The Medicaid population in the Portland metropolitan area includes some of the state’s most vulnerable people who are currently enrolled in Health Share of Oregon, a stable and well-run coordinated care organization that has been ensuring the provision of quality health care to this population since 2012.
This week’s decision by the Oregon Health Authority (OHA) to allow Trillium Community Health Plan to begin enrolling Medicaid members in the Portland area starting on September 1 threatens to disrupt important care relationships in the midst of the COVID 19 pandemic. Of even greater concern is the fact that this decision seems to have been made in a vacuum that ignores both the need for patient protections in a very vulnerable population and the intensified call for equity in our health care system.
Trillium, owned by health care giant Centene, a publicly-traded Fortune 500 company headquartered in Missouri, has been trying to establish itself in the Portland area since last year when OHA put out an RFA (request for application) to award contracts to Oregon’s coordinated care organizations that now provide health care to over a million Oregonians. A central requirement of the RFA was that applicants had to have an adequate delivery system in place at the time of application.
Despite the fact that Trillium did not have an adequate delivery system in place—because none of the Portland area hospitals would contract with them—OHA sent letters to Oregon Health Plan members in the metro region saying that they would now have a choice between Health Share and Trillium. When it became apparent that Trillium had listed on its webpage providers that had not, in fact, signed contracts, OHA ordered the health plan to take down this false information and sent new letters to members saying that there would only be one CCO in the region. At the same time, however, the agency gave Trillium until June 30, 2020, to build an adequate network and put pressure on Portland hospitals to participate.
The June deadline came and went. Then, this week, OHA inexplicably gave Trillium the go-ahead to start enrolling members despite acknowledging in its own press release that it had ongoing “questions about the quality of Trillium’s network, especially in the area of behavioral health … a lack of language access capacity [and] concerns about Trillium’s ability to demonstrate that it meets contract requirements around health equity and community engagement.”
This decision is hard to fathom and raises a number of troubling questions. Where is the commitment to patient protections? What is the justification for allowing vulnerable people to enroll in a health plan in which there remain questions about the quality of the behavioral health network and the capacity of language access? And how can we possibly justify moving forward in the face of “concerns about Trillium’s ability to demonstrate that it meets contract requirements around health equity” against the backdrop of eighty-four consecutive nights of protests in the streets of Portland demanding equity and social justice?
Without clear answers to these questions, there is no justification whatsoever to enroll or encourage transferring vulnerable people from a stable, well-run health plan—one with a good behavioral health network and a strong commitment to equity—to a health plan which, for almost a year, has failed to demonstrate the adequacy of its ability to provide the quality care that these Oregonians need and deserve.