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Options fade for members of health plan FamilyCare stops taking new Oregon Health Plan members, may leave county By SUSAN JAY Choices continue to shrink for low-income Jackson County residents enrolling in the Oregon Health Plan. Last week FamilyCare, one of the health insurers that contracts with the state to cover Oregon Health Plan members, announced it has stopped accepting new enrollees in Jackson County. FamilyCare officials say the HMO is losing money in Jackson County -- $1 million so far this year -- and may be forced to pull out of the county entirely this fall. That would mean fewer choices of doctors and health plans, not only for new enrollees, but also for 8,700 existing Oregon Health Plan members covered by FamilyCare. Local physicians, hospital officials, the state Medicaid office and health insurers are working together to try to prevent that. Changes at Medford Clinic complicate the situation. Dirk Foley, FamilyCare's network director, said the strong likelihood that FamilyCare could end up with many of the clinic's 4,000 Oregon Health Plan patients, contributed to the decision to stop taking new enrollees. Oregon Health Plan patients will be able to stay with their Medford Clinic doctor, but under a different Oregon Health Plan arrangement that doesn't involve HMOs. The Oregon Medical Assistance Program will send letters in September to Medford Clinic patients now on the Oregon Health Plan, explaining the changes and outlining patients' choices. The Oregon Health Plan is a Medicaid program that received federal waivers to provide health-care coverage for low-income residents by prioritizing treatments and contracting with managed care plans or HMOs to help manage patient care and costs. There are 21,800 Jackson County residents now on the plan. Hersh Crawford, state Medicaid director, said up to 300 Jackson County residents a week become newly eligible for the Oregon Health plan. FamilyCare's action, he said, "doesn't keep people from becoming eligible to the health plan. It just means they don't get to go to FamilyCare." That leaves Care Oregon as the only HMO available to new Oregon Health Plan enrollees. Care Oregon has a limited capacity to absorb new members and a limited panel of health-care providers. The list includes the Community Health Center, La Clinica del Valle and some nurse practitioners. Oregon Health Plan members who have questions about these changes should talk to their caseworkers, including those at Adult and Family Services, Services to Children and Families, Senior and Disabled Services and Jackson County Public Health, say state administrators. Meanwhile, FamilyCare officials are having conversations of their own. "We don't want to pull out of Jackson County, which is why we're having conversations with PrimeCare and OMAP (Oregon Medical Assistance Programs)," Foley said. PrimeCare is an independent physician organization that represents more then 250 Jackson County doctors in contract negotiations with health plans and HMOs, including FamilyCare. OMAP is the arm of the state Department of Human Resources that administers the Oregon Health Plan. "We are attempting to find ways for the Oregon Health Plan to succeed in Jackson County," said Mike Bond, PrimeCare CEO. PrimeCare is talking with all the companies that provide coverage under the Oregon Health Plan, including Care Oregon, FamilyCare and Providence Health Plans. "Our goal is very simple: to maintain access to comprehensive medical services for all the Oregon Health Plan recipients of Jackson County," Bond said. "We've had three major plans fail in Jackson County in a four-year period," Bond noted. They are HMO Oregon, Oregon Dental Service and QualMed. Providence Health Plans, with 2,000 Oregon Health Plan members in Jackson County, is not accepting any new Oregon Health Plan enrollees. There are many possible reasons for these failures, but no concrete conclusions yet, Bond said. Maybe Jackson County has a sicker population that other parts of the state. Maybe lower state reimbursement rates are part of the problem. Maybe mass advertising campaigns from pharmaceutical companies are encouraging pricier prescriptions. Foley said FamilyCare, PrimeCare and the state are looking for ways to control costs, such as encouraging the use of generic drugs for prescriptions. Foley said about 70 percent of the HMO's losses stem from the large number of prescriptions written and the proportion of expensive prescriptions issued. Foley also said FamilyCare's president had a favorable impression that something could be worked out with PrimeCare. "If we can't put some controls on our utilization and just our financial picture down there, we can't stay in business and be in Jackson County," Foley said. Mail Tribune Copyright � The Mail Tribune 1999, Medford, Oregon USA