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Health plan HMOs keep bailing out County may be left with one Oregon plan provider By SUSAN JAY A third HMO that serves Oregon Health Plan patients is leaving Jackson County, and another may be on its way out. If Providence Health Plans follows the lead of Family Care, only one HMO -- Care Oregon -- would serve Oregon Health Plan members in Jackson County as of Jan. 1. Family Care announced last month that it was thinking of dropping Jackson County service for 8,500 Oregon Health Plan patients, saying it has lost $1.7 million here this year. The decision became final Wednesday and takes effect Dec. 1. If it decides to leave as well, Providence Health Plans would stop coverage of 2,000 Jackson County health plan members on Dec. 31. Providence estimates it has lost $1.5 million in Jackson County this year. Local health care experts say they don't foresee people on the state plan running into problems getting medical care in the short term. But in the long run, without another solution, they say that access to doctors will shrink, emergency room use will rise and more people will be unable to get care, causing some of the very problems the state-funded plan was designed to solve. "I think for the average patient, there won't be a problem," said Peg Crowley, director of the Community Health Center. "I think for the special-need patient, there will be access problems, in spite of the very best intentions of everybody." Providence's decision awaits talks with PrimeCare, a local independent physician association representing 300 doctors, and the state Medicaid program to see if there is a way to stay and not lose money, said Greg Van Pelt, chief executive of Providence Health Plans. "We're trying to pull a rabbit out of a hat. If we can do it within 30 days, we'll do it. So far we don't have a solution," Van Pelt said. After discussions and proposals by Family Care, the PrimeCare board decided Wednesday that "we could not do anything to salvage Family Care's experience in Jackson County," said PrimeCare Chief Executive Mike Bond. Family Care has 20,000 Oregon Health Plan members in 10 counties, including Multnomah, Curry and Josephine. Jackson County represents 45 percent of Family Care's business and an estimated $17 million in annual revenues. "We're OK in the rest of the state," said Jeff Heatherington, Family Care chief executive. "Medford is the only urban city that hasn't been able to make this work." That concerns Bond and the rest of the local medical community. "We've had four pretty sophisticated companies," Bond said of the HMOs that have served Oregon Health Plan patients locally. Even though they were set up differently, "they all failed," Bond said. "That tells you that something is fundamentally wrong with the model for enrollees in Jackson County." The Oregon Health Plan HMOs that have left Jackson County include Regence HMO Oregon and ODS, or Oregon Dental Services. The state's health plan structure doesn't work in some other counties either, Bond said. HMOs serving health plan patients have left nine other counties this year. Of those nine counties, other HMOs took up the slack in six counties, leaving three, Lincoln, Yamhill and Baker without an HMO for health plan patients. "I think what we're seeing is some changes in the managed health care delivery system," said Hersh Crawford, director of Oregon Medical Assistance Program, which runs the health plan. "It seems to be more in rural than urban areas, and Jackson County is in the middle."' All three of the HMOs that have decided to leave Jackson County have cited an inability to control costs and the scope of services being provided, Crawford said. If the two HMOs leave, Jackson County's Oregon Health Plan members will use what is called an open card. It will allow Oregon Health Plan members to use any doctor, go to specialists without authorization and get drugs with few limits -- as long as the physician accepts them as a Medicaid patient. The state, instead of the HMO or the doctor, is at risk for the medical costs. While the open-card system has fewer restrictions than an HMO, Crawford said open-card patients sometimes have problems getting doctors to agree to take them as patients. Physicians receive less money when they see open-card patients than when they see HMO patients, Crawford said. Mail Tribune Copyright � The Mail Tribune 1999, Medford, Oregon USA