Trillium Community Health Plan’s on-again-off-again drive to sign up Oregon Health Plan members in the Portland metro area is on again, with the state’s approval.
The Oregon Health Authority on Monday said it was rescinding a freeze it had placed on Trillium on Dec. 1 that had forbidden the insurer from signing up new members. At that time, the state cited Trillium’s failure to meet agency requirements, including failure to provide an adequate lineup of health care providers for the Medicaid-funded low-income health program..
On Monday the state announced that in recent weeks Trillium has made enough progress coming into compliance that it should be allowed to resume signing up Oregon Health Plan members in Multnomah, Washington and Clackamas counties who want to pick Trillium.
The tri-county Portland area is by far the largest Oregon Health Plan market in the state. It has roughly 400,000 Oregon Health Plan members. The vast majority — about 385,000 — are covered by Health Share of Oregon. Trillium, prior to the freeze, had just 18,000 members in the Portland metro market.
Officials at Trillium, which is based in Springfield and is owned by giant for-profit health insurer Centene Corp., did not respond to emails from The Lund Report on Monday seeking comment.
Trillium has fought for years to access the Portland metro area’s Oregon Health Plan market. After several years of disputes, the state agreed to let Trillium enter the Portland market in January 2020. Then the state backtracked, saying Trillium’s plan 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. Trillium failed to satisfy the fix list, leading to more disputes and, finally, the December 2021 freeze.
Much of the argument over the years has centered around the state’s assertion that Trillium’s in-network list of providers is insufficient. Typically, an insurer needs to provide a solid line-up of in-network providers to give patients a good choice of services.
The Oregon Health Authority pays Oregon Health Plan insurers — coordinated care organizations — on average about $6,500 per member per year to cover health care services for members, plus CCO administrative costs and a profit. To stretch those dollars, the state wants CCOs to negotiate cost-saving in-network contracts with providers.
In its Monday announcement, the Oregon Health Authority said Trillium has made progress but must continue to make improvements in the following areas:
- Trillium’s plan has “low numbers of home health agencies,” the state said. Trillium must provide more documentation to show that these agencies — six in all — are enough to service Trillium’s membership. Plus Trillium must continue negotiations with eight other agencies to sign them up for the plan, the state said.
- Trillium has signed up a “low number” of hospitals — only four — and the company must provide data showing these are sufficient, the state said.
- Trillium has “low numbers of (in-network) mental health crisis service facilities” — three — and must provide data to show these are sufficient, or sign up more, the state said.
- Trillium must sign up more providers and facilities accepting new Oregon Health Plan members for outpatient and community-based mental health treatment services for members with severe and persistent mental illness, the state said. Trillium must continue negotiations to sign up two large behavioral health providers and identify additional providers it has not previously approached, the state said.
- Trillium is negotiating to try to bring a major unnamed behavioral health care provider to the tri-county area, according to the state’s summary. Trillium will continue those negotiations, the state said.
- Trillium also must do more analysis of health equity issues and finalize a health equity plan, the state said.
You can reach Christian Wihtol at [email protected].
