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Father of Oregon reforms says for-profit care of low-income people in greater Portland, other changes are a mistake

TRIBUNE FILE PHOTO - In 2012 then-Gov. John Kitzhaber spearheaded reforms intended to revolutionize health care. He now says recent changes will undermine them, including a for-profit provider for low-income people in Washington, Multnomah and Clackamas counties.Former Gov. John Kitzhaber has come out in public opposition to state regulators' recent moves to let a for-profit Fortune 500 company's subsidiary serve the poorest residents of Multnomah, Washington and Clackamas counties, and wants top leaders to rethink recent reforms to the Oregon Health Plan.

Kitzhaber, widely considered the father of the state's low-income program that serves one in four Oregonians, sent a letter last week to Gov. Kate Brown, Senate President Peter Courtney and House Speaker Tina Kotek.

He wrote that the changes underway will likely hurt the state's goals of providing quality care in an affordable manner, and undermine progress Oregon has made in past reforms.

The latest changes are "a deviation from legislatively adopted policies, and may have serious unintended consequences to the health care transformation efforts that I know we all support," he wrote in the four-page letter sent Sept. 8.

Click to read Kitzhaber letter.

Given Kitzhaber's history with the reforms, "we take it very seriously," Courtney told the Portland Tribune, adding that the letter will be addressed in a Senate hearing on Wednesday.

A Kotek spokesman said she is travelling and unavailable.

Charles Boyle, a Brown spokesman, said that as the new changes are implemented "we will need to continue to balance the goals of financial transparency and local control, and we welcome Dr. Kitzhaber's insight into these issues."

The state in July granted Trillium Community Health, owned by the Missouri-based Centene Corp., preliminary approval for a contract to administer the Oregon Health Plan in Clackamas, Multnomah and Washington counties. Trillium already administers the health plan in Lane County.

But local officials and local health officials have reacted with alarm, saying the existing Portland-area collaborative dominated by local hospital chains, called Health Share of Oregon, is better suited to provide quality care and should not be undermined with competition in the three counties.

Trillium has defended its record, but a spokesperson said she could not immediately comment on the former governor's letter.

Kitzhaber, a former emergency room doctor who pioneered the original Oregon Health Plan while president of the state Senate, pushed for a second round of reforms when taking over the governor's office in 2011: system of regionally based "coordinated care organizations," or CCOs, that function much like health insurers, managing networks of doctors and other providers to provide care.

They were intended to be local and community-based. But in addition to raising concerns about Centene, Kitzhaber said changes underway that state officials call "CCO 2.0" undermine the original vision, making it harder for locally based CCOs to operate.

Many of the reforms are intended to increase oversight of the CCOs, which a Tribune investigation published in January found to be substantially weaker than promised by the Kitzhaber administration.

But Kitzhaber wrote of the new changes that "These provisions and others appear to retreat from the community model based on local control and a sense of local 'ownership' in favor of a more punitive top-down approach.

Conceding that the changes are intended to address concerns over a lack of oversight in Kitzhaber's system, he wrote that he's convinced oversight could be achieve in a less burdensome way.

Oregon Health Authority Director Pat Allen, in Monday morning phone call, agreed that one of the changes highlighted by Kitzhaber, regarding staffing requirements for care coordination, would be modfied.

But Allen defended the need to beef up oversight on contracts worth more than $30 billion over the next five years. He noted that the Legislature had on multiple occasions rejected reforms that would have blocked for-profit companies from providing care to Oregon Health Plan members.

"I think the challenge is that that (locally based) vision is not exactly what got passed into law," Allen said. "Right now what we're trying to do is take that vision as it's played out over time and take it to the next level."

And as far as protecting Health Share of Oregon from competition by Centene, Allen said, Kitzhaber's input counters the recommendations of the Oregon Health Policy Board that finalized the latest CCO changes.

"We've been clear for something like a year and a half that we were going to use a process that assessed applications and grants contracts to those who qualify."

Kitzhaber resigned his governorship in February 2015 while under investigation by the FBI over outside organizations paying his partner, Cylvia Hayes, more than $200,000 to work on efforts to influence state policies. But since leaving office he has maintained a high profile in the health care reform movement.

Allen said he will address Kitzhaber's letter in a House Health Care Committee on Monday afternoon.

This article will be updated later today.


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