Insurers Scramble In Newly Competitive Oregon Medicaid Markets
Medicaid insurers and their members in two of Oregon’s biggest markets – the Portland area and Lane County - are being dunked into a new world of competition and choice.
Over the next several months, the state-approved insurers for those two regions -- Health Share of Oregon and Trillium Community Health Plan in Portland, and Trillium and PacificSource in Lane County -- will compete with each other to enlist Medicaid members.
On the flip side, about 400,000 people, or 40 percent of the state’s Oregon Health Plan members, will get to choose between two insurers. For many, this will be a novelty.
At this point in the state’s months-long process to unveil competition and choice in these markets, all three insurers are focused on lining up contracts with as many behavioral health and primary care providers as possible. That’s because the state’s initial non-binding allocation of members to insurers – to be carried out later this month -- will center on making sure members stay with their current providers. The more providers an insurer signs up, the better their chances of snagging members.
The insurers “are working now to try and build their provider networks as much as they can,” said David Baden, chief financial officer of the Oregon Health Authority. An insurer’s “ability to contract (with more providers) will mean more members will be allocated” to them, he said.
If members’ key behavioral and primary care providers have contracts with both competing insurers, then the state will tentatively allocate an equal number of those members to each insurer, Baden said. However, members will get two chances, first in October, and again early next year, to pick their insurer, Baden said.
The insurer-provider contracts are also important because they spell out the rates insurers will pay. Without that guarantee, Medicaid insurers can’t anticipate their costs and can’t figure out whether they’ll be able to turn a profit or at least break even with the money they receive from the state to cover care for Medicaid members.
Even as the state unfurls choice and competition, the pros and cons remain unclear. Elected officials in Lane, Multnomah, Clackamas and Washington counties earlier this year asked the Oregon Health Authority to designate only a single Medicaid insurer in their market. County-run health clinics play a big part in providing health care to Medicaid members, and the local officials said it would be inefficient to have multiple competing insurers.
In the Portland market, hostility toward Trillium, owned by for-profit Centene Corp., has run high. When Trillium formally applied for the market earlier this year, Multnomah, Clackamas and Washington officials refused to talk with the company. After the state this summer tentatively designated Trillium for the market, the three counties changed their tune and have grudgingly opened negotiations with the company.
Even now, though, some county officials remain sceptical of the looming competition, worried it will be wasteful and confusing.
Kate Willson, a Multnomah County spokeswoman, said the county “still has concerns that the allocation of members in the tri-county is going to cause confusion and disruption to some of our most vulnerable clients.”
But the Oregon Health Authority has brushed aside such anxieties. The state says it is letting multiple insurance companies compete in a single area because those companies showed they are financially and organizationally strong and will improve service to Medicaid members.
The state says it did not design the new Medicaid system it launched this year to foster competition. But having multiple insurers in a single market provides “an opportunity for some of that healthy competition,” Baden said. For example, he said, having rival insurers may foster more robust lists of health care providers for members under the new version of the Oregon Health Plan, dubbed CCO 2.0.
Competition and choice have been patchy in Oregon’s Medicaid program thus far. Nonprofit FamilyCare competed with Health Share in the Portland market until FamilyCare folded in early 2018 and Health Share took over its membership. Some observers said the most prominent feature of that rivalry was squabbling between FamilyCare and Health Share.
In the Jackson County area in Southern Oregon, there’s been choice among several small insurers in small geographic areas.
This time around, state officials say it will be up to insurers in competitive markets to decide later this fall whether they have signed up or been allocated enough Medicaid members to make the business financially worthwhile.
“It comes back to the (insurer) to (make) its own business decision,” Baden said.
Trillium Challenges Health Share In Portland
Currently, the Portland metro market’s single Medicaid insurer – with 300,000 members - is Health Share of Oregon, a nonprofit founded and run by 11 health and social service entities. Health Share figures it is ready for competition.
“Health Share members have access to the largest network of health plans, doctors, dentists, counselors, and more — and that will stay the same in 2020,” said spokeswoman Stephanie Vandehey. “We expect members will want to continue relationships with their current providers, whether that’s a primary care provider, behavioral health provider (or) specialists, ”she said.
Multnomah County, which through its clinics is a major provider of primary, behavioral health and dental care, has already signed a contract with Health Share for 2020, said Jeston Black, the county’s director of government relations.
But Multnomah has not signed a contract with Trillium, the new kid in town, Black said. In fact, the county has only just started talking with the company.
“We had our first formal meeting with them” in late August, Black said. “We’re not far enough along to say we’re definitely going to have a contract with them or not.”
Clackamas County doesn’t plan to meet with Trillium until the middle of this month, said county spokesman Tim Heider.
Trillium is putting on a brave face at the frosty reception.
“During the more than 20 years that we have worked with the Oregon Health Plan population in Lane County, we have cultivated strong partnerships with community organizations to provide whole health integrated care to our members – from medical, dental, and behavioral health care services, to addressing social determinants of health such as access to housing and food,” Trillium spokeswoman Karen Sawyer said in a statement.
“We are proud of the work that we do, and we are pleased to have the opportunity to bring our experience to the unique communities of Washington, Multnomah, and Clackamas counties in the Portland metro area,” she added. “We know that growing relationships in the Portland metro area as we have in Lane County will take some time. However, we have a strong record of building partnerships with local organizations that have a deep understanding of their communities. It’s that wealth of experience that we will leverage in the Portland metro area.”.
“We continue to align and engage Portland-area stakeholders,” she said.
PacificSources Takes On Trillium In Lane
In the 90,000-member Lane Medicaid market, PacificSource is the newcomer, taking on Trillium. However, the nonprofit’s commercial health insurance business has long been active in the county. Also, PacificSource is the Medicaid insurer in two other regions of the state, and was tentatively awarded the 100,000-member Marion-Polk market for 2020 onwards.
“We expect to work with all major provider groups to serve (Medicaid) members via a comprehensive network” in Lane, said spokesman Lee Dawson. The company declined to talk about specific contracts.
But inking contracts with behavioral and primary care providers is only one step insurers have to go take.
Another is a “readiness review,” a broad look by the Oregon Health Authority at whether the Medicaid insurers the OHA tentatively approved for 2020 onward are fit for the job. That review, set to be completed this month, examines finances, staffing and other issues. “There is a chance a (Medicaid insurer) wouldn’t pass readiness review,” Baden said.
Following that, the state hopes to sign contracts with insurers by the end of this month.
But before they sign, insurers will have to figure out if they have received, or expect to receive, enough Medicaid members to make the business viable. How many members will Trillium get in the Portland market, or PacificSource in Lane? How many do they need in order to run an efficient and profitable operation?
To keep members in the loop, the state will send out a string of mailers – one each in September, October and December. In markets with insurer competition, the state says it will provide members with comparison guides in print and online, and a “pick your plan” graphic to help them. In competitive markets, members will be able to choose an insurer Oct. 16 to Nov. 17 and again from Jan. 1 to March 31 next year.
You can reach Christian Wihtol at [email protected].