If FamilyCare is shut out of the coordinated care market by the Oregon Health Authority, there’s no shortage of CCOs willing to step in.
After FamilyCare didn’t sign its contract amendment for 2015, the Health Authority struck back, giving the other CCOs the opportunity to take over its members by submitting a binding letter of intent by Dec. 2. FamilyCare has 128,000 people in Washington, Multnomah, Clackamas and Marion counties, and had refused to sign the contract because of what it considers significant rate reductions. But now CEO Jeff Heatherington says he will sign the 2016 contract amendment and take up the rate reduction problems at a later date.
The Health Authority insisted it’s taking a “precautionary step to ensure continuity of coverage," and it's unknown whether the agency will move forward with its emergency plan.
If FamilyCare loses its contract, Health Share is ready to pounce, having a strong footprint with 230,000 members in the tri-county area. And its partners – Legacy Health, Providence Health & Services, Oregon Health & Science University, Kaiser Permanente, CareOregon and Tuality Health -- claim to have the resources to take care of this new population.
"Our partners are confident we have the capacity to meet the needs of all the OHP members in our service area," Beth Sorenson, spokeswoman for Health Share, told The Lund Report, saying its letter of intent is forthcoming.
Health Share is unlikely to be alone in vying for FamilyCare’s members. Centene Corp., a Fortune 500 company based in St. Louis which recently purchased Trillium Community Health Plan in Eugene, has a very strong presence in the Medicaid market nationwide and interested in growing its presence in Oregon.
Moda Health might also want to spread its wings after announcing a partnership with Oregon Health & Science University, which will have a 25 percent ownership in the insurance company. Moda already has a CCO in Eastern Oregon, 12 counties. But if it hooks up with OHSU to get into the Portland metropolitan area, OHSU could endanger its relationship with Health Share because it’s a founding partner.
Then, of course there’s PacificSource Heath Plan, which has announced a joint venture with Legacy Health. Once again Legacy would have a difficult time breaking away from Health Share since its CEO and president, George Brown, chairs its board.
PacificSource is moving into Portland, having announced the opening of its downtown location next spring to accommodate its sales and marketing teams. .
“PacificSource has been eyeing expansion to a second location in the greater Portland area for several years, but we had some very specific criteria and hadn’t found the right fit until now,” said Sharon Thomson, Vice President of Community Strategy and Marketing for PacificSource. “The Crown Plaza building’s proximity to mass transit and the freeway is convenient for both staff and visitors, allows us plenty of room for growth, and gives us a strong presence with the business community in the heart of downtown Portland.”
Whoever decides to venture in, anyone familiar with Heatherington knows he won’t give up easily. Earlier, he filed a lawsuit against the state alleging breach of faith and tort claims, contending that his 2015 rates were not made on an “actuarially sound basis” as required by the federal Medicaid act. And, he’s refused to pay back $55 million to the Health Authority, which contends FamilyCare was overpaid during the first eight months of the year.
Diane can be reached at [email protected].
This story has been corrected to say that Jeff Heatherington intends to sign the 2016 contract amendment, not the amendment in 2015. We apologize for the error.
