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Steve Lewis served as Speaker of the Oklahoma House of Representatives from 1989-1991. He currently practices law in Tulsa and represents clients at the Capitol. You can sign up on his website to receive the Capitol Updates newsletter by email.
Last week’s Oklahoma Healthcare Authority (OHCA) planning retreat provided a wealth of thinking about how to work through the next few years. It seemed to be pretty much a consensus that problems are increasing and resources to deal with them are decreasing. A good number of the endeavors that are thought to be necessary to make life better are finding themselves sort of in the ditch-or on the edge about to fall in. You name it — mental health, addiction, health outcomes, hospitals, education, higher education, corrections, courts, roads and bridges, services to children, the disabled, the elderly — and we seem to be slipping. Excellence is hardly a realistic goal. Predictions are that this won’t get better anytime soon. So, if you’re among those whose life is about helping to meet one or more of these needs, what lies ahead?
Sen. AJ Griffin, one of the best policy thinkers in public life in our state, was on an OHCA panel and had this to say to state officials: “For the first time we’re going to have officials looking at blended funding. You’ll have to work together to do that. It’s funding based on outcomes. We’ll hear more about that. We’re not going to have more money. We’re going to have to apply those dollars differently. We can spend every dime we get on healthcare and still not meet all the needs. Next year is going to be tough.” No doubt she’s reflecting the thinking of other leaders in the legislature.
Dr. Terry Cline, Director of the Oklahoma State Department of Health and Secretary of Health, said “I’m of the firm belief that unless we change the way of payment in our state we won’t be able to affect change and outcomes. We’re putting millions into healthcare but are we getting the outcomes? No we’re not. I think we have the opportunity for payment reform.” Talking about our schools Dr. Cline said, “[School officials] say they can’t focus on health because they have to focus on academics, and no surprise, academics increase when kids are healthy. Necessity is the mother of invention.”
This is probably unwelcome information to service providers that have seen their rates stagnate or decline due to budget cuts. Or to state employees who are doing the work of colleagues whose post has been left vacant to meet the cuts. But the signal here is that some sort of structural change may be on the way. Innovation is the order of the day. To keep doing services you’ll need to learn (or develop) the expected outcomes and be able to show you are meeting them. That’s tough duty in many fields where you can often do everything right and still get a bad outcome. But in the zero sum times we are living through there’s a low level of tolerance for bad numbers. Some will argue that doing more with less has passed its limit, but so far that idea hasn’t taken hold in our state.
