Oregon Representative Ben Bowman (D-Tualatin) participated on a panel at a Salem City Club event about the rapid trend of corporations and private equity firms acquiring local medical practices. He writes, “In the last 10 years, there has been a 100,000% increase in private capital invested into primary care. The scale of that increase alone should give us all pause.”

Bowman reports, “Across our state and the country at large, small doctor-owned clinics are being bought up by large corporations and private equity firms. When you replace a locally-based physician owner with a private equity firm there are serious, negative consequences. Prices go up, quality of care declines, injuries increase, and physicians burn out. In short, worse care at higher prices. We are seeing the harm of not acting in real-time.”

Bloomberg writer, Angelica Peebles, says, “Several large companies are also making a push towards primary care in an effort to control access to more expensive specialists and influence patients' treatments over time. For example, CVS Health plans to put doctors in up to 350 of its retail pharmacies…Walgreens Boots Alliance last year purchased a controlling stake in the primary care clinic chain VillageMD, which it previously partnered with to open new primary care clinics across the United States…health insurers are expanding their primary care capacities. UnitedHealth Group's Optum unit now has more than 60,000 physicians, around half of whom are in primary care… Humana plans to open 26 new primary clinics under its CenterWell brand this year and will add between 30 to 50 more annually.

According to Peebles, this interest in primary care is partly motivated by a shift in how medical care is paid for. Private health plans, as well as government programs like Medicare, are increasingly turning towards value-based payment, which links doctors' pay to patients' health outcomes, rather than volume-based payment. This change may increase the risk that profit motivation could eventually outweigh patients' best interests.

Bowman wants to bring legislation in 2025 that will address this growing problem. He sites thousands of patients in Eugene received letters informing them that their local clinic, the Oregon Medical Group, could no longer provide care for them. They would have to find a new doctor.

Independent Health News reports that UnitedHealth’s vehicle for growth – and more profits – is its Optum Health division. Observers say the consolidation could improve the quality of care — or lead to higher prices as the corporate owners exploit their greater control.

Since the purchase of Oregon Medical Group, close to 30 physicians have left the clinic and, due to the contracts they signed with United Health, were forced to either retire from the practice of medicine or leave the community they had made their home. Those leaving the clinic reported that UnitedHealth’s focus on efficiency and profit left them feeling disillusioned and unable to provide the best care for their patients.

Bowman also reports that Oregon’s Coordinated Care Organizations (CCO), are having very important and very-under-the-radar conversation going on around the Oregon Health Plan and CCO’s model serving Medicaid population. The goal of Oregon’s CCO model is to provide a coordinated service delivery model to promote physical, behavioral, and oral health.

CCO’s were established in 2012 and is thought to have bent the cost curve. The second round of “procurement” in 2020, CCOs were given contracts and performance metrics setting the goals for the entities that provide care to low-income families. The behind closed-door meetings are for a third round of procurement. This will likely be the largest procurement process the state has ever done according to Bowman. It involves investing millions of dollars to ensure Oregonians are well cared for, and how it is distributed, and what benchmarks are set for the entities who are awarded contracts.

A D V E R T I S E M E N T

A D V E R T I S E M E N T

Bowman releases his goals for legislation to enact the next procurement process:

• Ensuring every Oregonian has access to a basic level of quality health care.
• Incentivizing upstream investments in health that lower the cost of providing medical care in the long run.
• Providing stability that ensures CCOs are rooted in the communities they serve.
• Providing flexibility so that CCOs are able to innovate and build local partnerships that better serve the needs of the people they serve.
• Ensuring there are clear accountability measures directly connected to the health outcomes of people and populations.

These sound oddly familiar to the Oregon State University 2023 Health Care Workforce Needs Assessment report done in accordance with HB 3261 for the Oregon Health Authority. It exposed a severe health care crisis and higher than expected, partially from burnout after the pandemic. The report recommended improved support for health care professionals, expand telehealth and integrated care models, and increase the use of community-based care providers like health interpreters and peer wellness specialists to connect on a more personal level with their local communities. Had this report been acted on, would the small doctor-owned clinics been saved?

Since voters passed the right to health care, Governor Kotek hasn’t supported the universal health care board proposed cost of $2 million plan. She says it’s costly and cited potential duplications. Kotek has prioritized behavioral healthcare in response to HB 4002. Oregonians shouldn’t be surprised that UnitedHealth is positioning their clinics to meet Kotek demands on cost reduction while expanding free care to non-insured non-residents, covered treatment for reproductive care (abortions and transitioning), the need for specialized behavioral health physicians, and the projected CCO procurement process to cover universal healthcare. It all adds up to unsustainable budgets and higher taxes.


--Donna Bleiler

Post Date: 2024-06-03 11:37:59

Last Update: 2024-06-03 22:56:48