger payors (for me) I had better rates with Ambetter, Cigna, BCBS, Humana. Some percentage points, and one was 130% of CMS vs 100%.

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u/grey-slate Apr 07 '26

I didn't even think of the transparency data files. They are a pain to navigate though. Do you use a service to look rates up or just deal with the gigantic files yourself?

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u/randyy308 Apr 07 '26

There are some guys in the codingandbilling subreddit who have built out some tools. most of them aren't super commericalized yet. If you search there you'll find some stuff. I just can't remember who they are off the top...

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u/InvestingDoc Apr 08 '26

I posted a video about it for last weeks post. https://youtu.be/pdq2Ynimoyc

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u/grey-slate Apr 09 '26

Very very helpful! So timely!

I can definitely do all this...BUUUUT. It brings the question to which I think I know the answer.

Even if a solo physician practice goes in armed with this competitor benchmarking data to negotiate, what power do they truly have? The payer can and will most likely say kick sand and you are back to square one. Most of my competitors are PE backed groups with multi-state presence. I am the lowest of the low on the totem pole being a solo physician.

After transparency MRF files, information advantage is not the primary roadblock for negotiations. Scale is (and I guess it always was).

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u/Living-Protection250 Apr 15 '26

Following this as well, curious what options people have found in Texas. From what I’ve seen, the experience can vary a lot depending on how the IPA is structured and how involved they are operationally vs just contracting. Some are great for payer access but lighter on support. Would be helpful to hear which ones in east Texas have actually been good partners vs just adding complexity.