Trillium commits to close gap for thousands of incoming members who have out-of-network providers

For nearly 96,000 Lane County residents on Medicaid who will move from PacificSource to Trillium in the new year, Oregon Health Plan benefits will remain the same, Oregon Health Authority representatives said during a listening session, Thursday, Dec. 11.

Some members, however, may need to change heath care providers once the transition takes effect Feb. 1.

As of Thursday, between 15,000 and 25,000 members have doctors or clinics that are not in Trillium’s network. About 10% of PacificSource members — 9,600 people — have primary care providers who are not part of Trillium’s network. Nearly 16% of PacificSource members — 15,360 people — have behavioral health providers who are not in the network.

A handful of Oregon Health Plan members attended the session in person at the Graduate hotel in Eugene, and about 20 attended virtually. Those attending in person received printed materials, including a copy of a letter mailed to all members.

The materials encouraged people to keep their appointments, noted that a new ID card will arrive before the switch, and stated, “You may need to pick a new provider after Feb. 1.” It included a link to Trillium’s provider database so members can check whether their providers are in network.

“Please continue to see your providers, your doctor and your behavioral health provider, your dentist, please continue to get your care through this transition,” said Jeanne Savage, chief medical officer at Trillium. “We will help you all through the process, and we want you to continue to see your providers.”

To support that, Trillium has 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:

After that window closes, members can still see out-of-network providers but must obtain prior authorization, said Brandie Thielman, Trillium’s vice president of network development.

During the presentation, Thielman said about 90% of PacificSource primary care providers contract with Trillium, along with 84% of behavioral health providers. She reported 100% alignment in dental and pharmacy networks, meaning no gaps are expected there, though some medication coverage may differ between Trillium and PacificSource.

Some mental health counselors contracted with PacificSource who applied to join Trillium’s network were denied. One counselor told Lookout–Eugene Springfield last week that she was informed the denial was due to “network sufficiency,” though the notice did not explain the term.

Thielman said the determination comes from comparing the PacificSource and Trillium networks and assessing whether a service area already has enough providers for the number of members. She said the company is still learning about specialized services and the populations being served, and in some cases additional information has led to adding providers to the network — information Trillium did not receive initially.

“We have remained focused on having a high-performing network to meet the needs of our members and providing access to care in all service areas, across all services,” Thielman said. “For us, building that network is not just getting ready for Feb.1, but this an ongoing process for us.” 

Thielman said Trillium is working daily to close network gaps and has identified three primary care groups to potentially add, which would raise primary care coverage from 90% to 98%, and has identified 33 behavioral health providers to potentially add, which would increase behavioral health coverage from 84% to 97%.

When Lookout Eugene-Springfield asked how confident she was that Trillium could reach those targets, Thielman said, “We’re committed to that goal.”