Dupell explains that insurers have been reluctant to subcapitate medical groups. I think the health plans have been threatened by that. Mockabee counters that, although BlueCross-BlueShield rarely subcapitates physicians, it does so with three medical groups. Direct contracting Last year, two for-profit HMOs wholly or partially withdrew from the Oregon Health Plan, citing losses. One, the Blues, withdrew from central Oregon, where in the town of Bend an independent practice association covering 20,000 people in 10 counties now contracts directly with the state and has done well with capitation.
Premiums are the same for direct contractors as for HMOs, but are lower in rural areas.
In our area, physicians own the contract. We don't have an insurance company involved. This year, the Oregon Legislature enacted what amounts to about a statewide 10-percent increase in capitation rates. Doctors and health plans welcome the increase, which was effective Oct. 1, but doubt that it will be enough. Many lose compensation because, often unknowingly, they treat patients who have lost eligibility.