Editor's Note: This story has been corrected from its original version. Sky Lakes has seen a dramatic increase in ER visits, not total care, and most of these patients are not likely CCO members. We regret the errors.
The success of the Medicaid expansion in Oregon has been overwhelming, to say the least – with more than 300,000 low-income people joining the ranks since January. The latest data show that nearly 1 million people now rely on the government-funded coordinated care organizations for their physical, mental and dental healthcare.
At the same time, at least two CCOs find themselves struggling to find primary care providers for their swelling populations and have either closed enrollment to adults or aren’t taking anyone else -- Cascade Health Alliance in Klamath Falls and Trillium Community Health Plan in Eugene.
Already, in Klamath Falls, the Sky Lakes Medical Center has seen a dramatic increase in people flooding the emergency room – climbing by 30 percent – according to Bill Guest, who runs Cascade Health Alliance. He stated that he doesn't know the payment types responsible for that reported increase.
It's possible that many of the patients are new Medicaid clients blessed with health coverage from Obamacare but who have not been able to enroll in the Cascade CCO because of a shortage of primary care providers in Klamath Falls.
A similar trend has occurred in Eugene where PeaceHealth reported a 20 percent hike, said Terry Coplin, CEO of Trillium Community Health Plan. It’s unknown whether other hospitals have witnessed similar trends.
Did Oregon bring too many people onto Medicaid too quickly? And, if so, what unforeseen problems could arise?
Mike Shirtcliff, CEO of Advantage Dental Plan, is among those wondering whether Oregon might have “bit off more than we could chew,” raising the question – “Are we really capable of doing centralized planning at the magnitude we’re talking about?”
Even though a lot of people are covered, “I don’t know whether they have access to care,” Shirtcliff said. ”I believe it’s criminal to have people fall through the cracks in our medical system and losing everything they have because they can’t get access to care.”
With the shift of leadership at the Oregon Health Authority, following the departure of Bruce Goldberg, and no permanent replacement likely to be appointed until after the general election, it’s difficult to know how state officials plan to overcome this access issue.
Shirtcliff suggested it’s time for everyone to take a deep breath for a while. “Let things settle down for three or four years, and see if we can’t assimilate what we’ve already done and leave any drastic changes alone. It seems like over last 10 years all we’ve done is change things – and maybe it’s caught up with us. Let’s step back as a state and realistically look at this. Unfortunately, right now no one wants to talk about it because it’s an election year.”
Inside Cascade Alliance
Since January, the population inside this Klamath County CCO has reached 11,000 – and it’s been forced to close enrollment because there’s simply not enough primary care providers.
“The number of people have exceeded our capacity in the community,” said Guest, who called this a continual problem with only 5 percent of medical students saying they want to work in a rural community like Klamath Falls.
With the 300,000 people who’ve come onto Medicaid, the state would need at least 150 new providers, he estimated, given that one physician can care for 1,800-2,200 people.
Because of that shortage, only 62 percent of people eligible for Medicaid in Klamath County are enrolled in a CCO, compared to the statewide average of 85 percent. “The efforts by the state to have incentives for providers hasn’t been sufficient compared to the new people who now have coverage,” Guest said.
The lack of an increase in Medicare reimbursement in the last decade has also had an impact and reduced the number of people willing to accept Medicaid patients. “When one or more parties doesn’t increase rates, it puts pressure on the payer mix. There’s already a small amount of providers who don’t take Medicaid right now,” Guest added.
Trillium’s Coming Up with Answers
Although Trillium Community Health Plan is closed to new adults, it’s still open for children under 18 and pregnant women. Since January, it’s seen a surge of 20,000 new members who do have primary care homes, while 9,000 adults lack access.
As their numbers swelled, Coplin praised the dental care organizations for their help in coming to the rescue. “Our relationship with the dental care organizations have helped us create additional capacity; it’s been amazing to see the work done by dentists in this community.”
To tackle the access problem head on, Trillium is investing over $3 million to assist people in a rational and coordinated manner. It’s dedicating $900,000 to help fund a federal qualified health center scheduled to open in July that’s been approved by the Lane County Commissioners. Once that clinic has been up and running for six months, it’s eligible for federal grants, but needed seed money to get started, Coplin said.
Incentive payments – up to $500,000 – are also being offered to medical groups willing to accept new members because PeaceHealth is at capacity. Trillium is also bringing a national consulting company, TransforMED, created by the American Academy of Family Practitioners, on board to help medical practices achieve quality outcomes and become high functioning patient-centered medical homes.
“We’re doing everything we can to muster our resources to provide access to care,” said Coplin, who dispelled the idea that the Medicaid expansion occurred too quickly. “If we had taken a slower approach, the population that needed access would still be invisible. This also forces us to deal with the issue and face the problems we already have rather than take a slower approach and leave people out of the dark for another couple of years.”
Health Share Managing Growth
In the tri-county Portland area where Health Share’s numbers reached 215,080 by May 1, everyone’s inside the system, said CEO Janet Meyer. Since January, it’s brought on 55,000 new members.
“That doesn’t mean all these people need to be seen right away,” Meyer told The Lund Report. “We’re trying to snuff out who’s new to the system and what they need by doing assessments on our new members.”
When it comes to mental healthcare, many of Health Share members are seeking addictions treatment, said Susan Kirchoff, chief operations officer. She acknowledged there were huge bottlenecks that didn’t exist earlier because mental health and addictions treatment has long been underfunded.
To combat that need, several of Health Share’s partners are giving capacity payments enabling providers to expand their services.
“It’s been a wonderful challenge bringing on so many people onto the healthcare system,” Meyer added. “I’d be hard pressed to say we grew too fast. It’s like drinking out of a fire hose, with a rush of people who are citizens in our community, and our job is to figure out how to serve them.”
Diane can be reached at [email protected].
