With less than two weeks before the state allocates Medicaid contracts for the next five-year round, Lane County’s coordinated care organization has forged a key tie -- one that was recently broken.
Eugene-based Trillium Community Health Plan announced June 28 it has signed a new contract for PeaceHealth facilities to continue serving Trillium members into 2020.
The announcement comes about a month after The Lund Report revealed that Moda was soliciting support from health care providers in Lane County as part of its competing bid to gain a Medicaid contract there. Moda said it had sealed an alliance with PeaceHealth, the dominant health care provider in Lane County. https://www.thelundreport.org/content/bid-squeeze-out-trillium-medicaid-contract-moda-says-it-has-backing-large-medical-groups
Trillium, currently the sole coordinated care provider in the county, acknowledged that PeaceHealth had cancelled its contract starting in 2020. At the time, Trillium said it was trying to get Vancouver-based PeaceHealth to reverse that decision.
Now, Trillium says it has accomplished just that.
“Trillium and PeaceHealth will continue to serve (Oregon Health Plan) members without interruption and work to achieve shared goals of improving patient access to care, collaborating on innovative programs that address community health needs, and improving the health and social outcomes of Lane County,” Trillium said in a statement.
"PeaceHealth plays a crucial role for Lane County's OHP members as the largest hospital network in the area," said Trillium CEO Chris Ellertson. "This agreement ensures that Trillium and PeaceHealth will continue to serve OHP members without interruption."
Trillium has asked the state to renew its roughly $500 million per year contract for Lane County’s roughly 90,000 OHP members. Besides Moda, which is based in Portland, PacificSource in Springfield has also applied for the Lane Medicaid contract.
On July 9, the state is slated to announce its selection of coordinated care organizations statewide for 2020 through 2024. It’s unclear whether the state will approve multiple coordinated care organizations for geographic regions currently served by a single insurer. Currently, most of the state's region's each have a single Medicaid insurer. The main exception is in Curry, Josephine and Jackson counties, which are served by four insurers with overlapping territories. The state has issued guidelines on how Oregon Health Plan patients would be allocated in regions currently served by a single insurer but where the state approves more.
Trillium’s announcement doesn’t give details about the new contract with PeaceHealth. Trillium did not respond to an inquiry from The Lund Report. PeaceHealth said it had nothing to add to Trillium’s statement.
Lane County is one of four Medicaid markets that are in play with multiple health insurers seeking a slice of the $5 billion a year in federal and state money Oregon spends on Medicaid.
In Multnomah, Clackamas and Washington counties, the current CCO, HealthShare of Oregon, wants to keep hold of that market. But Trillium has also applied for it.
Meanwhile, PacificSource has applied for the Marion/Polk OHP market. So has Salem-based Marion Polk Coordinated Care, a new coordinated care organization intended to replace the current Salem-based Marion/Polk nonprofit that is being disbanded.
And Moda wants in on the Tillamook/Clatsop/Columbia OHP market, which is currently held by Columbia Pacific CCO – which wants to renew its contract with the state.
In these contested regions, insurers have been jostling each other to line up Medicaid contracts with health providers on the assumption the state may allow all eligible CCOs to enter regions they want access to.
For example, emails reviewed by The Lund Report in May showed that Moda is working hard to line up support from and contracts with health care providers in Lane County.
Under its contracts with coordinated care organizations, the state provides a fixed dollar amount per CCO member – typically about $5,000 per year. Each organization tries to ensure the total amount it receives is enough to cover the medical needs of all its members. Contracts between the CCOs and health care providers – such as PeaceHealth – are crucial in this equation. To help them stretch out their dollars from the state, CCOs try to get cost discounts from providers, in the hopes of clearing a profit or at least breaking even.
Trillium is owned by for-profit Missouri-based Centene, which specializes in managing Medicaid contracts nationwide.
Correction: Several Oregon counties, including Curry, Josephine and Jackson, are currently served by multiple insurers offering Medicaid. An article posted by The Lund Report on June 2 about PeaceHealth and Trillium, incorrectly stated that each county or region in the state was served only by a single Medicaid insurer.
You can reach Christian Wihtol at [email protected].
