FamilyCare will stay open through January
Last week, the dry topic of medical reimbursements turned dramatic as FamilyCare, the nonprofit care organization for about 115,000 Portland-area low-income Oregon Health Plan members, agreed to stay open just one more month, to Jan. 31, to try to prevent harmful disruptions to patients' care.
The 33-year-old organization, headquartered in the Lloyd District, had been prepared to leave the Oregon Health Plan on Dec. 31 over a bitter rate dispute with the state — meaning patients and providers in Clackamas, Washington and Multnomah counties would have had just two weeks over the holiday season to try and figure out what comes next.
Now, under the current plan negotiated Dec. 21, the care organization and state officials will have more time to do what they can to brace members for the news and address the fears that had been circulating among patients. The rumors had already sparked some mental health episodes, providers said.
State officials will be circulating detailed information this week to FamilyCare's members about their rights and how the transition will work as most of the members are transferred to Health Share of Oregon, another local care organization that serves the OHP.
Jeff Heatherington, FamilyCare CEO, had previously rejected the state's suggestion of a temporary contract. But at a dramatic meeting Wednesday night in Portland at the Doubletree Hotel, dozens of FamilyCare providers, many of them working in mental health, expressed fear and uncertainty to Heatherington about their fragile clients — some saying flat out that if FamilyCare left OHP as planned by Jan. 1, people will commit suicide over fear of losing their provider or coverage.
One provider noted that earlier in the day, Heatherington had told the Portland Tribune the group would transfer its reserves to other nonprofits rather than accept the idea proposed by the state of a temporary contract extension.
After Heatherington admitted to being "ornery," Dr. Megan Bird, a gynecologist at Legacy Health, challenged him directly.
"You do realize that people's lives are on the line," she said, adding that an extension" could prevent actual suicides. But you're being 'ornery'?"
"I have been in this business for 32 years and we have always been concerned for the lives of our patients and we have done over and above what any other CCO in Oregon has done," Heatherington said, to applause from the crowd.
"I'm just going to call you out on what you just said," Bird shot back. "'I'm being ornery ... at the expense of actual human beings' lives."
A counselor chimed in. "Jeff, I think we all want to support you," she said. "We're trying to keep it from being a nightmare turned into a catastrophe."
After other providers chimed in, Heatherington warmed to the idea and said he would propose it to the FamilyCare board, and he expected they would approve it.
On Thursday, the deal was quickly negotiated with Oregon Health Authority Director Pat Allen. Under the move, OHA will pay FamilyCare a $5 million fee to help with the transition.
The funds will offset what Heatherington had said was a projected $10-million monthly loss under the state's rates offered to FamilyCare for 2018.
"I offered to extend the contract to ensure the transition of the patients and we have agreed on a 30-day transition," said the FamilyCare CEO late that morning, "So we will do what we can get everybody moved."
On Thursday afternoon, Oregon Health Authority Director Pat Allen called the extra time valuable to provide a smooth transition and said Health Share of Oregon is accelerating its efforts to sign up providers now with FamilyCare, to help their patients adapt.
He said the extra month will allow a more seamless transition in providing uninterrupted coverage for enrollees. He said those currently in treatment may stay with their current provider for 90 days after FamilyCare leaves the market Jan. 31, assuming their provider agrees to accept standard Oregon Health Plan rates.
FamilyCare had paid better rates to providers, a source of tension with the state.
The Oregon Health Authority will send out more detailed information to enrollees this week, Allen said.
Two Republican lawmakers, Rep Julie Parrish of West Linn and Rep. Cedric Hayden of Roseburg, sat through the evening meeting last week. They urged providers to keep contacting their lawmakers in the hopes of keeping FamilyCare in the market on a more permanent basis.
Responding to several providers 'concerns that patient care will suffer due to the loss of FamilyCare, Parrish suggested an emergency session at the Legislature could keep FamilyCare in the business long term.
On Thursday morning, Parrish sent a plea to Democratic leaders of the Oregon Legislature to hold a special one-day session to try to keep FamilyCare in business, citing the meeting.
"The chaos of shutting down one of the state's oldest and largest provider networks is palpably real amongst the practitioners who were in attendance, particularly those in the behavioral health community," she said.
Parrish is also spearheading a referral headed to the ballot, Measure 101, which if rejected would eliminate taxes that would support the Oregon Health Plan — causing some providers to question her at the meeting.