Open Enrollment Allows Fresno-Area Federal Employees to Leave PacifiCare

Nearly 4,900 Fresno-area federal employees and retirees will be permitted to leave PacifiCare of California during a "mini" open enrollment period approved by the U.S. Office of Personnel Management and the Office of Insurance Programs, the Fresno Bee reports. According to a letter mailed by PacifiCare on Monday, beneficiaries have until May 11 to choose another health care plan, or they can remain with PacifiCare until the next open enrollment period in November. The new open enrollment period applies only to federal employees. The decision to hold open enrollment stems from PacifiCare's "abrupt" decision last month to terminate its contract with Saint Agnes Medical Center and its affiliated physician group, Matrix, leaving some of PacifiCare's 61,000 area beneficiaries searching for new physicians. PacifiCare has signed a new contract with Community Medical Centers and Sante Community Physicians and maintains that about 80% of its beneficiaries will be able to remain with their current primary care provider (Trujillo, Fresno Bee, 4/25).

Meanwhile, PacifiCare's decision is affecting physicians, who are being forced to choose between their loyalty to Saint Agnes and joining a competing physician group to maintain patient relationships, the Fresno Bee reports. Saint Agnes stands to lose $52 million a year, but hospital officials expect that other plans will provide enough business to keep the facility afloat. However, that is "not the case" for many Matrix physicians, some of whom stand to lose as much as 40% of their revenue. The Bee reports that nearly 85% of Matrix doctors have committed to Sante. Scott Wells, CEO of Sante Health Systems, the administrative arm of the physician group, said that it was "important" to recruit as many Matrix physicians as possible so relationships with patients could continue (Correa, Fresno Bee, 4/25).