FamilyCare Outwits CareOregon Over Kids
Close to 8,500 children have transferred to FamilyCare so they can keep their same pediatrician
Rather than automatically transfer these children to the new health plan, state officials determined the children should remain in the hands of CareOregon – unless they notified FamilyCare – and set a deadline of June 15.
The Children’s Health Alliance, a 110-member pediatric group, had been affiliated with CareOregon since the inception of the Oregon Health Plan. After negotiations stalled and they were offered a higher reimbursement rate from FamilyCare, that contract came to a halt.
The state’s decision infuriated Jeff Heatherington, president of FamilyCare, who refused to sit on the sidelines. He kept urging Medicaid officials to transfer these children to his health plan so they could keep their same pediatrician. But his repeated requests went unheeded. Officials insisted the families had the right to make that choice -- not a government bureaucrat.
In the end, Heatherington won out. The latest count showed that close to 8,500 children had voluntarily switched to Family Care – out of 10,000 families who were sent a letter.
And, now, Medicaid officials are going one step further – they’re giving the other families until Sept. 15 to switch plans.
“We want to see these members and their providers maintain their relationship, and they still have time to do it” said Dayna Steringer, director of government affairs, who’s working with officials on drafting that letter. “Right now the state’s trying to eliminate any duplication and not send the letter to people who’ve already switched to FamilyCare.”
Earlier, Senator Alan Bates (D-Ashland) called the situation “a mess,” and encouraged CareOregon to take the lead and transfer those children to FamilyCare. People have a much deeper relationship with their physician than their health plan, he had said.
But CareOregon was unwilling to budge. “If we moved the children wholesale, what would happen to their family members?” asked Pam Mariea-Nason, director of health policy and community engagement who has announced her retirement. “I’m not willing to endorse that gamble. The alliance terminated its contract without thinking through what would happen to their families.”
When Heatherington appeared before legislators in May, he criticized the Medicaid agency. “There’s been virtually no communication,” he told them. “I’ve had to chase down rumors, and this is the most bizarre nontransparent situation I’ve seen in 25 years. We don‘t know who’s in charge. The agency lacks leadership.”
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Comments
we have been on both programs and yes there are differances with them. One thing that is the same is trying to find a office that will take your plan, wow what a pain. we are looking for a ortho doc that takes familycare and I have called over 50 offices and nothing, all the while my son whos finger is severly broken and in a lot of pain, has to wait till we can find a doctor to put pins in it. there must be list somewhere that gives us the names of the docs that take familycare or careoregon. thanks
I'm a mother of two young children who have been covered by CareOregon since they were born. We have been going to the same pediatricians office for 8 years, and on August 4th I recieved a letter telling us that our pediatrician stopped accepting Careoregon as of July 1st, so we would have to go somewhere else. There was no mention of switching to another insurance coverage, and definitely no mention of a deadline to switch by. I don't understand the politics, but I do understand that when you are a person who is being helped by the government, you begin to feel less than human, when all of these decisions that affect your families lives are made by people who never have to worry if they can feed their kids from one day to the next. Don't get me wrong, I am extremely grateful that these programs exist, but until politicians and big money companies start to see the people instead of numbers, nothing will ever change.
It is unfortunate that people hide behind "Anonymous" to make false an judgmental statements. Neither FamilyCare or CareOregon used the kids as pawns. The decision of the Pediatricians group to change health plans was made by them without the involvement of either plan. Once their decision was made they informed both health plans of the decision.
As to the anonymous posting on August 16, the author is correct on all counts. FamilyCare did not outwit anyone, It was a matter of patients choosing to stay with their doctor.
Finally there is the posting on August 18. The facts are:
FamilyCare has not laid off employees. They had added employees for the last two years. We have 7 Directors, one retired, one was recruited by another company who offered a substantial salary increase.
As for claims payments, we converted our claims software 18 months ago and had implementation problems that did delay payments. to providers. FamilyCare has never withheld payment on a claim that is properly submitted That would prompt State involvement.
Contracting, payments for service, bonuses and incentives are strictly regulated and limited by Federal and State laws. Taxpayers can be assured that health care dollars spent under the Oregon Health Plan are spent on health care services and programs that promote the health of the member.
Jeff Heatherington, President
FamilyCare, Inc.
The fact that FamilyCare can't pay claims and had laid off over 8 people this year worries me about the health of Oregon children. FamilyCare owes many portland area physicians large sums of money in fact many times the state had to get involved in settling payment disputes.
FamilyCare should be investigated for withholding claim payments, and wacky deals they sign to get these large groups to work directly with them. Our healthcare dollars fund outrageous and somewhat illegal sign-on bonuses and capital investment deals.
Recently three of their four directors left the company, this should send up red flags to everyone. The turnover at this company has always been high. I would never allow anyone in my family on any FamilyCare product.
I take issue with your headline announcing "FamilyCare Outwits CareOregon Over Kids." It would be more accurate to say "Pediatric group drops contract with CareOregon and signs with FamilyCare," though it sounds less sensational. It appears that the only "outwitting" FamilyCare did was to offer more favorable contract terms. The pediatric group considered the consequences of terminating the contract with CareOregon (as would any physician group terminating a contract) and decided that the benefits outweighed the potenital disadvantages, including the possibility of disrupting physician-patient relationships. Although most physicians, myself included, hate the idea of losing a relationship with an established patient over an insurance change, it is a fact of life in the current system.
I suspect the state's decision not to automatically switch enrollment for these kids has less to do with protecting the right of families to choose instead of a "government bureaucrat," and more to do with the fact that the state would not have had the systems in place to make that type of change. I believe that the state currently assigns people initially to a health plan based random selection, rather than patient choice.
The fact that patients chose to stay with their doctors instead of their health plan doesn't really amount to "FamilyCare trump[ing] CareOregon in a face-off over 10,000 Medicaid children." I expect more substance and less sensationalizing from the Lund Report.
The fact that FamilyCare and CareOregon each use these kids as pawns in their quest to one-up each other is ridiculous. Judy Mohrs-Peterson, et. al. need to step in and investigate what is really going on with both of these groups. It's the pot calling the kettle black
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