Editor’s note: This is the fourth in a six-part series from The Political Center analyzing federal rule changes to Medicaid under H.R. 1, and how Oregon lawmakers can help navigate the shifting regulatory landscape. Read the previous installments below:

• Part I — Implementation Deserves Its Own Conversation
• Part II — Implementation Begins Before the First Notice
• Part III — Where Implementation Becomes Real

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The previous installment of this series ended with an important question: If no one person can see the whole picture on implementation, then who has the ultimate responsibility to bring these perspectives together?

Our instinct in public policy is often to look to whomever has formal authority — whether that’s the Legislature, Oregon Health Authority, or another government agency — and assume the responsibility is theirs. And in an important sense, it is.

But having authority over a decision doesn’t guarantee the full perspective necessary to make that decision well. The greater the responsibility is for making a decision, the greater the responsibility then to seek out those people who will experience, administer, and live with its consequences.

No one implements alone.

Shared Responsibility

Consider how many people will play some role in implementing Medicaid community engagement requirements in Oregon.

OHA will develop guidance and oversee implementation statewide. Coordinated Care Organizations (CCOs) will help translate those requirements into local systems. Providers and care managers will answer questions from members. Community organizations will hear about confusion and barriers. Policymakers will hear from constituents and organizations about what is working and what isn’t.

Each has a different responsibility, and each sees something the others may not. Shared responsibility means doing our own jobs well while recognizing when someone else has information or experience we need.

Members shouldn’t have to understand how Oregon’s healthcare system is organized in order to successfully navigate it. The system has to connect for them.

Everyone Has Something to Contribute

Fortunately, Oregon isn’t starting from scratch.

For more than a decade, healthcare providers, CCOs, community organizations, state agencies, policymakers, and others have been building relationships within the communities they serve. Those relationships give Oregon something important to build upon.

Successful implementation will require people throughout the system to contribute what they’re seeing and experiencing, and people don’t need formal authority for their experiences to matter.

A provider may notice the same question coming up again and again. A community organization may recognize that members are misunderstanding a notice. A CCO may see a pattern developing across thousands of members. OHA may recognize that what appears to be a local challenge is actually occurring statewide.

None of those observations is a competing claim to authority. They come as critical information to those in charge, allowing them to make better, more informed choices.

Building a Culture of Learning

That may be one of Oregon’s greatest opportunities as implementation moves forward.

Oregon can create a culture where people throughout the system contribute what they know, listen to what others are learning, and adapt as experience reveals what is working and what needs to change. That requires more than asking for feedback once and relationships strong enough for information to move through the system in both directions. Even a thoughtful decision can create an unintended consequence somewhere else.

The only way to recognize those consequences is to keep learning from one another. Shared responsibility gives accountable leaders the perspective they need to make better decisions.

Ultimately, that responsibility connects back to the same place implementation becomes real: the member experience.

No one implements alone.

If successful implementation depends on all of us contributing what we see, learning from what others see, and adapting along the way, then the next question becomes:

How will we know whether it’s actually working?