Oregon Health Authority Approves Trillium’s Portland-Area Medicaid Application With Caveats
The Oregon Health Authority notified Trillium Community Health Plan that it can expand its service area and serve Medicaid patients in Clackamas, Multnomah and Washington counties.
Trillium can start to enroll Oregon Health Plan members in those regions on Sept. 1, the authority said Tuesday. The 350,000-member tri-county market currently has just one other coordinated care organization: Health Share of Oregon.
But Trillium isn’t in the clear yet with state regulators. The Oregon Health Authority plans to issue a corrective action plan to Trillium, citing concerns about its capacity to provide behavioral health and meet health equity requirements.
Trillium serves Medicaid members in Lane, Douglas and Linn counties, but the coordinated care organization has faced challenges in qualifying for the profitable Portland region. The Oregon Health Authority initially refused to let Trillium serve the tri-county area. The authority notified Trillium in November 2019 that it had until June 30 to contract with a hospital and gain enough providers in order to qualify to serve Portland-area patients. Without meeting those requirements, the authority said the coordinated care organization would lose its ability to serve patients in the tri-county region for the next five years.
A spokesperson for Trillium didn’t immediately respond to a request for comment. James Schroeder, Health Share's CEO, said Health Share is committed to working with "all partners and entities to help ensure equitable access" to health care services. However, Schroeder said, Health Share has concerns about the shortcomings in Trillium's application.
"As the coordinated care organization for the tri-county area for over 358,000 Oregon Health Plan-covered individuals, Health Share of Oregon has a robust and established network of providers that is currently in place to meet our members’ needs," Schoeder said in a statement. "Based on what we have seen in the announcement, we are concerned about the deficiencies OHA has identified in Trillium’s network and how that could impact OHP members in the metro area, especially during these pandemic times."
Trillium sent updated provider network information to the health authority in June. In its filing, Trillium said it had signed contracts with multiple hospital and major clinic systems and providers.
Oregon Health & Science University, for example, agreed to provide speciality services like sports medicine and pregnancy care, but not primary care. Two OHSU-affiliated hospitals, Tuality Community Hospital in Hillsboro and Adventist Health Portland, agreed to provide some services, as did the Portland-based Legacy Health network of hospitals for services such as pediatrics and rehabilitation medicine.
County-run community health centers in Multnomah, Clackamas and Washington also have signed contracts with Trillium, according to Trillium’s submittal. But Portland’s largest provider, Providence Health & Services, hasn’t signed up with Trillium. Providence has four hospitals in the metro area and a network of clinics for primary and specialty care.
Health Share’s provider network includes all the hospitals in the tri-county region, and some officials have said Trillium isn’t necessary in the region. Health Share is the largest of all the 15 coordinated care organizations in Oregon and receives $2 billion a year from the state.
Health Share is a nonprofit while Trillium is owned by Missouri-based Centene Corp., a Fortune 500 company and the nation’s largest Medicaid insurer. Its corporate status has stirred opposition to Trillium’s expansion into the Portland-area over concerns that it’s focused on its bottom line and not serving low-income residents. When Trillium applied for the contract almost all major Portland-area providers refused to sign Medicaid contracts with the company.
Though the health authority gave the go ahead, it still has questions about the quality of Trillium’s network, particularly in behavioral health. The health authority said it has concerns about Trillium’s ability to meet contract requirements tied to health equity and community engagement.
The health authority will issue a corrective action plan for Trillium to address those concerns during the next several months. During that period, Trillium must demonstrate growth in its network. If Trillium fails to comply, the coordinated care organization faces potential sanctions, fines, a membership freeze and termination of its contract.
The approval means that Oregon Health Plan members in the tri-county region will be able to choose Trillium when they enroll starting Sept. 1. Members will also be able to switch from Health Share to Trillium once a year and when they renew their enrollment in the Oregon Health Plan, Oregon’s Medicaid program..
Centene bought Trillium from its Lane County owners in 2015. Trillium was the only CCO for about 90,000 Medicaid members in Lane County until this year, when the state let PacificSource Community Health Plans enter the market. Many providers and members ditched Trillium and switched to PacificSouce.
PacificSource has about 63,000 members in Lane County, and Trillium has about 34,000.
Aug 18 2020