The way Oregon cares for its most vulnerable residents went through a big change Thursday as the state’s second largest coordinated care organization, FamilyCare, closed its doors.
That leaves 115,000 customers facing uncertainty or at least a period of major transition. Take Nora Frala, who lives in Portland and is on disability. She’s 59 and has suffered a form of bipolar disorder since she was 15.
She says the peace of mind she got from having coverage under the Oregon Health Plan and FamilyCare was a blessing. Now she’s worried.
“I’ve heard rumors that they’re closing my clinic. That would be tough for me,” she said. “I’ve gone to that clinic for 15 years now. The same one.”
Poor and disabled people such as Frala receive their health insurance under the Oregon Health Plan, the state’s version of Medicaid. That care is provided by 16 different coordinated care organizations, spread across the state.
The failure of FamilyCare in Portland has the Health Share, Willamette and Yamhill CCOs scrambling to pick up FamilyCare’s former customers.
HealthShare is receiving the most. So far, it’s welcomed 102,000 new customers.
CEO Janet Meyer said Health Share officials looked at which doctor each patient had, then reverse engineered FamilyCare data to continue coverage with the same provider.
She said ID cards are in the mail on their way to customers. And even if a former FamilyCare patient hasn’t received theirs yet, they can still go to their regular doctor for care.
“Health Share has blanketed the market with messages to say: ‘Please see these clients, we will pay for these services,’” she said, “so that there isn’t disruption.”
That coverage guarantee lasts for 90 days for people suffering with physical problems. But it’s longer — 180 days — for those with mental health issues. That’s because Health Share doesn’t pay as well as FamilyCare, and there’s been significant reticence among providers to sign up.
Still, Meyer is optimistic.
“We’ve had many town hall meetings, lots of one-on-one meetings,” she said. “And I think what they’ve found is that we’re a good company to work with. We want to work with them.”
Meyer estimates there is a 75 percent overlap between FamilyCare and Health Share mental health providers. That makes her hopeful that most patients won’t have to change providers.
The outspoken head of FamilyCare, Jeff Heatherington, isn’t so sure.
“Some of the clinics, I’ve been told, have already started laying off staff,” he said.
Heatherington is in the middle of laying off 322 FamilyCare employees. “I’m really pissed off about it, to be quite frank,” he said.
State Rep. Mitch Greenlick, D-Portland, chairs the House Health Care Committee. He said there have been some problems getting mental health clinics to sign new contracts. But he’s not worried
“My impression is it’s going fairly well in most areas,” he said.
The failure of FamilyCare has left some people wondering about the future of Oregon’s coordinated care organizations.
But Greenlick doesn’t think there’s a systemic problem, mainly because, unlike FamilyCare, the remaining 15 CCOs haven’t spent years battling the state over Medicaid payments.
“The possibility that some wouldn’t make it was always in the cards,” he said.
Meanwhile, patients such as Nora Frala worry about the prospect of finding a new doctor or therapist.
“You don’t know them to begin with. You don’t have the inherent trust for a stranger that you’ve just met,” she said. “It takes a little while for you to impart the information to them about who you are and what your needs are and then for them to receive that and be able to assimilate the information so they can best help you.”