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Changes muddle health choices HMO, clinic complicate patients' future By SUSAN JAY Audrey Borders was dreading this morning. Every week, she helps 10 to 12 low-income pregnant women sign up for the Oregon Health Plan and choose a doctor. But this time she wasn't sure she could answer all their questions. "I have my first client at 8 a.m. in the morning and hopefully she is going to want Dr. Linda Harris and I'll know it's OK," Borders said Thursday. Harris is a Medford obstetrician who is able to accept new Oregon Health Plan patients. Not all doctors can. Borders, who works for the Jackson County Public Health Department, called several doctors' offices Thursday to figure out which obstetricians would accept women on the Oregon Health Plan who needed prenatal care. Multiple changes happening in the Oregon Health Plan and at Medford Clinic are making Borders' head spin, and causing her, along with doctors, nurses and clinic directors, concern over the future of the state medical plan in Jackson County. FamilyCare, a not-for-profit HMO that contracts with the state to cover Oregon Health Plan recipients, has stopped accepting new enrollees in Jackson County because it is losing money, and it may pull out of the county altogether. FamilyCare covers 8,700 Oregon Health Plan members in the county. That leaves one -- Care Oregon -- accepting new Oregon Health Plan enrollees here. In the meantime, the state is working with Medford Clinic to make sure its health plan patients -- an estimated 4,000 people -- continue receiving care from their clinic doctors. Medford Clinic had a contract with Oregon Health Management Services, a Grants Pass plan, to care for thousands of health plan patients. That contract will not be renewed in October. Those patients should be receiving a letter in September explaining their options. They will still be in the Oregon Health Plan and will receive care, but not through an HMO. A number of doctors have left Medford Clinic, which faces an uncertain future because of its partnership with Physicians Partners Inc., a physician management group in Portland facing financial troubles. "Choices have been cut in half when it comes to health plans and doctors" for her clients, Borders said. In the long run, she said, "My main concern is that the Oregon Health Plan is there to help the people who fall through the cracks" -- People who work but can't afford health insurance and do not qualify for other assistance. One person who is optimistic but still worried about the future is Peg Crowley, director of the Community Health Center, which has a contract with Family Care and Care Oregon and clinic sites in Medford, Ashland and White City. She wanted to assure local Oregon Health Plan members covered by FamilyCare that they will receive care for at least the next three months. She also encouraged low-income residents who need medical care to apply to the Oregon Health Plan. The recent changes do not mean new enrollees can't get care, it just means there is only one plan to select. And Jackson County still has hundreds of children who are eligible but have not applied for medical coverage under another Oregon Health Plan option called Family Health Insurance Assistance Program. For more information, call 1-888-564-9669. Crowley said HMOs with the Oregon Health Plan struggle in Jackson County because of a combination of factors, including flaws in how the health plan is designed, the behavior patterns of some doctors and patients, and direct advertising of prescription drugs by pharmaceutical companies. But FamilyCare's decision to close new enrollment is a blessing in disguise, she said. The action means most Oregon Health Plan patients will be able to keep their Medford Clinic doctors, and gave the community -- doctors, health plans, hospitals and the state -- some time to find another solution. If FamilyCare had kept enrollment open, the state would have shifted all of the Oregon Health Plan patients with the Medford Clinic into FamilyCare and Care Oregon. That would have meant changing doctors, because Medford Clinic has no contract with those plans. The worst-case scenario would be if Family Care left Jackson County and another health plan didn't take its place, Crowley said. Access to health care for those on the state medical plan would drastically shrink, she said. The Oregon Health Plan would have to go to another arrangement, where doctors would be reimbursed at a much lower rate, and slowly be unable to take more patents. Mail Tribune Copyright � The Mail Tribune 1999, Medford, Oregon USA