The hospital districts in Travis and Nueces counties have publicly owned, privately operated hospitals, setting them apart from their urban peers across Texas. But as the two communities begin an overhaul of the way they provide health care to low-income and uninsured residents, they are taking different paths.

Both counties, along with the rest of the state, are participating in the so-called 1115 Medicaid waiver program a sweeping overhaul of the federal-state program that covers health care for poor, elderly and disabled people. Medicaid has become increasingly expensive, and Texas sought the federal waiver to find creative ways to do Medicaid care better and cheaper.

Travis County has devised a one-of-a-kind plan that gives the hospital district board new authority to hold hospitals and health care providers accountable for the dollars they get, Seton and Central officials said.

Central Health, the hospital district, is creating a new nonprofit group with its partner, the Seton Healthcare Family. The new group will be called the Community Care Collaborative. Over the next four years, the collaborative will distribute several hundred million dollars in public money to projects that the state has judged to be successful at improving health care and increasing efficiencies. The public Central Healths board will oversee the nonprofit by setting policy and maintaining ultimate control over the money, district officials said Thursday.

Government authorities in Nueces and other counties wont have that same power.

The hospitals in Nueces County, like those elsewhere in Texas, will be paid directly for their performance and are not required to share information with the hospital district, said Jonny Hipp, the Nueces hospital districts CEO. That means the hospitals will have control of the money without another local board looking over their shoulders.

Hipp called Central Healths approach innovative.

I think a lot of folks are going to look at Travis County, and I genuinely think that, once the things are in place, if they work the way they say theyre going to work we might consider a nonprofit model, he said.

The Central Health-Seton collaborative will provide regular financial reports to the Central Health board, which also will publicly approve its budget. Central Health will receive reports on how well the changes are going, and it will set up an electronic network of information about patients aimed at cutting duplication of services.

The 1115 waiver requires hospitals and other providers to report more information than ever before, said Seton executive Greg Hartman, president and CEO of the publicly owned, Seton-operated University Medical Center Brackenridge.

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