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Oregon Health Authority Puts Trillium On 30-Day Notice

The agency outlines changes that the coordinated care organization has to make to enter the Portland-area Medicaid market.
Trillium's offices in Eugene. | CHRISTIAN WIHTOL/THE LUND REPORT
September 3, 2020

The Oregon Health Authority has given Trillium Community Health Plan 30 days to fix its Medicaid services in the Portland-area  market.  

In a notice of noncompliance filed this week, the agency said Trillium needs to provide written proof of providers who are willing to work with Trillium and take on new Medicaid patients. It also told the company to detail its strategies for health equity and have an adequate pool of language interpreters. 

Trillium, an affiliate of the national Medicaid for-profit giant Centene Corp., opened its doors as a coordinated care organization in Multnomah, Clackamas and Washington counties on Sept. 1. But that approval came with caveats: The Oregon Health Authority has lingering concerns about the company’s provider network capacity and ability to reach multilingual communities. 

Coordinated care organizations sign contracts with medical, dental and behavioral health providers who serve patients on the Oregon Health Plan. Health Share of Oregon, which was the sole coordinated care organization in the $2 billion a year Portland market, has a wide network. Trillium has struggled to carve out its own turf.

The notice filed Wednesday gave Trillium specific directions for a correction action plan that will need to be approved by state regulators. Trillium had 30 days to submit a plan.

Trillium already serves Medicaid members in Lane, Douglas and Linn counties. The Oregon Health Authority initially refused to approve Trillium’s application in the tri-county area, telling it in November 2019 that it had until June 30 to contract with a hospital and sign up a sufficient number of  providers.  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. 

In August, the authority approved Trillium’s application for expansion into the Portland market but said the company needed to make corrections. The notice provided more details of what the state expects.

The authority said Trillium needs to either demonstrate how it will expand its capacity or show how its current “low numbers” of providers are adequate to meet patient demand. 

Providers include home health agencies, rural health centers and mental health crisis service facilities. The notice said Trillium needs to provide more information about member-to provider ratios and the geographic distribution of its network. 

For each county, Trillium also needs to submit its contracts with providers or provide other written documentation with information about their ability to take on new Medicaid patients. 

A spokesperson for Trillium didn’t respond to a request for comment. 

Concerns About Behavioral Health

Trillium sent updated information about its providers 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 has 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, and the Portland-based Legacy Health network of hospitals agreed to contract with Trillium for pediatric services 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, didn’t sign on, cutting off Trillium’s access to its four metro-area hospitals and a network of primary and specialty-care clinics. 

The authority is concerned about adequate mental health and behavioral health services. 

“Trillium has not demonstrated adequate network provider capacity to serve members, especially in the area of behavioral health,” Lori Coyner, the authority’s Medicaid director, wrote in the notice. 

Trillium also needs to demonstrate an increase in mental health providers that accept Medicaid members for outpatient and community-based services in Washington County. And it needs to detail how it will add more behavioral health providers, the authority’s notice said. 

The health authority is concerned about the company’s ability to serve non-English speakers and ensure that minorities are adequately served. The notice said Trillium needs to demonstrate that it will have adequate access to language interpreters for patients. Trillium must explain how it will analyze demographic and health equity data to meet the needs of minority patients. 

Overall, the health authority was unimpressed with Trillium’s community engagement in the Portland area. Trillium is required to have a community advisory council, but it “has not demonstrated these requirements are being met,” the health authority said in its notice. 

Trillium’s application focused on its Lane County work and “did not show evidence of sufficient engagement with the tri-county community and stakeholders,” according to  the notice, which called on Trillium to develop a community engagement plan. 

The Oregon Health Authority regulates coordinated care organizations to provide health care services to about 1.2 million people enrolled in Medicaid. The agency contracts with 15 coordinated care organizations, including Trillium. Health Share, a nonprofit, has been the biggest one, serving 350,000 members in the tri-county area. Trillium was a homegrown Oregon company before Centene, a Missouri-based insurer, purchased the company in 2015. 

Its bid for a slice of the Portland-area market has raised eyebrows among some health care officials who say the coordinated care organization is unnecessary in the region. Critics are suspicious of Centene, a Fortune 500 company and the nation’s largest Medicaid insurer. They fear that under Centene, Trillium will be focused  on its bottom line and not on the mission of serving low-income residents on the margins. 

When Trillium applied for the contract almost all major Portland-area providers refused to sign Medicaid contracts with the company.

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 PacificSource. 

PacificSource has about 63,000 members in Lane County, and Trillium has about 34,000.

You can reach Ben Botkin at [email protected] or via Twitter @BenBotkin1.