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Strategic Healthcare Investment for Transformation (SHIFT)

Advancing behavioral health in Oregon 

CareOregon’s Strategic Healthcare Investment for Transformation (SHIFT) program is a new investment in transforming specialty behavioral health organizations across Oregon so that people with behavioral health needs are truly at the center of care delivery, and care teams can thrive. Through a collaborative process, SHIFT will build member-driven, outcomes-focused, team-based care models that reduce health disparities, assure timely access to care, and prepare providers for advanced value-based payment models. 

Why now?

CareOregon is committed to a vision where members in each of its regions have access to a high-performing behavioral health home. Decades of systemic underinvestment in behavioral health at the local, state and federal levels has resulted in significant access challenges and health inequities. Today, we are entering a new phase of opportunity for transforming behavioral health. New and significant financial investments are being made to shore up specialty behavioral health services, and we must capitalize on this opportunity to reimagine and transform the practice of care delivery.

SHIFT components

The SHIFT program will support clinical, financial and operational transformation of outpatient behavioral health agencies by:

  • Defining the principles and operational components (“Building Blocks”) of excellent behavioral health care, in collaboration with community stakeholders.
  • Engaging six to eight diverse behavioral health organizations to implement the Building Blocks and providing them with intensive technical and financial resources to learn what works and accomplish the program’s aims.
  • Analyzing the success of earlier stages and refining and spreading the reach of the program to additional behavioral health organizations across CareOregon’s networks.

Timeline for SHIFT

  • August 2023: Submissions of letters of intent by agencies interested in SHIFT
  • September - November 2023: Written applications and invitations for interview
  • December 2023: Agency selection and planning phase funding issued
  • January - June 2024: In-depth self-assessment and planning phase
  • July 2024 - December 2026: Agency implementation with CareOregon support

Application process

To select the first cohort of agencies to support through SHIFT, CareOregon will engage in a multi-step process.

  1. August 2023: CareOregon invited eligible agencies to indicate their interest and intent to apply for SHIFT by submitting a letter of intent. The submission period is now CLOSED.
  2. September 2023: Written applications will open September 5 and be due no later than September 29.
  3. October - November 2023: CareOregon will review applications and invite select agencies to interview.
  4. December 2023: CareOregon will notify the first agencies to participate in SHIFT.

Want to learn more?

The SHIFT program team hosted an informational webinar to kick-off the SHIFT application process in July 2023. The meeting was recorded and is available via an on-demand link. If you’d like to review the presentation, email SHIFT@careoregon.org  and we will send the link to the recording.

Additional office hours will be held throughout September for interested, eligible agencies to ask questions about the application process and receive one-on-one application support from the SHIFT program team. The office hours schedule and sign-up information can be found here.

SHIFT eligibility

To participate in SHIFT, agencies must:  

  • Be a contracted, in-network provider for Columbia Pacific CCO, Jackson Care Connect, and/or Health Share of Oregon CCO
  • Have nonprofit status
  • Provide outpatient mental health and/or substance use disorder level of care 
  • Serve clients with serious or persistent mental illness, substance use disorder and/or complex youth; SHIFT will prioritize agencies that serve clients with more complex needs and do not deliver only clinic-based services
  • Have majority behavioral health revenue from CareOregon for outpatient care
  • Have a certificate of approval
  • Have their board’s endorsement of their application to SHIFT
  • Minimally serve at least 200 unique CareOregon members annually in outpatient behavioral health care 
  • Be in the top 10 providers by volume by service/population category (adult/youth, MH/SUD), unique to each region OR is a culturally specific agency (*CareOregon contacted agencies directly that we believe meet this criterion) 
  • Where eligible, be participating in the Feedback Informed Treatment (FIT) incentive program (does not apply to SUD agencies or to agencies in CPCCO)
  • Employ staff or offer the following services directly or through contract: 
    • Medication management and/or medication supported recovery 
    • Qualified mental health associates and/or certified addiction treatment counselors
    • Traditional health worker services (peer support specialists, peer wellness specialists and/or community health workers) 

Instructions to access the Building Blocks Framework

The Building Blocks Framework document is available to all behavioral health providers serving CareOregon members through the CIM and Connect provider portal platforms. To access the document, follow these steps outlined below or email SHIFT@careoregon.org:

CIM Connect
  • Navigate to the CIM login page and log into your account.
  • The Building Blocks Framework document is available to view and download from both the:
    1. “System Messages” feed, accessible by selecting the bell icon in the top right of your screen, and
    2. “Provider Services” page, accessible through the navigation bar on the left of your screen when you select the “Provider” drop down.
  • Navigate to the Connect login page and log into your account.
  • The Building Blocks Framework document is available to view and download from the “Resources” tab on the navigation bar located on the left side of your screen.

Frequently Asked Questions

The SHIFT Learning and Advisory Council provides strategic advice and guidance to CareOregon for the SHIFT program during at least the program's first launch year. Specific responsibilities of the Council include:

  • Guiding the development of and recommending and endorsing a set of “building blocks” for delivery of excellent behavioral health care to be used in the SHIFT program
  • Advising on the components of companion tools and technical support strategies for SHIFT participating providers
  • Advising on the evaluation plan for the SHIFT program 
  • Advising on the eligibility and selection process for SHIFT participating providers 

View the SHIFT Learning and Advisory Council member slate for the April 2023-April 2024 year.

The SHIFT cohort refers to the six to eight behavioral health providers who will be selected to participate in SHIFT and will receive the intensive technical and financial support and resources to implement the Building Blocks, learn what works, and accomplish the program’s aims.

Participation in the Learning and Advisory Council does not suggest later participation in SHIFT’s first cohort of providers.

Unlike certified behavioral health clinics which have a formal designation/certification and are required to serve clients across the lifespan and both mental health and substance use disorder (SUD) services, SHIFT is not a certification program and will intentionally support providers who serve specific populations or offer specific service arrays (e.g., mental health only, or SUD only). We envision certified community behavioral health clinics (CCBHCs) will benefit from the operational structure and processes to be outlined through SHIFT. Additionally, the SHIFT program provides participating agencies a unique menu of tools, training, and technical assistance, including executive coaching.

“Building Blocks” are the core components of specialty behavioral health care necessary to deliver the SHIFT vision and include the specific operational processes and structural elements required for behavioral health agencies to operate efficient and effective services according to the guiding values. The full set of Building Blocks to be used in SHIFT were endorsed by the Learning and Advisory Council. The concept of building blocks is modeled from a similar framework established for person-centered primary care homes. The Building Blocks Framework document is available for review by all behavioral health providers serving CareOregon members and is accessible through the CIM/Connect provider portal platforms. Click here for instructions to access the document.

Agencies to participate in SHIFT have not yet been selected; there will be a comprehensive application process to reach that decision as described above. Only outpatient behavioral health agencies that hold a certificate of approval and are in-network with Columbia Pacific CCO, Jackson Care Connect, and/or Health Share of Oregon/CareOregon behavioral health network will be eligible to participate. A list of all eligibility criteria can be found above in the section on SHIFT eligibility.

To participate in the first SHIFT cohort, active enrollment or plans to initiate/resume enrollment in the FIT incentive program is a requirement for agencies who have been offered the opportunity to be in the incentive program. Enrollment in the FIT incentive program is not a requirement for agencies who have not had the opportunity to be in the incentive program. For example, substance use disorder (SUD) agencies and agencies in CPCCO have not yet had the opportunity to enroll in FIT and are therefore eligible to participate in SHIFT despite FIT enrollment. Other considerations may apply, and if you have questions about your agency’s participation, email SHIFT@careoregon.org.

Agency does “not deliver only clinic-based services" refers to (a) the regular provision of services to clients in settings other than the clinic, including in the client's home, or in another community setting and (b) outreach and engagement work with, for example, people experiencing houselessness. It is not referring to telehealth only services.

Assuming that the school-based mental health programs provide full outpatient mental healthcare (with assumed pediatric focus) and meet all other eligibility criteria, these services would qualify as eligible for the SHIFT program.  Agencies with school-based mental health programs will not be excluded from applying just because of their unique site of service. Noting that more information about the program’s current business model, services offered, and population served will be requested and reviewed throughout the application and interview process to evaluate against SHIFT supports and expected outcomes.

The SHIFT program team hosted an informational webinar to kick-off the SHIFT application process in July 2023. The meeting was recorded and is available via an on-demand link. If you’d like to review the presentation, email SHIFT@careoregon.org  and we will send the link to the recording. Additional weekly office hours will be held throughout September.

Board endorsement does not mean that the agency’s board is required to review and approve the application before submission, rather that they are supportive of the agency applying for SHIFT. An applying agency’s board should be fully informed about the SHIFT program opportunity, in agreement that SHIFT is aligned with the organization’s mission, and confident that the agency, if selected, will be able to participate in the level of effort described in the SHIFT application. The intention is to ensure that selected agency boards are aware and prepared for discussion and approval of the eventual CareOregon/agency business plan and financial terms.

Success of the first cohort of agencies in the SHIFT program from 2024-2026 will entail:

  • Equity-based planning incorporated throughout building blocks implementation to assure improved care, experience and outcomes for minoritized communities
  • Agencies have launched one or more teams, and, if applicable, a plan for spread to the full complement of outpatient behavioral health program sites
  • Clients served by teams are reporting a positive experience of care
  • Improved satisfaction amongst care teams
  • Improved front door for access (which must also include back door management)
  • Improved capacity for data analysis and population health-based planning
  • Improved pathways between behavioral health and primary care, social health agencies
  • CareOregon and agency bidirectional confidence in the financial sustainability of models being deployed
  • Agencies are through exploration and installation phases of Feedback Informed Treatment and are in initial implementation
  • Leadership teams are prepared to sustain transformation activities 

The full support plan will be developed over 2023 but is anticipated to include:

  • Organizational assessments, support for business plan development
  • Financial resources around $1.5-$3.5m for achieving milestones
  • Technical assistance, leadership coaching, operational playbook development to promote systemization
  • Financial monitoring and forecasting tools
  • Engagement from CareOregon leaders and technical teams, National Council for Mental Wellbeing, financial consulting firm CohnReznick, and the Center for Outcomes Research and Education

It’s difficult to estimate the level of effort for SHIFT because the answer is highly dependent on the specific agency’s size, capacity and needs. However, we do know that SHIFT will be a really intensive effort. SHIFT is intentionally well-resourced by CareOregon to comprehensively support participating agencies throughout the duration of the three-year cohort engagement. To launch SHIFT, participating agencies should expect to have committed and engaged executive teams, dedicated program leadership and program team (if not full-time program staff), and resourced administrative/ operations design and implementation experts. SHIFT funds can be used to resource some of these roles, but it will not be successful if existing leadership does not have the time/capacity to engage. Again, the structure and staff designations are agency-dependent, but the intention is to have, at a minimum, dedicated support to design, implement and manage the efforts.

An executive leadership team is typically made up of the following roles, and in smaller organizations, one person may hold more than one role:
  • Chief Executive Officer/President/Executive Director
  • Medical Director
  • Chief Financial Officer
  • Chief Information Officer/Chief Technology Officer
  • Chief Clinical Operations Officer
  • Chief Diversity Officer
  • Chief Marketing/Communications Officer
  • Chief Innovation/Quality/Compliance Officer

The executive team provides strategic and operational oversight of the agency, including developing and executing the strategic goals to achieve the agency’s values, mission, and vision. The executive team works together to:

  • Manage budgets and make financial decisions
  • Develop strategic plans and execute short- and long-term goals
  • Align operations with a company's strategic goals including new initiatives
  • Oversee teams of employees and motivate them to succeed
  • Engage with funders and policy makers to address resource needs
  • Engage community stakeholders to streamline effective access and care coordination

Executive coaching support to the executive team and individual executive team members will be designed to allow the team and its individual members to reflect on their approach to working with each other as leaders of the agency. Topic areas include aligning the values of the organization with the culture and day to day operations, adoption of team-based care principles, adaptive versus technical approaches to change management, aligning resources with strategic priorities, and managing versus leading staff. Fundamental to executive coaching is the creation of a dynamic, catalytic space for executive staff to grow together in their knowledge and skills as leaders. 

Agencies will need to carefully assess whether and how implementing SHIFT with its funding, training, tools, and technical assistance can align with and strengthen existing large-scale programs. SHIFT program consultants and coaches will work closely with participating agencies to help integrate SHIFT plans with other ongoing agency programs.

The Learning and Advisory Council is initially being established for the program’s first launch year, and its membership and objectives will be re-evaluated in 2024. The SHIFT program is currently resourced to support approximately six to eight behavioral health agencies, but we are hopeful that, with successful outcomes, the program will be able to expand its reach in the future.

Have more questions? Contact the SHIFT program team at SHIFT@careoregon.org.

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