16,000-plus Yolo County residents lose access to their Dignity Health primary care doctors

Thousands of Yolo County residents began receiving messages April 1 that Dignity Health has canceled their appointments for medical care or that the health system will no longer be providing their care.

The county’s Board of Supervisors discussed at its meeting Tuesday ways to use the body’s influence to restore residents’ access to care. Members said they are fielding calls and emails from people all around their region.

“Can you imagine someone who lives with psychosis getting a letter saying they have to get new doctors?” former Yolo County prosecutor Jonathan Raven asked during the board’s public comment period. “That person then has to navigate this challenging terrain and part with doctors who have been treating them.”

All this upheaval stems from the March 31 expiration of a contract between Dignity, a division of CommonSpirit Health, and a public-private organization known as Partnership HealthPlan of California. It is Partnership HealthPlan’s responsibility to see that more than 900,000 state residents in 24 counties receive the Medi-Cal benefits promised to them.

Fewer than 5% of Partnership Health’s overall members are affected by this contract termination, however, Partnership HealthPlan CEO Sonja Bjork explained.

These are the numbers affected and where they live, according to Bjork: 16,154 in Yolo County, 921 residents in Nevada County, 3,959 in Shasta County, 1,766 in Siskiyou County and 8,827 in Tehama County.

As her team continues negotiations with Dignity, Bjork said, they also are working to ensure the affected members — all individuals with Dignity primary care physicians — are connected to new providers.

“This is very difficult, what everyone’s going through right now, and we hope it is temporary,” Bjork said. “We need Dignity and they need us, and the members and the patients need us to come to an agreement.”

Dr. Robert Quinn, the chief executive officer Dignity Health Medical Foundation, said the health system has been working diligently over the last several months to reach an agreement with Partnership HealthPlan.

“As a not-for-profit healthcare provider, we encounter challenges associated with rising costs and inflation,” Quinn said. “Fair and equitable contracts are vital for us to continue to care for our patients.”

Dignity’s first chance to exit since merger approval

The contract talks between Dignity and Partnership are the first to occur since the California Attorney General’s Office consented to the 2018 merger that formed Chicago-based CommonSpirit Health. Dignity Health, then headquartered in San Francisco, united with Colorado’s Catholic Health Initiatives in that deal.

The AG’s office put a number of conditions on the merger, including that it maintain its Medi-Cal managed care contracts with Partnership and a number of other safety-net health plans for five years. That condition expired in November of last year, allowing Dignity to exit the deals if it chooses.

The nonprofit CommonSpirit Health reported a $1.3 billion operating loss in its latest fiscal year which ended June 30, 2023. Lucas Frerichs, chair of the Yolo County Board of Supervisors, speculated at Tuesday’s meeting that this is what is driving the Dignity Health division’s move.

“The bottom line for this corporation is that they are not making money,” Frerichs said, “and so they are trying to really sharpen their pencils.”

Constituents also said that, when they call for assistance with accessing care, they are having to wait hours on hold, Frerichs said.

Bjork said members did experience long hold times in the first few days this month, but Partnership brought on additional staff and waits for member services is now down to six minutes, below the 10 minute on-hold guideline established by the state.

The organization also sent out letters to its members with new cards that assign them to new primary care physician practices, she said, but they can request different primary care doctors if they like. Members should call 800-863-4155 to get help, she said.

As Partnership’s representatives field calls, she said, and they must determine whether the member has a pregnancy or serious condition that qualifies them to continue their care with Dignity for a limited time. Known as continuity of care, state law requires insurers and providers to make these arrangements.

“We’re talking to each and every person to understand their situation and make sure that we get things in place for them,” Bjork said.

Weeks ago, she said, Partnership Health sent out letters to roughly 54,000 members, anyone who had used a Dignity Health emergency room or had a Dignity primary-care physician, to alert them that the contract might not be renewed. Those letters, Bjork said, explained that members could seek “continuity of care” to avoid disruptions to care.

Yolo supervisors will seek help to restore Dignity access

Yolo County supervisors said they planned to write letters to California Health and Human Services Secretary Mark Ghaly, the governor and state legislative leaders to seek a mediator or other assistance to reach a successful conclusion to the contract talks.

“We are disappointed an agreement could not be reached and we sincerely appreciate our patients’ understanding during this time. … We are eager to finalize a new contract with Partnership that safeguards our providers while ensuring the continuity of our services for years to come,” Dignity’s Quinn said.

Partnership HealthPlan is run by a board composed of patient advocates, providers and elected leaders, Bjork said. Yolo County’s board of supervisors voted to join the organization back in 2021, but residents also can choose to have Kaiser Permanente manage their Medi-Cal benefits.

Dignity has been a member of Partnership HealthPlan’s provider network for 20 years or more, Bjork said, and while she’d like to keep them, “ the amount they’re asking is, it’s higher than we’re able to pay within our budget.”

Partnership HealthPlan has advocated for measures that have increased reimbursement rates for providers, Bjork said. For instance, in 2017, Partnership and other safety-net health plans backed Proposition 56 which increased tax rates on tobacco products and devoted much of that new revenue to pay for health care for low-income Californians.

Reimbursement rates also increased as of Jan. 1 for non-specialty mental health practitioners; for primary care providers, including nurse practitioners and physician assistants; and for maternity care providers such as obstetricians, gynecologists and doulas, Bjork said.

The revenue for this rate increase comes from a tax that providers must pay and matching dollars from the federal government. Bjork said that she and leaders of other local health plans are working to put an initiative on the ballot that would make this tax permanent and dedicate a good portion of those dollars to improving Medi-Cal rates.

The other way that Partnership HealthPlan supplements provider reimbursements is by paying a sizable bonus to organizations that meet certain quality metrics.

While a good portion of Partnership HealthPlan’s budget allotment goes toward paying providers for medical care, Bjork said, the organization also has to cover many other mandated responsibilities.

“(If) your grandmother was getting out of the hospital, but … she can’t cook for herself, we can order medically tailored meals or whatever meals she needs so that she doesn’t have to stay in the hospital just because she’s unable to do meal preparation,” Bjork said.

Perhaps you’re taking care of a grandparent, sparing Medi-Cal the higher cost of nursing home care, Partnership HealthPlan can pay for respite care when you need a break or want to visit with friends.

“We get funding from the state and from the federal government, and we have to live within the budget. … We feel a pretty big responsibility to stay within our means.”