Saxton Exit Adds Drama to Medicaid Funding, CCOs

With funding for the Oregon Health Plan facing a referral to voters, the resignation of Lynne Saxton as head of the Oregon Health Authority creates more anxiety for health care stakeholders, including the fate of Coordinated Care Organizations.

With funding for the Oregon Health Plan facing a referral to voters, the resignation of Lynne Saxton as head of the Oregon Health Authority creates more anxiety for health care stakeholders, including the fate of Coordinated Care Organizations.

The departure of Lynne Saxton as head of the Oregon Health Authority adds more drama to the fate of the Oregon Health Plan, the state’s Medicaid program.

Legislatively approved funding for the Oregon Health Plan faces a potential referral by three GOP Oregon House members who claim the funding plan contained in House Bill 2391 amounts to a sales tax on health care. If the referral makes it to the ballot and voters approve it, Oregon lawmakers could face a budget hole greater than $300 million over the next two years.

Saxton’s departure could have implications for the coordinated care organizations created in conjunction with Oregon Health Plan funding to act as transformational models for bending the health care cost curve and integrating physical, mental and dental health services.

“With the most prominent visionaries of the CCO development process long removed from office (including Governor Kitzhaber), Saxton was a tether to the old guard at OHA that built the CCO model,” writes DJ Wilson, organizer of the State of Reform effort, in a blog post this week.

Wilson, who advises on health care policy, says Oregon health care leaders are already antsy because of congressional actions that threatened to slash Medicaid funding and the looming Oregon Health Plan funding referral. “Saxton’s removal exacerbates to their anxiety.”

He links the anxiety to what Wilson says is a widespread view that Governor Brown doesn’t consider health care policy one of her top priorities. He quoted one unnamed stakeholder as wondering “who the advocate will be at the state to take the transformation model into the procurement next year, into the legislative session, and make sure the CCO model continues. We may just be heading back to managed care.”

That could be ironic because Saxton resigned in connection with a running battle with FamilyCare, one of 16 CCOs operating throughout Oregon. Jeff Heatherington, CEO of FamilyCare, once accused OHA of acting like a “bully.”

An even more fundamental problem is OHA, according to Wilson. “Since 2013, OHA has had four leaders, two interim and two permanent. Pat Allen is now the fifth.” Allen was named acting OHA director after serving since 2011 as director of the Department of Consumer & Business Services. Wilson says Allen is respected as an effective agency manager, but some health care stakeholders are unsure of his knowledge about CCOs and Medicaid.

Brown told Allen his “highest priority from day one should be restoring trust with the public, legislators, stakeholders and, most important, the clients OHA serves.” In a statement, Brown said, “I have asked Pat to bring his expertise to the Oregon Health Authority and lead the agency into a forward looking and responsible steward of taxpayer dollars.”

Allen responded to Wilson’s questioning by saying, “I’m committed, as is the governor, to the CCO model as the only realistic way to deliver Oregonians improved health through quality care we can afford.”

Straightening out OHA could take time and energy. Dating back to the Cover Oregon fiasco, OHA’s bureaucracy and culture have been criticized. Rep. Mitch Greenlick, in a recent interview, questioned the agency’s dedication “to making sure the most eligible people have access to care” as opposed to “dotting all their I’s and crossing all their t’s.” In the previous session, Rep. Greenlick was the leading legislative voice on the future of CCOs and will continue that conversation in next year's short February session.