5 Things Oregon: Pat Allen, Knute Buehler, Jeremiah Rigsby

We have a lot for you this month, including independent reporting and analysis on the OHA and behavioral health. We also think there are lessons for Oregon in our coverage from California, which we share. Finally, we’ve got a few bonus items for you.  We just couldn’t keep it to 5 Things this month…!

1.  Podcast: A Conversation with Pat Allen

Since being named Director of the Oregon Health Authority last fall, Pat Allen has dug into some of the most challenging topics in Oregon Medicaid. In this podcast, I sit down with Pat to talk through the work he has done at the OHA, from giving behavioral health a new focus to shaping the upcoming CCO procurement. If you’re looking for answers about the future of CCOs, this is an important conversation.

“I think that’s a lot of what these first nearly nine months has been, is really thinking as much about how we do what we do as about what we do. And you know the good sign to me is about six or seven months in, my conversations and what I’ve been thinking about stopped being about hearings and audits and business issues and starting being more about health care. And to me that was a sign that we had maybe started to turn a little bit of a corner in getting out of some of those structural crisis kinds of things and getting back to focusing on what our mission is.”

2.  Knute Buehler makes the case nationally

Knute Buehler is gaining some notice among national donors as one of the best potential opportunities for a Republican pickup among 2018 governor races. In a slide deck the campaign is shopping, Buehler shows Kate Brown’s favorability has dropped 13 points in the last year.  It notes Buehler has “twice been elected State Representative in a +12 Democratic district.” Yet, Real Clear Politics puts Oregon in a “Safe Democratic” column.

In conversations with health care leaders from across the state, I find few strong advocates for Brown. Some Democrats now tell me they are likely Buehler voters, though it’s hard to find anyone that will say that loudly in an otherwise blue state.  One told me this week “Oregonians don’t like people who have a sense of entitlement, and there’s a little bit of that with Kate.”  I’m not sure  it is even possible for a Republican to win statewide in Oregon in a time of President Trump?  It might depend on turn out, and that projection is mixed (see #3 below).

3.  California, health policy and implications for 2020

California’s primary election last week reinforced my belief that to win a competitive Democratic nomination for President in 2020 a candidate will need to have some proposal for a single payer-like health care system. That could be Medicare for all, or a buy-in option for Medicaid, or a full embrace of single payer like Gavin Newsom made. Newsom won the gubernatorial primary on the back of support for a single payer health plan.  This idea about single payer is one of the three key implications for national elections I think come out of the state.

That said, I’m just as sure that a single payer model is a poison pill for a general election electorate. In other words, to get through a Democratic primary, a candidate may need to embrace a policy that will sink him/her later in the fall. We’ll see.

Notably, also, is this:  if a blue wave is going to form in 2018, a place like California is where it should swell the highest. Instead, only 30% of the electorate voted, well below the average primary turnout of 37% since 2006.  Sure, it’s a primary and there is a long way to go until the general.  But, that doesn’t look like a wave, particularly in a blue state with a competitive gubernatorial contest.

4.  Video: Jeremiah Rigsby, CareOregon

Jeremiah Rigsby, Director of Public Policy and Regulatory Affairs at CareOregon, has done considerable work to improve Oregon Medicaid under the CCO model. He joins us in this edition of “What They’re Watching” to talk about addressing the social determinants of health through the CCO model.

“The CCO experiment over the last five years has made some pretty major and positive steps towards figuring out the health plan’s role in addressing the social determinants of health, but there’s a lot of work left to be done to figure out how to push that envelope forward I think a bit… Having 16 different CCOs that are community-based means that you might be addressing different social determinants in 16 different ways, none of them wrong.”

5.  Getting our hands around BH funding

How the funds flow in Oregon behavioral health, from counties to carve outs, is opaque.  After hours of conversations and even more hours of research, we’ve distilled down a few key takeaways.  Marjie High on our team reports there are at least three key takeaways from this work.

First, even the OHA has little to no window into how the funds flow in BH. We actually see some evidence to suggest overall BH funding has fallen in recent years, contrary to what most folks might think.  Second, there doesn’t appear to be a comprehensive plan for what an “optimal” system would look like. The Performance Plan is not it.  Finally, the conversation runs into “death by work group.”  As Marjie says “a work group means something is happening, right?”  Meh.

Bonus #1:  Oregon’s health system performance

The Commonwealth Fund released a report on states’ health system performance, ranking Oregon 11th in the nation. Oregon manged to improve its overall rank by ten, largely driven by significant improvements in addressing access and affordability and health disparities.

However, Oregon saw its rankings decrease for avoidable use and cost and healthy lives. Oregon’s lowest rankings were child vaccination rates, home health patients without improved mobility, and mentally ill adults reporting unmet need. You can explore the data here.

Bonus #2: AP issues ruling: “health care”

You’ve struggled with it at some point in your career.  We all have. But, apparently, now there is new clarity for us all.  The AP Stylebook has decided that it is “health care” not “healthcare” – two words, and not one.  Naturally not everyone agrees with this decision.

That said, because our goal is to foster constructive conversations in health care today, and because we know there might be some pain in the transition for some in moving from healthcare to health care, we worked hard to bring you this high tech tool to support your team during this switch.  It looks great on the wall of your break room or cubicle…