State Regulators Fault Trillium’s Portland-Area Medicaid Program - Again
More than three months after the state let Trillium Community Health Plan begin offering Medicaid insurance in the Portland metro area, regulators and the insurer are running in circles as the state tries to push Trillium to improve its provider network, community outreach, translation services and other key elements of its program.
Trillium appears substantially short of meeting standards set by the Oregon Health Authority for the Oregon Health Plan, according to letters and reports between the state and Trillium.
Nevertheless, the agency indicated it will let the company continue to serve Medicaid members in Multnomah, Clackamas and Washington counties into 2021.
In a Nov. 30 evaluation of Trillium, state officials said the for-profit company has failed to show how it will meet the state’s requirements. These include signing up additional providers, securing access to more youth psychiatric beds, securing more intensive home health care services, providing interpretative services for the metro area’s diverse community and ensuring community engagement.
The Oregon Health Authority said it needs a more detailed plan by Dec. 14.
Getting Trillium’s plan into shape is a “six-12 month process,” said Dave Baden, the Oregon Health Authority's chief financial officer. “Our goal is ensuring members have access to the services they need and contractual requirements are met,” he said.
The state in August told Trillium it could enter the Portland-area Medicaid market effective Sept. 1, but said in a Sept. 2 directive that Trillium’s plan for serving the market was inadequate. The state gave Trillium until mid-October to file a “corrective action plan.”
But that 17-page corrective plan isn’t up to snuff, the state said in its evaluation.
The back and forth illustrates how difficult it can be for a Medicaid insurer to construct a new program in a new territory, especially when that region has been a monopoly served by another insurer. Prior to Trillium’s arrival, the metro Medicaid market was served solely by Health Share of Oregon.
Trillium entered the Portland-area market after enjoying a monopoly in Lane County. It now shares thecounty with PacificSource Community Solutions, a nonprofit. Trillium is owned by Centene Corp., a Missouri-based Fortune 500 company that is the largest Medicaid insurer in the country.
The Oregon Health Authority has repeatedly picked apart Trillium’s plans for serving the Portland market, highlighting deficiencies.
For example, the agency said that Trillium’s Oct. 15 plan focused too much on the fact that Trillium was negotiating to try to sign up hospitals and home health care services for its provider network. Such negotiations don’t satisfy the state’s requirement, spelled out in the Sept. 2 notice of deficiency, that the insurer must expand its network of providers, the state said. The state said it wants to know locations of newly signed up providers and whether they are accepting new members. One of Trillium’s pitches in its Oct. 15 plan was that it was in talks with a hospital system and hoped to have a deal by the end of the year.
Another problem is languages. Some 15 languages are spoken in the Portland area, including Russian, Somali and Nepalese, creating a need for interpreter services. But Trillium’s interpreter plan is lacking, the state said.
“Trillium has entered a diverse market with dynamic language access needs,” the Oregon Health Authority cautioned Trillium. Trillium’s plan relies too heavily on outside contractors, the state said.
“Trillium’s plan describes working with language service companies to provide interpreter services but is silent on how (Trillium) will develop internal operations structures and workflows to complement the use of contractors to provide language services.” Trillium should “train staff on the importance of language access needs,” the state said.
In addition, “Trillium’s community engagement plan and strategies are generic and lack specificity,” the agency wrote in its Nov. 30 evaluation.
Trillium has signed up four hospitals – Oregon Health & Science University, Tuality hospital in Hillsboro, Adventist Health and Cedar Hills Hospital, a psychiatric hospital in Portland. Of these, only OHSU accepts youth psychiatric patients, and only a limited number, the state said. It added that Trillium should try to sign up Unity Center for Behavioral Health in Portland, the state’s only psychiatric emergency care hospital, and Providence Willamette Falls Medical Center. Both have beds for youth with behavioral health problems.
But the Providence system – which operates the Willamette Falls hospital - has declined to join Trillium’s Portland-area network. And Unity is run by a hospital consortium that is led by Legacy Health, a hospital system that also has declined to sign a contract with Trillium.
The Portland area’s big hospital systems generally opposed letting Trillium into the market, saying they were satisfied with Health Share, and that adding another insurer would simply add paperwork.
The state said it expects to closely monitor Trillium’s program in the Portland area into next year.
Trillium did not respond to a request for comment from The Lund Report.
The state and Trillium have engaged in protracted skirmishing for 18 months on whether Trillium is able to provide an adequate Oregon Health Plan insurance program in the Portland region.
The market has 364,000 Oregon Health Plan members, almost all handled by Health Share. Since the state opened the market to Trillium, Trillium has managed to sign up just 3,985 members, according to the state.
Under the state’s contracts with Medicaid insurers, the state pays insurers on average about $6,000 per member, which the insurer uses to cover member health care costs, its administrative costs and profits.
In 2019, the state initially approved Trillium’s plan to enter the Portland metro Medicaid market in January 2020, then backtracked, saying Trillium lacked an adequate provider network. The state gave Trillium until the summer of 2020 to come up with a better network. In mid-2020, Trillium submitted a new plan, which led the state to let the insurer proceed, provided it made many fixes.
In its August 2020 letter letting Trillium into the market, the state warned that if Trillium failed to make improvements in its Medicaid program, it could face “monetary penalties, membership freeze and potential contract termination.”
If Trillium had not “fully satisfied” its “corrective action plan” by the end of 2020, the state will renew Trillium’s contract for 2021 and the state will continue to seek Trillium compliance, the state wrote.
You can reach Christian Wihtol at [email protected].
Dec 7 2020