CareOregon, OHSU, and LifeWorks NW were acutely aware of the area’s workforce shortage, particularly in child psychiatry. Because they realized they shared a similar goal, CareOregon provided funding to OHSU for two child psychiatry fellowships and one additional addiction fellowship at OHSU. This was the first time in over twenty years that new fellowship positions were added, in part due to the severity of the workforce shortage. As of 2023, OHSU is currently exploring additional adult psychiatry residency positions because of additional funding from CareOregon.

CareOregon’s collaboration with OHSU and LifeWorks NW was successful because all the organizations benefitted. For CareOregon, building a pipeline of qualified candidates through the additional fellowships means that they will have a larger provider network to work with, improving access to care for their members and ultimately reducing total cost of care. For LifeWorks NW, having additional fellows alleviated some of the workforce shortage and helped drive interest in community behavioral health in the long term. OHSU benefited because they could grow their psychiatry fellowship program, provide more learning opportunities for their students, and position OHSU as a more desirable university to attend. The first rotation of fellows reported that the child psychiatry fellowship was their favorite, and one of the fellows shared that they now want to stay in the area and work in community behavioral health.

As this program continues to increase the supply of qualified psychiatrists, the broader Portland, Oregon market will benefit — including other local partners and competitors of CareOregon, LifeWorks NW, and OHSU. And sufficient psychiatrist staffing levels can reduce burnout and improve overall resilience and retention across the entire behavioral health care workforce.

Though health plans may not think that it’s in their lane, health plans can and should play a role in supporting behavioral health workforce development.

CareOregon conducted internal payment studies to assess the wages of behavioral health staff at different levels and ensure the organization was meeting parity requirements. In response to the results, the organization set a goal of internally increasing rates by about 30%, addressing higher-need specialties like substance use disorder care first. But leaders knew that the impact of higher rates would be elevated if their peers joined them.

The organization convened local leaders to start the conversation. They met with VP level or above government affairs and clinical leaders from Health Share Oregon, their health plan partner, and local provider associations around once every two weeks for amount two months to come to consensus on the value of raising rates — and by how much. The clinical and government leaders benefited from CareOregon’s guidance on specific billing codes and where the additional money was needed.

Once the organizations came to an agreement, they joined together to lobby the Oregon state legislature to raise statewide Medicaid behavioral health reimbursement rates to match CareOregon’s new policies. Their lobbying efforts were successful because the stakeholders went to the negotiating table with a shared purpose and specific recommendations, rather than individually lobbying for different asks.

This example demonstrates the influence health plans can have over legislature action by setting new norms with independent action and leading joint advocacy efforts. It also indicates how raising reimbursement rates can help improve workforce supply. For example, Morrison Child and Family Services, a behavioral health service provider based in the Portland metro area, was able to raise therapist salaries by 17% after the introduction of higher reimbursement rates. And after the salary raises took place, their therapist vacancy rate decreased from 35% to 6%.

CareOregon is continuing its influence over legislature action and has submitted a request for proposal for additional technical assistance on how to develop an accurate usual and customary fee schedule for clinical leaders.

The Alliance for Culturally Specific Behavioral Health Providers, referred to as the Alliance, was established in 2010 with the goal of supporting providers that treat primarily patients of color. CareOregon partnered with the Alliance in 2019 to develop an alternative payment methodology that rewards culturally specific providers with additional reimbursement per code. CareOregon and the Alliance went through a collaborative codesign process across 2020 and 2021. This included jointly created agendas, cofacilitated meetings, and an iterative consensus process with the group. During the meetings, the group discussed decisions around creating a fee for service equivalent increase for culturally specific service delivery and outreach and engagement funding to leverage the way of culturally specific providers in the community and in the health care system. Through this work, CareOregon increased their payment of culturally specific providers by up to 20%. Additional payment was possible by leveraging traditional payment models and Health Related Service dollars.

To achieve a similar result, health plans can follow a tiered reimbursement model to support the highest value and most in need providers, retain the local safety net, and support the delivery culturally responsive care.