The Portland-area coordinated care organization FamilyCare will be raising its primary care rates in August to match those of commercial insurance -- a remarkable decision given Medicaid’s historical practice of reimbursing physicians less than all health insurance types.
FamilyCare President Jeff Heatherington announced the move Tuesday night at a banquet for primary care providers in Portland’s Lloyd District, and it follows an earlier move two years ago that increased primary care provider rates above those of traditional Medicare, the healthcare program for the elderly.
“We raised the rates, and we said we could expect more out of you,” Heatherington told the healthcare providers. “You’d spend more time with them, and we’d see some costs go down because you’d be spending more time with the clients.”
Heatherington said it was no coincidence that the United States has both the highest medical costs in the world and the smallest percentage of those costs dedicated to primary care -- the two are inversely proportional.
Boosting primary care rates was among Heatherington’s first acts when FamilyCare was converted from a managed care organization that served Medicaid clients to a full-fledged coordinated care organization to become responsible for the physical, mental and dental health of its members. Heatherington said the result was cost-neutral: spending on speciality care went down at roughly the same rate that spending on primary care increased.
Heatherington hopes that by further boosting payments at the front end, it will further decrease the need for higher cost tests and procedures, the idea being that primary care physicians can more holistically determine a patient’s overall health outlook. And if a patient does need a referral, the primary clinic will have greater ability to properly diagnose a patient so that they are referred to the correct specialty the first time, instead of getting shuffled around to several different doctors.
The smaller of the two Portland Metro CCOs, FamilyCare more than doubled in size from 48,000 members to 110,000 members as a result of President Obama’s expansion of Medicaid.
“There was a lot of strain on everyone but that was expected,” Heatherington said. “We were able to put all of those clients with a primary care provider.”
Vanessa Esteves, a naturopathic physician at Portland Integrated Health & Sports Medicine, said the boost in pay has allowed her clinic to expand its staff, increasing the number of patients it sees each month.
The clinic doesn’t determine the length of its patient visits based on insurance type, but the increased pay from the traditionally lower-paying Medicaid provider does allow the clinic to offer more comprehensive care and take on more patients, regardless of payment type. “It gives you more wiggle room,” Esteves said.
When reached for comment about the CCO transformation efforts, Gov. Kitzhaber’s chief spokeswoman, Nkenge Harmon Johnson, declined to add anything to this article.
Salem & Eugene CCOs
Other CCOs have tried different approaches to enhance primary care access. Dean Andretta, interim director of the Willamette Valley Community Health Plan in Salem, said he agreed with Heatherington’s faith in primary care in spirit, but his CCO is trying a number of payment models designed to move the healthcare delivery system away from its fixation on payment per procedure and office visit.
Willamette Valley may increase payments to those wedded to the old model, but for now it has focused on getting more physicians to accept global payments based on a per patient per member amount each month -- and the risk that goes with such payments, along with quality rewards. Most of the bonus pool money that the CCO won for its relatively high scores this summer is being rolled right back into the primary care providers.
“We would like to eliminate the major, major discrepancy between commercial insurance and Medicaid,” Andretta said, and hopefully create a primary climate where insurance type will be irrelevant for physicians.
Trillium Community Health Plan in Eugene, which has struggled more than most CCOs to deal with a lack of primary care capacity, is taking a three-pronged approach to get back on track after reluctantly shutting its doors to new adult members in April. Trillium has about 9,000 people without a primary care physician, and an unidentified number of other adults in Lane County were given the so-called “open card” for their Medicaid benefits through the Oregon Health Authority, which pays their bills but only offers limited access.
Trillium has budgeted $1 million to boost payments to primary care providers based on the number of new patients it accepts; plans to open a new $890,000 clinic in West Eugene in August; and is offering $500,000 in grants to physicians willing to transform their practice by adding more support staff which enables them to accept more patients. The clinic is expected to serve about 6,000 people while the transformation grants might cover an additional 5,000 people.
Chris can be reached at [email protected].
