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State health plans down to one Providence drops coverage in county By DAVID PRESZLER The exodus of HMOs from the Oregon Health Plan continues. Citing financial losses, Providence Health Plans announced Thursday that it will drop the Oregon Health Plan in Jackson County on Dec. 1, making it the fourth HMO to drop the plan here. The move leaves just one managed care plan to serve the 22,000 low-income Jackson County residents eligible for the plan's benefits. The remaining HMO, Care Oregon, says it has no plans to leave but it can handle only about 3,000 patients in Jackson County. The rest will have to work more directly with physicians to get access to care. Chuck Wright, chief executive of Providence Health System's Southern Oregon service area, said the health plan has lost $1 million-$1.5 million this year serving its 1,750 Oregon Health Plan members. The plan's reimbursements simply haven't kept up with the rising cost of care here, he said. Providence will continue to serve 35,000 Oregon Health Plan patients elsewhere -- mainly in Portland, Eugene and Salem, where Wright said larger populations make the plan more viable. Providence also will continue to provide coverage for Medicare and employer-sponsored plans in Southern Oregon. Wright said Providence remains committed to providing care for the poor. "We will continue to serve the poor and needy in Southern Oregon regardless of their ability to pay or whether they have health insurance," he said. The three other HMOs that pulled out also cited financial losses. FamilyCare, which said it lost $1.7 million serving its 8,500 plan patients here this year, also leaves Dec. 1. But not every plan has struggled here. "We're doing well enough," said Care Oregon's Deborah Friedman. "We have no intention of pulling out at this point." Care Oregon, which has about 40,000 members statewide, works mainly with community health centers that specialize in serving low-income patients rather than more commercially oriented practices where low-income patients make up only a small portion of the base. She said that focus has been key to making the state plan work for Care Oregon. "It's a different way to practice medicine," she said. "It's a much more comprehensive way of working with folks." Still, Care Oregon says it only has room for about 300 more patients. Oregon Health Plan officials don't expect the departure of Providence and the other HMOs to keep patients from receiving care -- at least in the short term. In the long term, however, it could make it harder to get care -- especially for plan members who don't already have a doctor. "Inevitably, what you are going to see is a decreased access to care," said Hersh Crawford, director of Oregon Medical Assistance Program, which runs the plan. The benefit of managed care, Crawford said, is that those who join a plan are guaranteed access to care. Without an HMO to join, Oregon Health Plan patients will have two choices: find a physician willing to become their primary care case manager or operate on what's call an open card. Under the open card arrangement, patients can see the physician or specialist of their choice -- as long as the physician accepts them as a Medicaid patient. Under the primary care case manager model, the physician assumes the role once filled by the managed care plan -- directing the patient's access. The fear, Crawford said, is that physicians will be hesitant to accept Oregon Health Plan patients -- especially those who require more attention. "These are the kind of people who have lots of issues," he said. However, area physicians remain committed to providing care for Oregon Health Plan patients, according to Michael Bond of PrimeCare, a local physicians group representing 300 doctors. Bond says about two-thirds of them have already signed up to be primary care case managers and he expects physicians will continue to see their existing patients. Asked how difficult it will be for new plan patients to find a physician willing to take them, he said, "I honestly don't know." The reimbursements that doctors get for providing services to Oregon Health Plan patients is about 50 percent lower than what they receive from non-plan HMO patients, Bond said. However, he doesn't expect that to play a large role in doctors' decisions. "To the physicians and the community hospitals," he said, "providing care to Oregon Health Plan patients is about more than money." Mail Tribune Copyright � The Mail Tribune 1999, Medford, Oregon USA