A Feb. 1 shift moved most of Lane County’s Medicaid population to the Trillium Community Health Plan. Benefits will remain the same, but provider access may change for thousands.
The Oregon Health Authority switched nearly 96,000 people who use Medicaid in Lane County from PacificSource Community Solutions to Trillium Community Health Plan Sunday, Feb. 1.
That means about 1 in 4 people living in Lane County are now accessing their health care through a new network.
As of Sunday, Feb. 1, Trillium became the only coordinated care organization, or CCO, in Lane County. Coordinated Care Organizations — typically operated by insurance companies — contract with the Oregon Health Authority to manage health care services for Oregon Health Plan members, the state’s Medicaid program.
The change follows a months-long transition as Trillium Community Health Plan worked to take over coverage for members previously served by PacificSource Community Solutions, which did not renew its Lane County contract with the Oregon Health Authority in September.
Executive leadership at PacificSource said the company could not financially sustain its contract for services in Lane County, which it said would have compromised its ability to continue operating as a CCO in eight other Oregon counties.
Since then, leaders ranging from elected officials to health care advocates have raised concerns about whether Trillium Community Health Plan could absorb a Medicaid population nearly four times the size of its previous CCO enrollment, which was about 30,000 Oregon Health Plan members.
Trillium executives committed to closing network gaps for thousands of incoming members who had out-of-network providers and said about 90% of members already had primary care providers within its network as of December.
That was when the Oregon Health Authority held three public meetings across Lane County, explaining details it published on a website about the transition. The authority has not publicly shared updates since and has not responded to calls or emails from Lookout Eugene-Springfield since Jan. 9.
The following information reflects what Lookout Eugene-Springfield has pieced together through months of reporting and conversations with Trillium leadership.
Same benefits, changes to access
Benefits will remain the same for people moved to Trillium from PacificSource because Oregon Health Plan coverage does not change, Oregon Health Authority representatives said during a Dec. 11 listening session.
What may change is provider access: some members may need to find a new doctor if they are not in Trillium’s network.
The insurer is trying to minimize how many members will need to change clinics, doctors and hospitals they accessed through PacificSource Community Solutions, according to a letter the insurer sent to elected officials Jan. 30.
As of Friday:
- Between 15,000 and 25,000 PacificSource members still had doctors or clinics that were not in Trillium’s network.
- About 10% of the PacificSource members — 9,600 — have primary care providers outside Trillium’s network.
- Nearly 16% of the PacificSource members — 15,360 — have behavioral health providers outside the network.
The letter to leaders did not say the gap closed, but said Trillium expects the primary-care number to eventually be close to 98%, meaning most members will not need to change their primary care provider. That would leave about 1,900 people looking for primary care providers.
Regarding behavioral health, the letter said, “we are adding 275 new behavioral health providers, including group and private practice providers, with additional expansion efforts underway.” It did not say whether that would close the out-of-network gap for members.
Trillium still expanding its network
Trillium has not released a comprehensive list of contracted providers, but it maintains an online database that allows members to check whether their doctors, clinics and hospitals are in network. The chart below highlights some of the larger health systems and clinics, based on information Trillium has shared publicly and previously reported.
Primary Care Clinics
30 -90 day grace period
Trillium rolled out what it calls a “transition of care,” which allows members to keep seeing their current providers for 30, 60 or 90 days, depending on individual needs. Here are some of the details:
For most members:
30 days for physical health and dental; 60 days for behavioral health.
For members with Medicaid & Medicare:
90 days for physical health, dental and behavioral health.
For members with specific high-risk conditions:
People undergoing surgery, who are pregnant, and with high-risk needs can finish treatment they began as PacificSource members.
After the transition of care window closes, members can still see out-of-network providers but must obtain prior authorization.
Dental, pharmacy networks remain; drug coverage may vary
Dental and pharmacy networks under PacificSource Community Solutions are essentially the same as those used by Trillium Community Health Plan, meaning no gaps in access are expected for members.
However, Trillium’s formulary — the list of prescription drugs a health plan prefers and covers — differs from PacificSource’s. In some cases, Trillium may prefer a clinically similar drug with the same effect but a different name or brand.
If a change is requested, Trillium said its pharmacists work directly with the provider. If the provider determines a switch is not clinically appropriate, Trillium said it will work with them and may keep the member on the original medication.
Trillium expands workforce
Trillium Community Health Plan doubled its workforce to meet increased demand, including hiring some employees laid off by PacificSource Community Solutions, an executive told Lookout Eugene-Springfield in December.
The company tested systems — including prior authorizations and claims payments — and ran practice scenarios to identify and fix potential problems before the transition, according to the letter sent to elected officials in January.
Members can call Trillium for support about the transition at 877-600-5472.
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