DHS Details Children Health Alliance Changes

Jody Mohr Peterson is Assistant Director of the Department of Human Services in charge of the Division of Medical Assistance Programs
June 2, 2010 -- As we assist Children Health Alliance patients who are affected by the change from CareOregon to FamilyCare, I also want to make sure all interested parties have the most recent information. Here is a status report of the current situation.
This change is unprecedented for the Oregon Health Plan both in timing and scope, but our priority has been clear: in these challenging circumstances, parents should have full information, choice to do what they feel is best for their families, and assistance from the Department of Human Services (DHS) to ensure they face as little disruption as possible.
More than 10,000 children are affected by move of Children Health Alliance (CHA) pediatricians from the CareOregon managed care plan. This change is effective June 30, 2010. DHS was notified on March 18th of the decision of CHA to terminate their contract with CareOregon. We began working with CareOregon on transition options and have also kept CMS apprized every step of the way.
About a month later, on April 23rd, we were notified that CHA had chosen FamilyCare as a replacement. We immediately began working to modify the earlier transition plan that would minimize disruption to patients and leave the ultimate decision up to parents. On May 14th, FamilyCare and CareOregon agreed to this plan and DHS moved forward.
We also asked CareOregon and FamilyCare to report on their provider network ability to support this change. With the pediatricians from Children Health Alliance moving to FamilyCare, they have adequate capacity to serve these children. After careful review, we believe CareOregon also has capacity to serve the children based on the number of pediatricians and general and family practitioners. Nationwide, family doctors provide nearly 30 percent of pediatric care and there is no reason to believe that would be different in Oregon.
Our analysis shows that both organizations have the capacity to serve these children. Therefore, the parents have basically two choices: stay with CareOregon and choose another doctor for their children or move to FamilyCare and keep their current pediatrician.
There are other factors for parents to consider in making this plan choice. Some of the children affected may be receiving specialist care that is already coordinated through CareOregon, and parents have to look at the best options to ensure continuity of care for them. Additionally, there are approximately 7,000 other family members of these children who are also on the Oregon Health Plan through CareOregon, including pregnant women, people with disabilities and with chronic illnesses whose continuity of care needs to be considered. For those parents, the decision between the two plans is a little more complicated. If they stay with CareOregon, they would keep their doctor and their child would have a new doctor. If they move to FamilyCare, they would lose their doctor but their child's pediatrician would stay the same.
These are difficult decisions for all the families involved and the decisions need to be made quickly. As soon as all of the details of the transition were finalized we began notifying clients. Earlier this week DHS sent a letter to all the families affected, letting them know about the choices before them. If they choose FamilyCare, they can simply fill out the notice and return it to us in the enclosed envelope. We have also added additional temporary staff to answer phone calls and respond to any questions the parents may have.
Additionally, for parents who decide to stay with their current pediatrician we wanted to make the transition to FamilyCare as easy as possible. To do so, we provided the client notification and form to the doctors that could be faxed from their office to DHS with the patient's signature. However, this week we were notified by CMS that we cannot accept those forms as this practice violates federal marketing regulations. While we have asked for legal advice on the issue, we are calling all parents who submitted the change form through their doctors to confirm their choice.
 
There are also about 5,000 other children who are on paper Children Health Alliance patients but have not been to their doctor within the last year, or had seen a different non-CHA primary care provider more recently. Those families have been notified by CareOregon they have assigned them a new primary care provider to ensure that when they do see a doctor, there will be no disruption of care. If any of these patients have concerns about this change, they can contact DHS, and if they wish to switch to FamilyCare, we assist them in doing so.
To date, we have received approximately 375 requests from clients asking to be switched to FamilyCare. We anticipate an increase in calls over the coming days and weeks as clients receive the letters sent to them by DHS. As we know from some of the calls already received, these decisions for these families are complicated by the fact people may be in the middle of a treatment plan or have surgery scheduled under CareOregon but want to switch to FamilyCare. We are being flexible and providing these families with options to meet their needs. We will accept change requests through September 2010. If a request to change comes in after that date, we will review them on a case by case basis.
DHS has worked very hard to try and ensure all parties involved in this change work together, and to ensure our clients have all the information they need. While our contracts with CareOregon and FamilyCare do provide some guidelines as to how to address a change such as this one, we are going far above and beyond those requirements to make this transition as easy as possible for families and ensure that they have as much control as possible over their health care.

 

Judy Mohr Peterson, Ph.D.
Asst. Director, DHS
Administrator, Div. of Medical Assistance Programs
PH: (503) 945-5768
BB: (503) 991-6229

 

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Comments

The way to settle this issue would be for the two health plans--FamilyCare and CareOregon to re-imburse providers the same. The reason the CHA went to FamilyCare is because the fee for service rates are not competitive compared to a captitated plan such as what FamilyCare offers.