I am the managing physician of two addiction recovery clinics in Portland that serve about 800 Oregonians at any given time. Like many providers, I have sat nervously on the sidelines watching the dispute between FamilyCare and OHA play out, wondering how it would impact not only our clinic but the thousands of CCO clients struggling with opioid addiction. I shook my head in disbelief while reading last week’s coverage in the Lund Report, which seemed to suggest there would be little impact to patients or providers in the event FamilyCare dissolved. For us, nothing could be further from the truth.
That’s why I’ve decided it’s time to tell our story – along with the stories of hundreds of patients we serve, whose treatment would be destabilized by the closure of FamilyCare.
In March of 2016, Recovery Works NW had been operating for one year. At the time, we were treating roughly 200 patients for opioid dependence using a combination of traditional drug and alcohol counseling in addition to supportive medications like buprenorphine to relieve withdrawal symptoms and cravings. We only accepted commercial insurance or cash and were barely breaking even month to month. But we had developed a treatment model that worked well and we believed in the mission.
At that time, we were forced to turn away countless requests from patients who were members of Oregon Health Plans, not because we didn’t want to help these patients, but because outdated OHP reimbursement models covered only half of the cost of treatment. It left addicted patients struggling without access to modern therapies like Medically Assisted Treatment (MAT), forcing many of them into the world of daily-dispense methadone, expensive ER visits or inpatient treatment.
That changed when FamilyCare reached out to us in 2016. They had looked at the science and associated costs of addiction and decided that investing money in less expensive outpatient treatment models like ours would save them a significant amount of money in downstream expenses such as ER visits and ICU admissions. They seemed to appreciate our innovative approach and offered to reimburse our clinic with rates comparable to commercial insurance. We were thrilled – and so were our patients.
Our monthly intakes tripled. Instead of wishing we could reach our capacity, we were scrambling to increase it. Last December we expanded to a second clinic on the east side of Portland and have already outgrown that space. We now treat roughly 800 patients a month and are barely scratching the surface of Portland’s opioid crisis.
For our patients who are FamilyCare members, this has meant new-found stability, like the ability to parent or hold down a job. We have patients who were once at risk of homelessness but are now secure. And the only reason for that is they hold coverage through FamilyCare rather than a different CCO that doesn’t allow them to access our clinic.
There is no doubt that our relationship with FamilyCare has spearheaded a multitude of efforts around combating Oregon’s opioid crisis. As our clinic grows, we are focused on training new providers and are quickly becoming an education center. We have partnered with University of Portland’s Nurse Practitioner program to train NP students in MAT. Next summer, we will begin funding a full-time fellow from OHSU’s Addiction Medicine program. These pilot programs have the potential to revolutionize Oregon’s addiction and recovery workforce, and I view them as a direct result of FamilyCare’s innovative leadership and reimbursement model.
Recent reports that FamilyCare may shut down have us very concerned. If that were to happen, the expansion of our east side office would likely have to go on hold. Approximately 350 of our patients would have to find a new CCO that we cannot currently accept – limiting our ability to serve them and risking their fragile sobriety. Accepting these patients at HealthShare’s current rates is not an option – our clinic would not be able to stay afloat. And potentially worst of all, the emerging partnerships we’ve developed to scale and combat the opioid epidemic would have to be placed on hold at the exact moment Oregon needs them most.
Bryan Schwartz is managing partner and physician at Recovery Works Northwest, a provider of opioid addiction and recovery services in Portland.
Comments
Data?
I want to believe that the outpatient treatment model you have outlined is actually effective, but it is crucial at this point to back up assertions with data.
Specifically, to what extent does treatment reduce homelessness, unemployment, child abuse, etc. -- all the consequences of drug and alcohol misuse?
The Data
We have run the numbers at our own clinic and do have data to back up the effectiveness of our outpatient model. On average, if someone shows up for a consult there is a 55% chance that they will still be with us 1 year later. If the patient actually engages (shows up to more than 1 or 2 appointments) the success rates go up to 70% retention. 70% at a fairly fixed cost: 1 year roughly equal to a 5-7 day inpatient detox.
When someone continues to struggle in our program, we refer them to a higher level of care. There is still a huge need for inpatient residential programs, but they have 4-6 week waiting lists in many cases. A patient that is not doing well in our program needs immediate care and can't get it.
There are multiple level of care and they are all needed. The only way for a business to expand to serve more patients is if they have the assets to do this. FamilyCare understands this and it would be a shame for everyone if they do indeed shut down.
If HealthShare and FamilyCare combined their models, they could potentially have an amazing thing.
Spread the word
I am sorry for how this will
I am sorry for how this will negatively affect your business and your patients. However it is karma catching up to him and now he can retire while still being the victim.
The Costly Ripple Effects of Forcing FamilyCare to close
At the stroke of midnight, December 31, 2017, about 120,000 Oregonians will have to find all new healthcare providers within HealthShare if the inequity in funding FamilyCare is not addressed.
It Doesn’t Make Sense
This note is from the point of view of those of us on the ground, working with clients.We don’t know the complexities behind this situation, that are discussed in the board rooms of upper management in HealthShare, FamilyCare, the legislature, OHA or the Governor’s office.
But from our vista, the FamilyCare system works exceptionally well for clients.You’ll read more about that below.
As we understand the situation, the OHA offered to pay FamilyCare $377 per person per month in 2018 while paying HealthShare $409. Ironically, if all 120,000 members will have to switch to HealthShare, the OHA will have to pay $409 for their healthcare anyway.
Why not just pay FamilyCare what it will have to pay HealthShare in 2018 and not disrupt the lives, the health and mental well being of so many people. Why create such unnecessary misery and chaos for 120,000 people?
Avoid Disruption
- The logical thing to do would be to pay FamilyCare the same as HealthShare and let 120,000 Oregonians keep their doctors, therapists, and medical care team.
Instead 120,000 FamilyCare members will have no access to health care, or mental health care for months and months, if not longer. Where will they go for treatment? The Emergency Department or Urgent Care, which typically costs 5 - 10 times more than primary care. FamilyCare reports they saved $65,000,000 in Emergency Department, Urgent Care, specialty referrals, surgical referrals in one year with their philosophy of easy access to primary care and mental health services.
How will HealthShare providers manage 120,000 new members, when colleagues report that they already have wait lists and unmanageable client loads? How long will it take HealthShare to simply enroll 120,000 new members, assign them case managers, let alone providers who can see them regularly?
There's a heroin epidemic, as mentioned by Dr. Schwartz above, in Portland and all those people in treatment under FamilyCare services will be left without treatment. According to the OHA as reported by Brent Weisberg KOIN 6 News Staff ”Oregon has one of the highest rates of prescription opioid misuse in the nation, according to OHA.” The down stream ripple effects of closing FamilyCare are increased crime, increased medical costs to local hospitals, and a strain on police departments.
The OHA cites three actuarial reviews which found the disparity in rates to be fair. However, the actuaries do not take into account the ripple effects of such a massive disruption of service to 120,000 members, nor the difficulty in doing a fair comparison when HealthShare costs are hidden within their subsidiaries.
And ironically, switching 120,000 people to HealthShare will still cost the extra $44 million they would pay FamilyCare that would keep them open.
What will the ripple effect cost Oregon Taxpayers?
- FamilyCare’s 250 employees will lose their jobs, which could result in $2.5 million in unemployment benefits[1]
- Another 1000 - 2000 jobs will be lost or reduced to part time as a result of the doctors, administrative personnel, therapists, etc who will no longer be treating 120,000 people. This might cost another $5 – 10 million in unemployment benefits.
- If 5% of those 120,000 people have even a single visit to the ER, 6000 uninsured people will be using charity care at local hospitals. At an average cost of $1223[2] per visit, that totals a minimum $7,330,000 in charity care.
- Job loss not only results in increased unemployment benefits, but reduced spending in Oregon businesses, defaults on car payments and mortgages. The dollar cost of this ripple effect is incalculable.
Unspoken Messages and Beliefs
What would cause the OHA, teh Governor and the Oregon Legislature to persist in a course of action that will not only hurt 120,000 FamilyCare clients, but also the Oregon economy?
As the campaign to destroy FamilyCare by OHA former director Lynne Saxton came to light in August of 2017[3], one can’t help but wonder what would motivate a public official to undermine the 32-year-success FamilyCare has had in providing excellent service and saving money. Could it be the philosophy we’re seeing in national politics whose beliefs seem to rest on the assumption that the poorest and weakest deserve to suffer.[4]
Who are FamilyCare clients?
Meet one of our clients who we will call Mary.
Mary was unemployed, depressed and anxious after a series of life events beyond her control, left her with crippling PTSD.
As a single mom, she raised a special needs child and helped her successfully graduate from high school. In the first year of her treatment, Mary started recovering and started looking for work. Though very scared, she faced her fears of job interviews and applied. She landed a minimum wage job working in a small boutique business that she had loved for years. It turned out to be her dream job. Here’s what happened next.
As her confidence grew, she took over management of the website and product development at the boutique business. With her growing confidence and the skills learned in therapy, she spoke up to the owners about how they could make the company more profitable.
After her second year in therapy, she was hired full time and was able to switch to commercial health insurance and drop her FamilyCare coverage because she was making more money. Just recently, she was made part-owner of the company.
This same client experienced the fall out of Lynne Saxton’s plan to destroy FamilyCare. Early in her treatment in 2015, Mary’s mental health claims were denied because staff at the OHA had switched her care to HealthShare without her knowledge or consent. We discovered a number of other clients having the same problem. With FamilyCare’s help, we reinstated her services and she continued treatment.
Had she gone along with the arbitrary switch to HealthShare, she would have been subject to long wait lists for treatment, with therapists struggling with unmanageable case loads who would likely be unable to see her weekly.
Taking advantage of her FamilyCare coverage, she was able have weekly appointments, with a veteran therapist who specialized in PTSD, not someone just out of graduate school trying to manage a large case load.
Where would Mary be now, if she had lost her FamilyCare coverage? She might still be on HealthShare, struggling with PTSD, getting appointments when her new therapist could fit her in to an already full schedule. Instead of saving the Medicaid system the cost of her treatment, it would be prolonging it.
Mary is just one of many success stories.
Put Yourself in the Shoes of the Working Poor.
Imagine you have a spouse or a child with a serious chronic illness. And all of a sudden, all of your trusted providers, your doctors, your case manager, your therapists will no longer be available to you. You may have difficulty affording prescriptions, some of which may not be covered by HealthShare. You will have to start over with all new providers, who will likely place you at the end of a long wait list for treatment. If you have surgery scheduled, it will not be happening. Would you want this for your loved ones?
Yes it’s not fair. But more importantly, it is not cost effective.
When your child or spouse gets ill, the only place you can go for treatment is the Emergency Department or Urgent care. As their chronic health problem worsens, they will need more care, not less. And it will be more expensive care.
What We Urge the OHA and Governor Brown to do.
The only fair, logical and sane response is to keep FamilyCare open and pay the extra $32 dollars per client per month to stay with a system that is already working effectively rather than pay HealthShare the same amount and disrupt the lives of 120,000 Oregonians.
Yes this is social justice in action, which challenges the underlying bias that the poor and vulnerable deserve to suffer.
But more importantly, it makes financial sense to provide quality healthcare so they can be part of the solution. We see our clients move in this direction every day.
Why pay HealthShare the same $32 a month to provide less service and cost Medicaid more through the ripple effect described above.
We urge the OHA, Governor Kate Brown and the Oregon Legislature to come to the table, to do not only what is right, but what will not only cost less in the short and long run.
We urge the Oregon legislature to call a special session to fund FamilyCare and help vulnerable Oregonians have the best chance of making a contribution to the quality of life and the community we love here in Oregon.
Sincerely,
Susan Wolfer, LCSW, SEP
Co-Owner of Counseling Services of Portland
7100 SW Hampton #129
Tigard OR 97223
[1] Based on $1500 in benefits per month, for 6 months
[2] https://www.washingtonpost.com/news/wonk/wp/2013/03/02/an-average-er-visit-costs-more-than-an-average-months-rent/?utm_term=.430fafc6016d
[3] https://www.bizjournals.com/portland/news/2017/08/08/oha-director-lynne-saxton-resigns-in-wake-of.html
[4] https://www.theguardian.com/commentisfree/2017/oct/14/trumps-biggest-enemy-isnt-the-media-its-poor-people
Let me echo Dr. Schwartz's concerns. As the only dedicated pediatric eating disorder treatment program in Oregon Kartini Clinic is following this development with growing alarm. We have worked succesfully with FamilyCare for several years and treated dozens of their patients (as well as nearly half a dozen other CCOs in Oregon, and Molina in Washington). Imagine our shock when Health Share told us they don't "see a need for pediatric eating disorder treatment" for their members? And the notion that Health Share can simply absorb Family Care's members because they (Health Share) has "80% overlap in providers" is laughable. But even if it were true, this means 20% of providers - like Dr. Schwartz - who currently provide vital and medically necessary treatment (in FamilyCare's own opinion) would simply be told 'sorry, you can't help these follks anymore'? It's unconscionable. OHA - who certifies and funds CCOs - cannot allow this to happen. Providers and members need to speak up.