Capacity For Care
Date: 12/13/15
Grants help clinics open to address needs of low-income patients
By Sherri Buri McDonald
The Register-Guard
Appeared in print: Sunday, Dec. 13, 2015, page A7
It’s been a long time coming, but all of the roughly 95,000 low-income Lane County residents with Medicaid coverage through Trillium Community Health Plan are set to have a primary care provider by the end of the year.
This was made possible by the recent addition of two local clinics, and $1.8 million in grants from Trillium to help finance the new clinics, which will serve patients with various insurance plans, including Medicaid.
In early November, Lane County began treating patients at its newest Community Health Center at Delta Oaks Shopping Center in north Eugene. It eventually will accept 6,000 to 8,000 Trillium members of the Oregon Health Plan — the state’s version of Medicaid.
Then, just a few days before Thanksgiving, Springfield Family Physicians opened a clinic on Centennial Boulevard in Springfield. That clinic has taken on 8,000 Trillium Medicaid members, practice administrator Jane Conley said.
Trillium is one of 16 Coordinated Care Organizations, or CCOs, created by the Legislature to deliver Medicaid services to Oregonians. Trillium awarded Springfield Family Physicians a grant for $800,000 and gave Lane County $1 million for its new clinic.
“Access to care has been our No. 1 priority, and we certainly made the financial investment,” Trillium spokeswoman Debi Farr said.
“With the investments in the new clinics, there’s more capacity,” she said, adding that this expanded ability to serve patients should help Trillium meet future as well as current demand.
“That’s additional capacity over and above the (members) we have assigned (to providers),” Farr said. “If we were to lose providers for whatever reason, we have capacity to serve additional members.”
Trillium has struggled to find enough primary care providers for its Medicaid members since the federal Affordable Care Act expanded eligibility for Medicaid at the same time that Lane County faced a shortage of doctors, nurse practitioners and physician assistants willing to care for them.
As a result of the expanded eligibility, Trillium received a flood of 13,000 new Medicaid patients in February 2015. Eight months later, about 6,500 of them still were without a primary care provider.
Trillium’s struggle to find providers for patients was reflected in the state’s CCO performance measures last year. Trillium ranked last among the state’s 16 CCOs for providing patient-centered primary care. However, Trillium’s performance on other measures was high enough to earn a performance bonus last year.
The new county Community Health Center at Delta Oaks shopping center that opened early last month immediately took on 4,000 Medicaid patients, and gradually will add staff to serve 6,000 to 8,000 Medicaid patients, county spokesman Jason Davis said.
The clinic leases 9,850 square feet of renovated retail space at Delta Oaks. It is the county’s sixth Community Health Care Center. The other clinics include Charnelton Community in downtown Eugene; Brookside in west Eugene; Lane County Behavioral Health Primary Care on Martin Luther King Jr. Boulevard in Eugene; and Springfield Schools Health and River Stone in Springfield.
The new Delta Oaks clinic cost about $2.4 million, which was financed by the $1 million Trillium grant and $1.4 million through fee-for-service revenue generated at the county’s other clinics, Davis said.
Most of the services the county clinics provide are paid for by some form of insurance. About 70 percent of patients have Medicaid, 11 percent have Medicare, 4 percent have commercial insurance plans, and about 15 percent are uninsured, Davis said.
The Delta Oaks clinic opened in early November with one doctor and one nurse practitioner as primary care providers, but by the spring it expects to have three doctors, two nurse practitioners, one mental health clinician, one community outreach worker, and 17 support staff, Davis said.
With the ongoing national shortage of primary care providers, it was a challenge to recruit, he said. But the county zeroed in on candidates whose careers had focused on serving communities and improving community health.
“It’s yielded fantastic results,” Davis said. “We brought in a medical doctor from Missouri ... and a nurse practitioner from California who (are) eager to do this work.”
Oregon’s CCOs, which aim to improve health care quality and overall community health while reducing costs, have attracted attention outside the state, and that helps with recruitment, he said.
“The work that our CCOs are doing is being noticed, so there are providers more and more who want to be part of that and want to be involved in (health care) transformation,” Davis said.
Springfield Family Physicians also has found job candidates who are interested in being part of the reform effort underway in Oregon.
“We have a deep commitment to transforming primary care,” said Conley, the Springfield Family Physicians administrator. “There’s a lot of pieces to that, and we’re very serious and dedicated to the transformation of care in our city and our state. That helps energize the candidates when they take a look at our practices.”
Following a six-month search, Springfield Family Physicians hired five primary care providers, for a total of 18 providers among its three locations.
The practice invested more than $2.5 million to buy and renovate the 10,000-square-foot clinic at 1800 Centennial Blvd., and to buy phones, computers and equipment, Conley said.
The practice’s other two sites are on Marcola Road in Springfield and at the Center for Family Development in Eugene, where Springfield Family Physicians has placed a physician assistant.
“We have embedded behavioral health at all of our sites,” Conley said, so behavioral health experts can work with patients on such issues as depression or substance abuse, which affect patients’ physical health.
“That’s an attraction to primary care physicians because it’s beginning to be understood that that’s necessary to providing full-service primary care,” she said.
Springfield Family Physicians recently hired a doctor who is retiring from the U.S. Navy, who will lead the new Centennial Boulevard clinic. The practice hired a health psychologist, who has training in physical health as well as training in psychology, Conley said.
“Her interest is in how the mental wellness of patients affects chronic disease, so we’re excited about having her join us,” Conley said.
The practice also has hired two nurse practitioners and a doctor. Those new hires will work at the Marcola clinic, while two seasoned physician assistants and one nurse practitioner will move from the Marcola clinic to the Centennial clinic, Conley said.
The latter clinic’s interior was designed with areas to facilitate communication and collaboration among team members treating the same patient, she said.
Accepting 8,000 Medicaid patients has been both exciting and challenging, Conley said.
“In general, people who’ve been without a doctor for a long time (are) very complex,” she said. “It may take a while and several visits to get to the bottom of health issues that have been ignored for a long time. That’s part of the excitement of having embedded behavioral health and social services taking care of patients in a deeper way and understanding the obstacles and challenges they have in their lives.”
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“We have a deep commitment to transforming primary care. There’s a lot of pieces to that, and we’re very serious and dedicated to the transformation of care in our city and our state. That helps energize the candidates when they take a look at our practices.”
— Jane Conley, Springfield Family Physicians