Q&A: Oregon Health Authority Director Patrick Allen Responds To Criticisms
This article has been updated from the initial version.
The state's next governor may remove Oregon Health Authority Director Pat Allen, but the fact is he’s already retired.
Effective May 1, a few months after a life-threatening fall at home, Allen formally retired — on paper, at least.
The very next day, he came in to work as usual, and few knew his status had changed to become a retiree-rehire. That's according to interviews by The Lund Report after it confirmed a rumor about his job status. He's earning roughly the same salary, about $20,000 a month, while collecting retirement — a not uncommon practice among public employees of retirement age.
The move was to protect his family’s benefits if he dies, Allen said when contacted about the change. Even while recuperating, though, he didn’t want to step away from his job — and nor is he particularly eager to now.
“There's a lot of work to do, and I think in a lot of ways we are making a lot of progress on that work,” he told The Lund Report. “We're doing really good things and really beginning to change how systems work and how people think about their work … I feel like I've got an obligation to, to the extent that I can, continue to see through that work and help the organization evolve.”
In recent weeks, however, Allen has faced the reality that he’s unlikely to complete that work as all three gubernatorial candidates have sharpened their criticisms of the agency.
Of the candidates, Democratic nominee Tina Kotek has been the most personal in her critique, telling Willamette Week that “There won’t be any more Allens there any more,” referring to the OHA director and the agency’s behavioral health director, Steve Allen. She’s faulted the agency’s handling of Measure 110 spending, among other issues.
The public jabs represent a major change for someone who once was viewed as among the most competent agency directors in the state — tapped to clean up the mess at Cover Oregon, and then the subsequent mess at Oregon Health Authority. But the agency's work has steadily gained in prominence, and not always in a good way.
In recent years Allen's efforts to fulfill a mandate to increase accountability for the coordinated care organizations serving the Oregon Health Plan, known as “CCO 2.0,” have been criticized as overly bureaucratic. Long-overdue reforms of the state’s dysfunctional mental health system have gone nowhere, tabled by the pandemic. Allen has even been criticized for failing to push back on initiatives imposed by lawmakers that stretched the agency’s capacity. His critics say he lacks vision and the necessary level of health care expertise.
The newly personal attacks on Allen, however, have sparked concern among OHA observers who say he's assembled a core of competent managers despite challenges. Longtimers also recall the exodus of talented staffers when then-director Bruce Goldberg left in 2014, and the many missteps that ensued under his successor, Lynne Saxton.
Asked about the campaign statements about Allen, Douglas County Public Health Officer Bob Dannenhoffer — himself once considered a candidate to run OHA — said “I think Pat's been a very competent administrator through this whole thing.”
Problems with the state’s behavioral health system and health care workforce staffing were both longstanding and exacerbated by a larger lack of leadership extending far beyond Allen, Dannenhoffer said, adding that huge turnover in the health authority’s management won’t help its ability to tackle problems.
“I’m more than a little worried by where we are at,” Dannenhoffer said.
Allen, for his part, said he’s realized his tenure is nearing an end. On Tuesday, he highlighted the agency’s work on equity and other accomplishments in a lunch keynote address to the Oregon State Of Reform Health Policy Conference in Portland.
“In my spare time I used to be a high school basketball official,” he told The Lund Report. “So I think a thick skin has served me well.”
What follows are excerpts from an interview with Allen, edited for clarity and brevity.
The Lund Report: After your fall in January, there was speculation you’d retire.
Patrick Allen: I had a chance to talk with my wife and do some introspection and those kinds of things, but really decided that the work that we do at OHA is important. I think we've been doing a good job at the agency through some incredibly difficult circumstances. But all the problems that were there when the pandemic started — that all got a little bit put on the backburner — were still there and mostly had gotten worse. And so it was really time to start digging into figuring out how to how to address those problems.
It's hard to remember clear back to 2019 but behavioral health was my topic coming out of CCO 2.0 So that was really an opportunity to go back to that work.
TLR: Did the comments in the recent Willamette week piece come as a surprise to you?
Allen: A little bit. The degree to which it was so personal with respect to Steve and me was definitely a ratcheting-up from comments before that. You know, having your name called out directly as part of a campaign doesn't feel good.
But, on the other hand, while I think I think we have done good work in behavioral health, we've clearly not met the needs that are out there. There's still work to be done. There are still things that aren't working the way they need to. You or I may think that there are good reasons for that, but you know, people walking down the streets in Portland don't know those reasons and don't care —they want their family members who can't get treatment to have treatment, they want people not sleeping on the streets, all the things that the (gubernatorial) campaigns are about. So in that context, I guess it really wasn't surprising that things need to change and it's up to the candidates to articulate that.
TLR: You say you’re making progress on behavioral health. How would you describe that?
Allen: What we've been working to do, clear back to the CCO 2.0 contracts, is improve accountability in the coordinated care system, for the resources that they get. And I think we've established structures that allow us to do that.
A theme that you're going to hear over and over again is how the pandemic slowed our ability to use those structures down. Performance measures and all kinds of things often got put on hold during the pandemic because everything was in such chaos. But those structures now exist.
The investments the legislature has made over one short and one long session, they're really, really important and valuable. And I think we're getting those dollars out in ways that that are going to help fill out much of the spectrum of care. I think the work that we did in Measure 110 had some big challenges and some big problems, but also some big wins. And this this notion of making sure that the people most impacted by the decisions that are being made are the ones making the decisions is really important. Getting a ginormous agency like this to start thinking differently about those kinds of questions, I think has been the most important change that we've begun to see progress on.
TLR: What else would you point to as something that members of the public or candidates for governor don't get about where OHA is right now?
Allen: I'm reluctant to characterize it as they don't "get it" because on some level, they don't need to get it. They see what the public sees and are concerned about what the public is concerned about. And the rest of it is operational stuff that people shouldn't have to have to care about. What I would say, though, is there are a lot of things that are quite different about OHA than they were five years ago. I think we've done a lot of work over the last five years to really tighten up how our systems are working.
TLR: You still hear people saying OHA is unable to execute. When the the bridge plan was coming up and Oregon Health Plan redetermination plans, there was lot of skepticism out there that OHA could pull off either one of those.
Allen: Some of that is I think, hangover that is hard to hard to dispel. In terms of the bridge plan? We've been working with a strong oversight committee, that's guiding the decisions that were that we're making, (but) it's going to be a challenge for sure. Redeterminations is a little bit different animal: I've been telling everybody it's going to go badly, not because of some operational thing. Mostly DHS is actually doing the operational work on that. You can't do 1.4 million of anything and not have a large enough percentage, even if it's really small, go badly and get lots of attention.
TLR: The other critique I've heard is that OHA, and including you, will take on projects, legislators' initiatives, and maybe won't push back and adjust expectations and talk about agency bandwidth.
Allen: The pandemic has made an impact on my ability to focus on the full breadth of things that I ordinarily would focus on. And so you know, there are a lot of things that honestly went by in a legislature that, that I wasn't in engaged in as much as I probably should have been. The other thing is, what do we say no to when the legislature is poised to make a historic investment in behavioral health capacity? My inclination has been, let's try to figure out how to get it done. Because the system really needs those resources.
TLR: You sound engaged. How long could you have seen yourself staying on as director?
Allen: Several more years. But I don't want to make it sound like, golly, please, please keep me here — because I'm ready to move on. And clearly the new governor, whoever she is, is ready to move on. The best thing to do for the organization and the work is for that to happen.
TLR: Talk about the tensions between your office and former Speaker Kotek's staff in the past.
Allen: I think the speaker has had high standards. She has brought a large degree of skepticism to the work OHA does. She was a place where CCOs could go to express their frustration with their perspective, particularly on CCO 2.0. And there have certainly been times where she has wanted us to do better or do more. That's not unique to her in the Legislature. There have been lots of legislators who have wanted us to do more and do better, and they've usually been right. And I think that, on balance, we have done more and done better. But I wouldn't characterize any of that as slipping into like a bad relationship or tension or anything like that. But you know, maybe I'm just unaware.
TLR: If you had a time machine and could go back, is there something you would have done differently?
Allen: There's not a time-machine fix for it. We threw the heart and soul of the agency at the pandemic. That's had huge ripple effects. It's been a monumental climb to deal with that pandemic response and then deal with with the things that went by the wayside because of it. The interesting question is, did we overreact to the pandemic? Should we should we have done less? Should we have focused fewer resources? If you look at the the deaths in Oregon, compared to the median per capita death rate in the United States, about 5,000 fewer people died here. Interesting question is, has it been at too great a cost to save those 5,000 lives? I'm not in a position to answer that, but I think that's the question.
TLR: You brought up Steve Allen and behavioral health. For however many years we've known full well that the system was in a shambles in this state. Audit after audit, report after report came to that conclusion. And Steve Allen came in and vowed to tackle it. And yes, the pandemic happened, but do you think you paid enough attention to that area?
Allen: Before the pandemic, yes. When I started at the agency, there was no behavioral health program at OHA. The previous director had kind of broken it up and spread it in various pieces. So there wasn't any kind of a coherent program. We ultimately reorganized the program and created a behavioral health program, then went out and got Steve, who had been working on a project in Oregon, a national leader in behavioral health working for national consulting organization, after having led behavioral health in the state of Minnesota. I think that we were focused in the right place, I still think Steve is the right person to do that work.
TLR: If you could reengineer the decade-old reforms to Oregon Health Plan, what would you do?
Allen: We waste a lot of resources on making sure that somebody's not accidentally getting health care who shouldn't. The other big reform that I would think about is even before the new money we've gotten, we're spending a lot of money on behavioral health, between CCOs and (county) Community Mental Health Programs. And I don't think it's being as spent as effectively as it could be.
TLR: What is your advice for the next governor?
Allen: I'm not sure I have any advice for the next governor (laughs), in context. The focus is on on the right stuff right now. Behavioral health is in crisis. We now have resources that can help with a big element of that around housing. Being able to successfully deliver those resources is going to be a challenge. We haven't talked nearly enough about health and kids, both physical health and behavioral health. The other issue is health inequity is caused by historic and present racism and oppression. And you have to be willing to first acknowledge that and then figure out what are you going to do to dismantle that. There are plenty of things at the local and state control level where we actually have to do things that are disruptive to the way people are used to having things done. The next governor needs to be willing to let not just OHA, but state agencies generally, do that disrupting if we ever want to get rid of these inequities that are based in large part on race.
TLR: If you're asked to stay on and help with the transition, how would you react?
Allen: I would listen to that. And if I felt I could be helpful, I would be happy to be helpful.
Oct 27 2022