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FamilyCare Matches Commercial Reimbursement Rates To Ensure Access to Care for Oregon Health Plan Members

Fosters stronger physician/patient relationship leading to higher quality of care for Medicaid patients  

July 9, 2014 – FamilyCare Inc. announced it is increasing reimbursement rates to primary care providers (PCPs) serving patients on the Oregon Health Plan (OHP).  The rate increase means  FamilyCare-contracted PCPs will be reimbursed for treating Medicaid patients at or above the level those providers are reimbursed by commercial insurers, making FamilyCare reimbursement rates the highest OHP insurer in the state.   This move helps ensure FamilyCare’s OHP members have equal access to primary care that is vital to improving their overall health and mitigating costs associated with specialty and emergency room services.  The news was announced last night by Jeff Heatherington, FamilyCare’s President, during a dinner event honoring FamilyCare’s primary care providers.

“The current payment methodologies under Medicaid and Medicare grossly underpay primary care providers for their services and discourage them from adding OHP members to their patient rosters,” notes Heatherington.  “We believe we need to compensate doctors for their time at a level that ensures our members have access to the care they need and our providers have the time to engage in the conversations that lead to better care and lower costs.”

Primary care reimbursement is based on the time providers spend with their patients, not on surgical procedures or expensive tests like CAT Scans and MRIs. The underpayment of PCPs by both the government and commercial insurers has contributed to a significant shortage of primary care doctors across the nation.   With an average age of 55 years old, attrition as a result of retirement is impacting the number of PCPs in both urban and rural communities.  Current graduating medical students with an average of $200K-$250K in student debt are opting for careers as specialists because becoming a PCP is seen as unaffordable.

“FamilyCare continues to be the first-mover in recognizing that paying primary care physicians for their time is the best way to increase access, improve quality and lower costs,” said Dr. Robin Richardson, an osteopathic physician for Family Medical Associates in Portland.   “The decision to match commercial reimbursement rates for Medicaid patients is unprecedented in the state of Oregon.”

FamilyCare’s Medicaid membership has increased more than 100% in 2014 as a result of the OHP expansion under the Affordable Care Act.  Recognizing that strong doctor-patient relationships lead to better quality care and lower costs, 100% of FamilyCare members have been successfully assigned to a “Medical Home” primary care physician.  As a result, time has become a high-value commodity for PCPs caring for more patients than ever before.  FamilyCare’s commitment to equitable compensation ensures providers can spend more time with patients to discuss health concerns, provide guidance on preventative measures and/or address more complex health challenges related to chronic disease management.   Research studies demonstrate the primary care-centered model dramatically lowers hospitalizations, use of emergency services and frequency of visits to specialists, all of which contribute to soaring health care costs.

The change to reimbursement rates demonstrates FamilyCare’s investment in new models of payment tied to increasing quality and lowering costs.  Currently, the state of Oregon’s Medicaid program and the federal Medicare program reimburse primary care providers at 55% of commercial insurance payment rates for a primary care visit.  Already at a higher rate than the majority of Medicaid and Medicare insurers, FamilyCare’s new payment model will pay primary care providers the equivalent of commercial reimbursement rate in order to eliminate financially-based access barriers for OHP members.


FamilyCare is the oldest Medicaid managed care organization in Oregon and currently serves more than 110,000 Multnomah, Clackamas, Washington and Marion county residents eligible for benefits through Medicaid (Oregon Health Plan).  Founded in 1984, FamilyCare, Inc. is committed to supporting the health of Oregonians through innovative systems that increase access to care, improve quality and lower costs.  At the heart of these systems is a belief that the relationship between patient and primary care providers is the foundation for creating a healthcare system that promotes caring, efficiency and community well-being.   


H3818_WEB_00248 CMS Approved