Oregon Gov. John Kitzhaber, a former emergency medicine physician, has resigned amid allegations he steered consulting contracts toward his fiancée. Kitzhaber has steadfastly denied those allegations.
“The questions that have been raised about my administration—specifically allegations against me concerning the work done by my fiancée Cylvia Hayes and the contracts she obtained during my last term—and the escalating media frenzy that has stemmed from this has clearly reached the point of no return,” Kitzhaber said in a news release.
Kitzhaber, 67, who was recently elected to a fourth term, expressed confidence that an investigation would clear him of any wrongdoing. But he said the process would take months and would undermine the state government in the meantime. Secretary of State Kate Brown, a Democrat like Kitzhaber, will replace him as governor.
Kitzhaber topped Modern Healthcare's list of the 50 Most Influential Physician Executives and Leaders in 2013 after Oregon received a $1.9 billion CMS grant in 2012 to finance the transformation of its state Medicaid system. Most of the state's Medicaid enrollees now receive care from a coordinated-care organization. The new system is designed to provide $11 billion in savings over 10 years.
The effort is showing significant results. The latest progress report showed a 21% decline in the number of emergency department visits among CCO members from a 2011 baseline. A 9.3% decline in hospital admissions related to short-term diabetes complications and a 48% decrease in hospital admissions for chronic obstructive pulmonary disease were also reported. These advances occurred despite an increase of 380,000 new enrollees into the state Medicaid system.
“Tonight over 95% of Oregonians will go to bed knowing (PDF) that they have health insurance coverage,” Kitzhaber said in his resignation statement. “We did that together.”
Martin Taylor, director of public policy and Community Relations at the CareOregon health plan, expressed disappointment over Kitzhaber's resignation, but said Oregon's reforms will continue to go forward. Taylor, whose company is participating in four of the state's 16 CCOs, explained that Medicaid reform is the law so the governor's departure won't change that. He added that the CCOs have been running long enough now to succeed or fail on their merits regardless of who serves as governor.
“I think there's a tendency to make symbolic leaders synonymous with the success of a movement or organization,” Taylor said. “Success in Oregon is happening because there is a great team of leaders in the state—among both providers and health plans—and we are doing things that don't happen in other states.”
Taylor described Kitzhaber as “second to maybe only Don Berwick” as a healthcare thought leader and said his resignation was “a loss to people who are enthusiastic about healthcare reform design.”
He also expressed confidence in Kitzhaber's replacement.
“We're lucky incoming Gov. Kate Brown has been part of our legislative process for a long time,” Taylor said. “She was there when this legislation passed.”
A key to the effort was Kitzhaber's push to open the system to new ways of thinking. The example he promoted involved “prescribing” an air-conditioner for senior citizens to avoid heat-related illnesses and hospitalizations.
In a similar vein, Cynthia Ackerman, a vice president for the CCO which covers southwest Oregon, told Modern Healthcare her organization helped put a morbidly obese, severely depressed man on a path to better health by getting him a dog.
“We provided him with every professional service available—and it wasn't touching him at all,” Ackerman said, adding that the man “completely opened up” after he was given a pet to care for.
Dr. James Rickard, a radiologist who serves as the health strategy officer for the Yamhill Community Care CCO, said CCOs have served as a platform for innovations such as teledermatology and community paramedicine programs. The latter program involves off-duty paramedics checking in on patients in their homes one or two days after a hospital discharge.
He described how there was one woman with frequent readmissions for congestive heart failure and chronic pulmonary disease. The paramedics discovered she slept on a mattress on the floor, lived with family members who smoked, and ate a high-sodium diet.
They worked to get her a hospital bed to sleep in, persuaded her family members to smoke outside and counseled the family on how to reduce their salt intake. The intervention has helped keep her out of the hospital, Rickard said.
“It's programs like that we've been able to start with funding from the Oregon Health Authority,” he said.
Kitzhaber's healthcare star was tarnished, however, with the disastrous rollout of the $248 million Cover Oregon health insurance exchange.
Kitzhaber, a former state senator and representative, served as governor between 1995 and 2003. Oregon's state constitution does not allow individuals to serve three consecutive terms. He returned as governor in 2011 and was elected to a fourth term this past November, defeating Republican state Rep. Dennis Richardson in a close race.
Between his terms as governor, Kitzhaber formed an organization called the Archimedes Movement that sought to spark healthcare reforms by seeking federal waivers to force Congress to defend practices that contradict its stated desire to improve the healthcare system. He explained his strategy to a national audience at the 2006 Healthcare Information and Management Systems Society Conference and received a standing ovation.
Kitzhaber finished second on Modern Healthcare's list of the 100 Most Influential People in Healthcare in 2013 (behind former HHS Secretary Kathleen Sebelius) after finishing third the year before.
In his resignation statement, Kitzhaber said he was inspired to go into public service after serving in Robert Kennedy's 1968 presidential campaign.
Follow Andis Robeznieks on Twitter: @MHARobeznieks