Tens of thousands of Oregonians who didn’t have health insurance last year now do as result of the Affordable Care Act.
And that translates to a greater demand for doctors.
Trillium Community Health Plan in Lane County is struggling to deal with the big influx of new patients.
It’s also learning that many of those patients are older and sicker — because they haven’t had insurance for years.
Cheryl Stumph and her husband Mike run Green Streak Automotive, an all service garage in the small Willamette Valley town of Veneta.
“Cars and trucks and tractors and generators and lawn mowers and boats and motor homes and I think the only thing I haven’t done, or my husband hasn’t done is an airplane, so far,” she said.
Stumph has six kids. She used to have seven, but her 27-year-old son had a stroke and died at the wheel of his tow-truck in November.
The stroke stemmed from a genetic problem. So Stumph spent this winter worrying about her other kids. Genetic testing is expensive and she didn’t have health insurance.
But then, she was referred to Cover Oregon and now gets Medicaid via the local coordinated care organization, Trillium Health.
“That was really relieving,” said Stumph. “You know, because like I said, then we can check on the other kids and maybe not lose them. And oh my god, we’re 50 and aren’t there things we’re supposed to do at this age of our lives. And you know, we’re doing it, and it’s great. It just gives you hope.”
She’s thrilled to be able to get a mammogram and treatment for a long-term infection she’s been dealing with. The kids can get genetic testing and her husband too, she says, has a chronic medical problem that needs attention.
Stories like Stumph’s are being repeated across Oregon.
The state estimated Lane County would enroll an extra 26,000 people in the Oregon Health Plan over the first two years of the Affordable Care Act.
But Terry Coplin, the head of Trillium Health, thinks all those people will probably have signed up by the time the enrollment window closes at the end of the month.
“We weren’t expecting to get such a large assignment of patients in the first two months,” said Coplin.
“Administrative systems can deal with this, that’s not a problem. But these patients who are coming onto the program, many have not seen a physician for years. We’re dealing with not just a large number of patients, but also what appears to be a much sicker population of patients.”
In fact, so many people signed up in Lane County, that finding a provider there can be difficult.
Stumph says it took her several weeks to get a doctor.
“It took a month I think to get the first appointment for my husband,” she said.
So, what’s Trillium doing about it?
Trillium’s Coplin says the coordinated care organization has a four-part plan.
First, pay bonuses to doctors who accept new members.
“It costs more for them to see a new patient than an established patient. Number two they’re getting much sicker patients up front,” he said.
Second, Trillium is granting Lane County $900,000 to open a new clinic but in an existing building. A custom build would take too long.
“They have proposed ways that they can get this clinic up and running by mid-year,” said Coplin.
Third, Trillium is hiring a medical time-and-motion consultant to see if existing clinics can be tweaked to increase capacity, for example by changing who fills out forms.
“Having physicians do clinical work is really a waste of valuable resources,” he said.
And finally, Trillium is offering half a million dollars to any clinic or group of physicians willing to expand their practice to take on another 5,000 adults.
“We have to move right now,” he said.
Meanwhile, Trillium has some short-term fixes to help OHP enrollees find a doctor in the area.
Coplin says if they suffer a serious accident, they can go to the ER. Or if the injury is less serious, they can go to urgent care.
But someone suffering a minor complaint can fall through the cracks.
Lane County Public Health Officer, Dr. Patrick Luedtke thinks Trillium’s plans will likely work, but he’s anxious about those cracks.
“I see it as more of a challenge,” said Luedtke.
“At what point does a challenge become a problem? I don’t know that answer. But we have a shrinking pool of providers and we have a growing need in an aging population for health care. So that’s pretty classic irresistible force meeting an immovable object. Those two things are tough to exist in the same environment. So we need to get creative and that’s what we’re doing.”
Back at her doctor’s office, garage owner Cheryl Stumph goes over some paperwork. She’s pleased to be getting treatment. But she’s finding that at her age, getting back into the health care system means she has to deal with some longterm health habits.
For example, her family bought her scuba lessons. But as an older smoker, she needed medical permission.
“So I went to the doctor and she told me no! She would not sign my form,” said Stumph.
“Oh My God. I just lost it. And started bawling I just couldn’t believe it. She said your health is too important, you could actually die. If I really want to do this and I do, I have to quit smoking. So I just quit smoking my last cigarette right before I came in here. Now it’s four hours until the appointment. They said no smoking before the appointment.”
In Lane County alone, about 9,000 adults who recently signed up for insurance don’t have a primary care provider yet.