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08/02/2017

OHA documents declare intent to harm FamilyCare

PORTLAND, Ore. (Aug. 2, 2017) – In response to a Freedom of Information Act (FOIA) request, the Oregon Health Authority (OHA) recently released documents that clearly demonstrate OHA’s intent to “hurt” and “isolate” FamilyCare Health, the second largest Medicaid health care insurer in Oregon.

This new information follows recently released data by the OHA that provide an inaccurate and misleading picture of cost growth rates at FamilyCare.

OHA’s communication document states, “This is a chance to showcase FamilyCare as an outlier in the CCO system that is more concerned with the bottom line and increasing revenues than the health of Oregonians.”  It also reveals that the agency intended to:

  1. “Highlight Health Share,” the other Portland-metro area CCO, “as a truly inclusive CCO that provides greater access to Oregonians with high cost medical needs.”
  2. Use “legislators and/or other lobbyists to pitch stories to news media if possible so that OHA can staff [sic] neutral.”
  3.  “Use media to continue to highlight FamilyCare as outlier and look for opportunities to hurt their credibility in the news.”
  4. Get a few discreet examples of Medicaid patients with high cost medical issues, such as HIV, who had selected Health Share because FamilyCare couldn’t provide the care they need, and pitch their stories to local reporters “off the record.”
  5. Develop “Stories from OHP members who chose Health Share over FamilyCare.”

E-mails show that OHA’s outside actuary, Optumas, who is hired to independently help set rates for all of the CCOs, was included in the communications planning. Multiple Department of Justice employees were also included in the planning discussions.

FamilyCare operates in good standing with OHA. In 2016, FamilyCare earned 95% of possible quality incentive payments through the OHA by meeting or exceeding benchmarks and improvement targets. FamilyCare was the leading CCO in the state for the Prevention Quality Overall Composite metric, which measures the rate of avoidable hospitalizations for its members.

FamilyCare’s attorney, Stephen English, says, “The disclosure of this information paints a very troubling picture of a state agency that appears to be operating far beyond the bounds of their duties and responsibilities to the people of Oregon.”


About FamilyCare Health

For more than 30 years, FamilyCare Health provided patient-centered health care to Oregonians. FamilyCare Health was the first health plan in Oregon to integrate models of physical and mental health and the first CCO in the tri‐county area certified by the Oregon Health Authority.

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