Goldberg’s Exit Shifts Medicaid Transformation into Uncertain Waters
The fallout from the Cover Oregon debacle will not be limited to the failed online insurance exchange and could have major repercussions throughout Oregon’s health system and the coordinated care organization reform efforts, largely due to the loss of longtime public servant Dr. Bruce Goldberg.
Last week, Gov. John Kitzhaber announced Goldberg’s resignation -- the health policy leader took responsibility for his role in the state’s failure to effectively manage lackluster web developer Oracle. While Goldberg headed up the Oregon Health Authority, the California technology giant sent Oregon a large infrastructure of bad codes rather than the functioning Amazon.com-style website it had promised, leaving Oregon as the only state where consumers cannot sign up for private health insurance online without assistance.
But Goldberg, who had stepped aside as state health director in December to salvage Cover Oregon and serve as its acting director, was responsible for much more than supervising the insurance exchange.
“I think scapegoating Dr. Goldberg was irresponsible,” charged Rep. Mitch Greenlick, D-Portland, the chairman of the House Health Care Committee. “It’s going to hurt the [Medicaid] transformation effort. He’s been a real force. A lot of the work that’s gone forward has been on his personal integrity and ability to get people to work with him.”
Since he started as director of the Department of Human Services in 2005, Goldberg has been a key state advocate of improving the healthcare system for Oregonians. He assisted the state in expanding health insurance to cover thousands of Oregon children, worked to spin the Oregon Health Authority off from DHS, and guided the new agency as it restructured the state Medicaid system through locally-operated coordinated care organizations.
Greenlick said he agreed Cover Oregon should sack its chief technology executive, Aaron Karjala, much as the state had been inclined to do with the Oregon Health Authority’s chief information technology person, Carolyn Lawson. But the real blame lay with Oracle, not the state’s managers.
“We trusted what seemed like a major American corporation to deliver the system,” Greenlick said. “They were expected to deliver and they delivered junk. … I guess shoddy work is expected at Oracle.”
Kitzhaber made the decision to accept Goldberg’s resignation after the release of the third-party Cover Oregon audit from Atlanta tech company First Data showed widespread state dysfunction in the rollout of the exchange. “Oregonians deserve more from their state health insurance exchange,” Kitzhaber told reporters last week, explaining his decision to clean house at Cover Oregon and the health authority. “The taxpayers should hold me accountable for the problems of Cover Oregon.”
Rep. Jim Thompson, a Dallas Republican, said he was still awaiting the audit from the U.S. General Accountability Office before he could determine the legitimacy of the First Data report from the governor.
“I feel the report’s fairly damning,” Thompson said. But “I don’t think the Cover Oregon audit was as thorough as it should have been.”
He also had reservations about clearing out personnel at Cover Oregon, including Goldberg, whom he called the anchor of the CCO program. “A lot of people are going to be careful from now on, afraid that they are going to get get nailed.”
The public saw a little of that when a rattled Cover Oregon staff ejected a reporter and barred two others from attending a routine legislative oversight committee meeting Tuesday. (See separate story).
Goldberg’s Unique Qualities
Goldberg’s replacement at the health authority, acting director Tina Edlund, is also a longtime civil servant, with 25 years of health policy experience, but Goldberg’s left some big shoes to fill, presiding over a state agency with a budget of $15.2 billion. Observers said Goldberg had the unique combination of a savvy communicator and a family physician with real-world experience.
“He understood the politics as much as he understood the medicine,” said Shane Jackson, an autism rights lobbyist.
“Bruce Goldberg was a catalyst for the Governor’s call for transformation and he will be tough to replace,” wrote Janet Meyer, CEO of Health Share, a Portland-area CCO, in an email to The Lund Report. “Throughout his tenure at the Oregon Health Authority, he worked tirelessly on behalf of many of our most vulnerable citizens.”
“I think Bruce was a visionary and created a new agency out of scratch,” said Doug Riggs, a lobbyist for CareOregon, the Portland healthcare organization where Goldberg worked before coming to the state. “He was committed to seeing healthcare transformation succeed. He’s been a great leader, and his heart has been in the right place.”
The reforms led by Goldberg to transform the Oregon Health Plan away from the fee-for-service payment model and its runaway costs will continue without him, Riggs said.
Need for Culture Change
Goldberg was not without his detractors and where some see unintended consequences, others see an opportunity for the state to improve. Jeff Heatherington, the CEO of FamilyCare, the other Portland-area coordinated care organization, said the mismanagement that’s plagued Cover Oregon has extended to the Oregon Health Authority, where he wanted to see a culture change that only the departure of Goldberg might provide.
“The culture has been to bury our heads and keep quiet,” Heatherington said. “Part of that culture change is to get good business processes for people to be able to be open.”
A data entry error resulted in about 4,000 non-citizens getting improperly enrolled in the Oregon Health Plan when they would only have qualified for a special program for pregnant women giving birth to Oregon babies.
Earlier, Heatherington told Kitzhaber that the health authority should ask for the tutelage of “loaned executives from the CCO world,” but the governor had yet to take him up on his offer. “The people who have the best interest of OHA in mind are the CCOs,” he said.
He added that the health authority had a chronic problem attracting the best people because of uncompetitive salaries. While actuaries make as much as $150,000 in the private sector, the state will only pay $80,000, he said.
The health authority has also been seen as too cozy to the interests of the large hospitals and not acting as a neutral broker between the hospital systems and other healthcare interests, including the public. Much of the staff at the Oregon Health Authority has worked for the better-paying hospital systems and vice versa, including Edlund, who was employed at Providence Health System until coming to the state in 2003.
In 2013, after a group of independent radiologists and physical therapists accused Providence of canceling referrals and blocking patients from seeking services from providers who were not Providence employees, Sen. Chip Shields, D-Portland, and Sen. Larry George, R-Sherwood, passed Senate Bill 683 as a bipartisan attempt to limit self-referrals.
Shields and George wanted physicians to give a verbal notice of potential conflicts of interest, but as it became time to write the rules for the law’s implementation, the health authority buckled under pressure from the hospitals and the Oregon Medical Association. Shields and George made a personal appeal for the verbal notice provision but dropped their request after months of contentious meetings.
Christopher David Gray can be reached at [email protected].