5 Things Oregon: ‘Phantom’ provider networks, Workforce grants, Q&A w/ Vince Porter


Emily Boerger


In less than two weeks we’ll hold our Convening Panel meeting for the 2022 Oregon State of Reform Health Policy Conference. The meeting kicks off our agenda-setting process and gets the ball rolling on our preparation for the October 25th event! We can’t wait to see some of you there!

If you have ideas on topics for our agenda or speakers you’d like to hear from, please let us know!

Thanks for reading!

Emily Boerger
State of Reform


1. OHSU’s Dr. Jane Zhu discusses ‘phantom’ provider networks

A recent study evaluating Oregon Medicaid’s mental health provider directories found that 6 out of 10 listed in-network providers are not actually available to see patients. These “phantom” networks undermine access to care for patients most in need, according to the study. In this Q&A, Dr. Jane Zhu, lead author of the study, discusses possible reasons for these directory inaccuracies and how they impact those seeking care.

Zhu says administrative burdens, a lack of standardization, and incentives to fulfill network adequacy requirements can all play a part in these inaccuracies. “In mental health care there’s already a shortage of providers, low participation of providers in the Medicaid program, high turnover of providers, and high demand for services,” Zhu says. “So, already patients are facing an upwards battle to get mental health care. Add on to that provider directories that don’t actually reflect who’s available and active.”


2. 12,000 Oregonians now eligible for full OHP benefits

The state is now offering full Oregon Health Plan benefits to residents who did not previously qualify for coverage due to their immigration status. As of July 1st, eligible adults 19-25 years old or 55 years and older can access the benefits. Last year, lawmakers approved the expanded coverage through the passage of HB 3352 and provided $100 million for its first year of operation.

OHA’s Jeremy Vandehey says approximately 12,000 members of Citizenship Waived Medical—which covers emergency medical, dental, and transport services—acquired full OHP benefits at the beginning of this month. OHA officials plan to expand Healthier Oregon coverage to additional age groups as additional funding becomes available.

3. Q&A: Vince Porter, Regence Health Policy Center

Vince Porter is the Director of the Regence Health Policy Center. Formerly the health care innovation hub Cambia Grove, the new policy center aims to inform and advance policies that promote affordable and accessible care. In this Q&A, Porter discusses thbenefits of home-based care services and what the end of the public health emergency might mean for the health care system.

Porter says the end of the PHE could mean the reversal of several flexibilities and innovations made possible during the pandemic. “Letting these programs expire—specifically Hospital at Home waivers—at this juncture would set everyone back a few years on research, data analysis, and process improvements. This is a pivotal moment and key opportunity that could help move the ball closer to a quality, community-based health care system that improves access and decreases costs for patients.”


4. Workforce Ready Grants now available

Nonprofit health care organizations can now apply for workforce grants through the Future Ready Oregon program. The program, which was approved by the state legislature in 2022, is a $200 million investment package aimed at supporting recruitment, retention, and career advancement opportunities for historically underserved communities.

One of its components, the Workforce Ready Grants, will offer funding to nonprofit and public workforce service providers and community-based organizations for workforce programs in the health care, manufacturing, and technology industries. Round one grant funds total $9.8 millionApplications are due August 13th.

5. About 7% of HealthCare.gov in-network claims denied in Oregon

A recent Kaiser Family Foundation analysis found that 18% of claims submitted for in-network services in the US were denied by HealthCare.gov marketplace insurers during the 2020 plan year. In Oregon, however, that denial rate was significantly lower at 7%. The only state (with available data) that performed better than Oregon was South Dakota, with a denial rate of 6%.

According to the analysis, national denial rates for in-network claims ranged from 1% to 80%. About 10% of denials were due to lack of prior authorization or referral, 16% were for excluded services, and 72% were for “all other reasons.” KFF’s evaluation also notes that consumers rarely appeal denied claims, stating: “Of the more than 42 million denied in-network claims in 2020, marketplace enrollees appealed fewer than 61,000 – an appeal rate of about one-tenth of one percent.”