Q&A: Lori Coyner discusses OHA’s outlook to best care for all Oregonians

Lori Coyner has been the medicaid director at the Oregon Health Authority (OHA) since 2018. She previously worked for OHA as director of health analytics before moving to the role of managing principal for Health Management Associates. 

In this Q&A with State of Reform, Coyner discusses OHA’s response to the pandemic, their lens on inequities in health care and their efforts to address the demand for mental health care.

 

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Patrick Jones: How has the pandemic changed the way the Oregon Health Plan (OHP) provides services to those who need it? How has OHP expanded its services to meet the rising pandemic demand?

Lori Coyner: “Throughout the pandemic, Oregon Health Authority (OHA) has worked with the CCOs that provide direct service to Oregon Health Plan (OHP) members to make sure that the unique needs of members during a pandemic have been met. Early on in the pandemic we released the quality pool payments to ensure that they could provide stability to the networks of providers that serve their local community. The intention was to ensure that OHP members would have access to the care they need.

One of the most impactful ways that OHP has adjusted its offerings to people in Oregon during the pandemic has been the pause on redeterminations keeping people on the Oregon Health Plan along with permission to self-attest income to streamline enrollment. Through these changes and others, people in need of OHP coverage throughout the pandemic have gotten and stayed covered. Through these changes, we’ve seen an additional 226,297 people covered by OHP, up more than 20% since the beginning of the pandemic. The impact of this coverage to people during the pandemic cannot be understated.

We also engaged in a rapid expansion of telehealth services and parity payments to ensure contact free access. And telehealth visits are now allowed for new patients to establish care with a new provider. 

We made many other changes to the OHP, some permanent and some temporary, under authorization allowed as part of the public health emergency.”

PJ: What have been the main struggles of operating during this pandemic? What has been taking up most of your mental energy in the last few months?

LC: “OHA’s focus has been on ensuring stability of OHP coverage and care for people in Oregon on the Oregon Health Plan. Like people nationwide, we struggled with uncertainty facing the upheaval of a global pandemic. We feel confident, however, that we have done our best to serve our members during this extremely difficult time.

Mental energy over the last few months has focused on improving vaccination rates among OHP members with particular focus on ensuring access for communities of color.”

PJ: How is your department incorporating discussions of equity and inequity into your decision making?

LC: “Prior to the pandemic, OHPB (Oregon Health Policy Board) established the strategic goal of eliminating health inequities by 2030. Those health inequities, driven by systemic racism and structural discrimination, have been amplified by the pandemic. As a result of COVID, however, we have accelerated the work to integrate an equity lens into every decision we make and the strategies we develop.”

PJ: How would HB 3352, which would expand OHP coverage to individuals who would be eligible if not for their immigration status, affect OHP? Do you support this bill? Why or why not?

LC: “As a state agency, OHA is supportive of the Governor’s legislative priorities, including HB 3352. Part of our agency mission to expand coverage to people in Oregon and this bill would align with that priority. OHA would have a significant role in implementing this bill and so we have tracked its progress closely.  This bill aligns with OHA’s commitment to eliminating health inequities for all Oregonians.”

PJ: How does OHP plan to better incorporate mental and behavioral health benefits into its services? How can OHP play a part in helping Oregonians with their mental health?

LC: “The Oregon Health Authority (OHA) continues to collaborate with state and national stakeholders to review current evidence-based and evidence-informed practices to improve access to services and supports. OHA is engaging with community and partners to further understand barriers to service and identify ways to overcome barriers. Collaborators include:

  • Individuals using behavioral health services
  • Oregon’s Nine Federally Recognized Tribes
  • Urban Indian Health Program
  • Coordinated Care Organizations
  • Behavioral Health Councils
  • Advocacy groups
  • Community Mental Health Providers
  • Legislators
  • County mental health providers; and
  • National organizations (SAMSHA, NAMD, etc.).

OHA will continue to work closely with the Health Evidence Review Commission (HERC) to ensure appropriate coverage is available to members who experience behavioral health concerns and help identify ways to remove barriers to receiving services.

OHA has been engaged in several stakeholder meetings in preparation for the implementation of 9-8-8, a federal initiative requiring states to develop a phone number, similar to 9-1-1, for behavioral health crises.

OHA has been engaged in work to improve timeliness in responding to community members’ needs and improve access to behavioral health services. The intent is to engage individuals where they are by providing several services to address their needs quickly and, if needed, refer to longer term services and supports.

Since the beginning of the public health emergency, OHA has received federal flexibilities to ensure the continuation of services and benefits to Oregon’s vulnerable populations. Some of these flexibilities, including broader telehealth and eligibility allowances, are being reviewed and added to the existing state plan. OHA is continuing to research modalities to improve the way services are offered to individuals needing behavioral health services and investigating how to leverage federal funding to bolster the services we offer.

The Oregon legislature is currently considering investments into the behavioral health system that will impact the Behavioral Health and Medicaid Programs Units. We are eagerly waiting to see what happens so we can implement some of our policy improvement packages.”

This interview was edited for clarity and length.