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A Case Study of Collaborative Governance: Oregon Health Reform and Coordinated Care Organizations

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A Case Study of Collaborative Governance: Oregon Health Reform and Coordinated Care Organizations Portland State University PDXScholar Dissertations and Theses Dissertations and Theses Spring 6-2-2014 A Case Study of Collaborative Governance: Oregon Health Reform and Coordinated Care Organizations Oliver John Droppers V Portland State University Follow this and additional works at: https://pdxscholar.library.pdx.edu/open_access_etds Part of the Health and Medical Administration Commons Let us know how access to this document benefits ou.y Recommended Citation Droppers, Oliver John V, "A Case Study of Collaborative Governance: Oregon Health Reform and Coordinated Care Organizations" (2014). Dissertations and Theses. Paper 1824. https://doi.org/10.15760/etd.1823 This Dissertation is brought to you for free and open access. It has been accepted for inclusion in Dissertations and Theses by an authorized administrator of PDXScholar. Please contact us if we can make this document more accessible: [email protected]. A Case Study of Collaborative Governance: Oregon Health Reform and Coordinated Care Organizations by Oliver John Droppers V A dissertation submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy in Health Systems and Policy Dissertation Committee: Sherril Gelmon, Chair Jill Rissi Neal Wallace Pamela Miller Portland State University 2014 © 2014 Oliver John Droppers V OREGON HEALTH REFORM AND COORDINATED CARE ORGANIZATIONS i Abstract The complexity of issues in health care in the United States—specifically insurance coverage, access, affordability, quality of care, and financing—requires effective new models for governing, in which governmental and non-governmental organizations seek to solve problems collaboratively rather than independently. This research explores collaborative governance as a model to form new partnerships among for-profit, nonprofit, and public organizations in an effort to create community-based, locally governed health care entities in Oregon through coordinated care organizations (CCOs). A key question is whether collaboration, through CCOs, brings together government and non-governmental organizations to solve “intractable problems” by establishing new public-private partnerships in Medicaid. The research focuses on the formation of CCOs, including the influence of local, political, institutional, and historical contexts, planning processes, and governance structures. The hypothesis is that conditions, norms, governance structures and processes, and the presence or absence of a combination of these factors, facilitate or impede participation and decision-making, and over time, successful system integration by these new complex organizations. This study developed insights into similarities and differences among CCO governance structures by investigating three CCOs. Findings from the case study suggest that the following key factors influence the collaborative governance process among government and non-governmental organizations within CCOs: prior history of conflict or cooperation; open, transparent, and inclusive processes for stakeholders; face-to-face OREGON HEALTH REFORM AND COORDINATED CARE ORGANIZATIONS ii dialogue, trust building, and shared understanding; and high-functioning governing boards. Results also indicate that maintaining stakeholder participation can be challenging due to time and cost, power imbalances and competing interests among stakeholders, and mistrust and lack of facilitative leadership. The results suggest that collaborative governance is a strategic approach for the allocation of limited resources across public, private, and nonprofit organizations to deliver services to Oregon’s Medicaid population. The significance of this study is that it identified starting conditions that facilitate and hinder the ability of CCOs to effectively solve problems through governance mechanisms. Oregon’s CCOs offer an example of multiple layers of governing institutions—federal, state, and county—using formal authority to influence a specified set of outcomes, the Triple Aim, in a specific policy domain: provision of health care services for underserved Oregonians. Results of the study can help inform a larger, more fundamental question in public administration about contemporary governance: whether government through collaborative governance can create the “conditions for rule and collective action” through public-private partnerships to achieve policy goals (Stoker, 1998). Further research is needed to better understand whether local community-based organizations such as CCOs offer a sustainable model to address policy issues in other arenas by which there is “more government action and less government involvement” (Agranoff & McGuire, 2003). This study contributes to the theory of collaborative governance and may inform future policy decisions about CCOs in Oregon and, more broadly, ongoing national health care reform efforts. OREGON HEALTH REFORM AND COORDINATED CARE ORGANIZATIONS iii Dedicated to my father, my wife and Bettye-Jean Marie OREGON HEALTH REFORM AND COORDINATED CARE ORGANIZATIONS iv Acknowledgements A doctoral program is a right of passage for a select few. The dissertation involves self-discovery, coupled with steadfastness, questioning the state of one’s area of study and one’s inner self: humility in its raw essence. PhD students would be remiss to not acknowledge that their academic, professional, and personal pursuits would not be possible without exceptional mentors. My own journey in pursuit of a doctorate likely parallels those who came before me, those I now call my mentors, whose footsteps I have sought to trace. To the scholars who endeavor to uphold the virtues of the academy, promote the importance and currency of knowledge, and challenge those of us willing to accept the odyssey—we, their students, are indebted with gratitude. To those who have come before us and who will follow, we owe much gratitude. To members of my dissertation committee, I thank you for your thoughtful guidance, wisdom, and compassion. I appreciate the level of commitment and encouragement shown by members of my committee throughout this process. To Sherril Gelmon, my chair and mentor: Nine years ago, for reasons still not fully appreciated, you were willing to take on yet another unsophisticated, inexperienced graduate student. As a well-respected mentor to many junior colleagues fortunate enough to cross your path, please know your discipline and devotion as a mentor, teacher, adviser, and confidant is an everlasting gift to your students. Over the course of several grant-funded projects as well as coursework, presentations, and teaching opportunities, you both encouraged and challenged me—challenged me to develop a better understanding of myself; pushed me to excel in my writing and critical thinking; helped OREGON HEALTH REFORM AND COORDINATED CARE ORGANIZATIONS v instill confidence when and where it was lacking; urged me to reconsider my professional goals and interests out of compassion, and all for the better. In reflecting on your technique or modus operandi in your role as a mentor, I have realized that the outcome, after years of caring and investing in me professionally and personally, is that you have afforded me with amazing opportunities, many unimaginable, all of which have significantly impacted and positively changed my life course. Thank you. To my parents: Thank you both for the love and sacrifices in providing me the ability to take risks and seek opportunities, and for your encouragement of my many pursuits including the privilege of an education, now a doctorate. These sacrifices, borne from a parent’s endless love for their child, without question, without judgment, have offered me the safety and protection that only a parent can provide in this world. It is through no virtue or accomplishment of my own that I’ve had and enjoyed these opportunities. I was merely fortunate enough to be born under the most comfortable conditions into a loving family. As my parents, you have shown me love without reservation, instilled in me a work ethic, and most importantly, were willing to make the necessary personal sacrifices to raise a child surrounded by a house of love. In thinking about others’ sacrifices and my own personal identity, it would be inexcusable for me not to acknowledge my forefathers and foremothers, for they took the real risks, bore unknown hardships, and endured immeasurable suffering. I owe a debt of gratitude and obligation to the farmer who sought a better life for his children by providing his offspring an education, sacrificing the family farm and moving into town to offer schooling for his children; to the minister who challenged his consciousness and OREGON HEALTH REFORM AND COORDINATED CARE ORGANIZATIONS vi decided to adhere to principles over convention for his sons, knowing that judgment would be harsh and hardships would be difficult to bare—he persevered, nevertheless, with his integrity intact; to a great grandmother who sought to alleviate the suffering of those served by her congregation, the poor—treating those less fortunate with dignity; to my beloved great-grandmother who traveled steerage class to the United States for an unknown, new world, and her staunch commitment to provide, through sheer toil and sacrifice, her great-grandson the educational opportunities never afforded to her; to a grandmother who traveled the railroad tracks picking up coal for heat, who worked tirelessly serving unknown faces, and yet somehow always remained buoyant and loving in the face of adversity, teaching me
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