Turmoil continues for Oregon Health Plan
The Oregon Health Authority is reassigning more than 10,000 AllCare Health patients to Jackson Care Connect after AllCare couldn’t reach a contract agreement with a local doctors’ group for primary care.
AllCare and Jackson Care Connect are local coordinated care organizations that manage Oregon Health Plan benefits for their members.
The change impacting thousands of Jackson County residents on the Oregon Health Plan will go into effect Jan. 1.
Jackson Care Connect was able to reach a contract agreement with PrimeCare, a Medford-based network representing more than 500 physicians.
The Oregon Health Authority announced this week it will switch more than 10,000 AllCare patients to Jackson Care Connect so those patients can keep their current doctors.
AllCare will keep its patients who are served by health care providers outside the PrimeCare doctors’ group, the state said.
Headquartered in Grants Pass, AllCare has about 50,000 Oregon Health Plan members throughout Jackson, Josephine, Curry and southern Douglas counties, said AllCare Vice President of Government Affairs and Public Policy Josh Balloch.
About 25,000 of those patients live in Jackson County, he said.
Patients affected by the change will receive letters from the Oregon Health Authority, Balloch said.
He said AllCare will cooperate in making the transition as smooth as possible for patients.
“We want to make sure everybody is safe and getting the care they need because that’s the most important thing,” Balloch said.
He said AllCare will continue to be a presence in Jackson County, serving its remaining Oregon Health Plan patients, offering other products such as Medicare Advantage insurance plans and working with community groups to improve overall health.
“We will continue to work with those partners to keep people from getting sick in the first place. That’s really what we’re going to be focused on. And we’re going to continue doing that for our members and for the communities we serve,” Balloch said.
Mike Bond, chief executive officer for PrimeCare, said the doctors’ group will no longer provide primary care services for AllCare’s Oregon Health Plan patients, but the two organizations did sign a contract for the doctors to be available on a referral basis.
The Oregon Health Authority is ramping up expectations and requirements on coordinated care organizations like AllCare and Jackson Care Connect that manage Oregon Health Plan physical, mental and dental care. The next stage for the Oregon Health Plan has been dubbed CCO 2.0.
Goals include improving mental health care, addressing nonmedical issues like housing that impact people’s health, and controlling costs.
With CCO 2.0 kicking in, Bond said, PrimeCare board members decided they could best serve Oregon Health Plan patients if they took a streamlined approach and worked mainly with one coordinated care organization.
“The typical Oregon Health Plan patient is more likely to have more complex illnesses and to have more social issues affecting their health than the average insured patient,” Bond said. “We’ve developed a close relationship with Jackson Care Connect.”
That close working relationship gave Jackson Care Connect the edge over AllCare when the board considered which coordinated care organization to pick, he said.
PrimeCare will be able to comb over a single set of data from Jackson Care Connect as it works to identify patterns of use and care, improve quality of care and boost access to care, Bond said.
Another factor that helped tilt the doctors’ group toward Jackson Care Connect was that Jackson Care Connect recently won a five-year contract with the state to continue managing Oregon Health Plan benefits, Bond said.
AllCare, meanwhile, got a one-year contract.
Balloch said AllCare has submitted additional information to the Oregon Health Authority to show its accomplishments and plans as a coordinated care organization. He said the feedback from the state so far has been good to glowing regarding the supplemental data.
“I fully expect us to get a full five-year contract before the end of the year,” Balloch said.
As for the working relationship between the doctors’ group and AllCare, Balloch said AllCare reached out repeatedly offering to meet more often.
The reshuffling of patients due to contract issues isn’t confined to Jackson County.
The Oregon Health Authority announced this week it’s also moving patients to different coordinated care organizations in Clackamas, Multnomah, Washington and Lane counties.
Trillium Community Health plan is losing 40,000 of its Oregon Health Plan members because it doesn’t have a hospital in its provider network in the Portland area. An unspecified number of additional Trillium members will be switched in Lane County because Trillium will no longer have a contract with a network of primary care providers, the Oregon Health Authority said.
The latest changes are a sign of continuing turmoil in the Oregon Health Plan marketplace.
In September, the Oregon Health Authority announced more than 1,000 Jackson County residents and more than 9,000 Josephine County residents on the Oregon Health Plan would have to move to a different coordinated care organization.
The announcement came after the state rejected PrimaryHealth’s application to continue as a coordinated care organization. The small coordinated care organization scored best among CCOs on getting quality care for its clients, but the state worried it wasn’t on track to remain financially solvent.
PrimaryHealth’s clients in Jackson County will switch to AllCare or Jackson Care Connect as of Jan. 1, 2020.
The organization’s Josephine County clients will transition to AllCare at the beginning of the year.
The state sent out postcards and letters notifying people of the changes in September and October.
In Jackson County, about one in four residents are on the Oregon Health Plan, while about one in three Josephine County residents receive the benefits for low-income children and adults.
Reach Mail Tribune reporter Vickie Aldous at 541-776-4486 or email@example.com. Follow her on Twitter @VickieAldous.