Grants Pass Health Plan Provider Contract Denied

Locals in Grant Pass, Oregon are seeing some major changes in new health care plans offered by the Oregon Health Plan this upcoming year. Residents in Josephine and parts of Jackson County may see a plan change due to PrimaryHealth’s contract being denied by the Oregon Health Authority (OHA).

The Grant’s Pass-based provider has been in business since 1995 however, due to the denial of the state’s contract which has been vital to operations they will be closing their doors after this year. This is a major change since the provider became a state-contracted COO (Coordinated Care Organization) since 2012. Financial reasons, as cited by OHA is the primary reason for ending their contract at the end of the year December 31st.

“For us, this is a big blow and something that we never thought would happen,” says Jennifer Johnstun, a Health Strategy Officer with PrimaryHealth. “We feel like this is not good news statewide either.”

Workers who have been with PrimaryHealth for many years now may need to look at what is in store for their futures. Pam Roderick who has been working at PrimaryHealth for the last 20 years has stated, “We’ve all been together through thick and thin. A lot of things — births, deaths weddings, you name it, we have all been there together,” Roderick said. “It’s not just all of us here together but our clients too. Yeah, it sounds like ‘yeah, your clients’ . . . but we have quite a few clients and they all mean very, very much to us.”

OHA in a statement said that PrimaryHealth’s clients should begin receiving letters in their mail soon encouraging them to choose a plan in Jackson County. New selections proposed are either through AllCare CCO Inc. or Jackson Care Connect. In Douglas County, the choices for clients will have the ability to select Umpqua Health Alliance in place of Jackson Care Connect for their district. While Josephine county clients will all be absorbed by AllCare CCO.

OHA is pushing to enter a new phase dubbed CCO 2.0 which has proven to be controversial in many instances. Former Governor Kitzhaber has voiced his opinion through a letter to Governor Brown and other Democratic leaders criticizing the new 2.0 model for abandoning the community-based model that began in 2012.

“The contours of CCO 2.0, as they emerge from the current procurement and contracting process, appear to reflect a decision to move away from a flexible, community-based, collaborative model toward a commercial insurance model with more focus on regulation,” Kitzhaber wrote. “This shift threatens to undermine the effort to transform health care delivery by embracing many of the attributes of the traditional rate-based insurance system we have been trying to escape.”

An example highlighted by Kitzhaber pointed at Trillium which is a Missouri-based COO that has attempted to merge into the Portland area and was met with stiff resistance from healthcare providers who are already satisfied with the existing local CCO’s.

“If viewed strictly through the lens of a publicly-traded commercial insurance company seeking to increase its ‘market share’ in Oregon, this may make some sense. If viewed through the lens of a community-based collaborative model, one committed to transforming care for our most vulnerable people, it makes less sense,” Kitzhaber said.

So far the only CCO that seems to be affected by these financial constraints and as a result been denied their contract renewal has been PrimaryHealth. PrimaryHealth does plan to keep its doors open until the end of January while their clients have the opportunity to migrate to another CCO.

Are you affected by this termination of your local CCO?  Let us find you new coverage and make the transition easy.