Strategic Healthcare Investment for Transformation (SHIFT)

The SHIFT Learning and Advisory Council provides strategic advice and guidance to CareOregon for the SHIFT initiative 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 initiative.
• 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 - March 2024 year.

NOTE: we’ve asked Learning and Advisory Council members to extend their membership through June 2024.

The SHIFT cohort refers to the six behavioral health agencies who applied and were selected to participate in SHIFT. They will receive the intensive technical and financial support and resources to implement the Building Blocks, learn what works, and accomplish the initiative’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 initiative 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 been selected; there was a comprehensive application and interview process to reach that decision. Click here to see which agencies were selected to participate in the first SHIFT cohort.

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 are eligible to participate.

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) 

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.

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 SHIFT.  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 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.

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 initiative 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 SHIFT from 2024-2026 will entail:

• Equity-based planning incorporated throughout the Building Blocks implementation to ensure improved care, experience, and outcomes for underserved communities.
• Agencies are providing team-based care in at least one program site, and, where applicable, have a plan for spreading team-based care across all outpatient behavioral health programs.
• Clients served by teams are reporting favorable care experiences.
• Improved satisfaction amongst care teams.
• Improved access for all community members including those returning to care.
• Improved capacity for data analysis and population health-based planning.
• Improved pathways between behavioral health, primary care and social health agencies.
• CareOregon and agency bidirectional confidence in the financial sustainability of models being deployed.
• Agencies complete 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 includes:

• Organizational assessment and support for SHIFT and FIT implementation plan development.
• Support with business plan development and templates for documenting baselines and tracking metrics.
• Financial resources around $2-$3.5m in the forms of grants with advanced distribution and milestone-based grants (varies by phase).
• Requirement to contract with external executive coaching support.
• SHIFT and FIT advisor meetings, site visits, trainings and supports.
• Technical assistance and operational resources & tools, including Building Blocks Toolkits for agency operational playbook development to promote systemization.
• Practice and 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. 

SHIFT agencies are required to hire external executive consulting supports for executive coaching scope at a minimum, change management and implementation consulting scopes are recommended as needed.

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 consultants and advisors will work closely with participating agencies to help integrate SHIFT plans with other ongoing agency programs.

Membership on the Learning and Advisory Council was extended through June 2024. The Learning and Advisory Council was initially established for the initiative’s first launch year, and its membership and objectives will be re-evaluated later in 2024. The SHIFT initiative is currently resourced to support six behavioral health agencies in this first cohort, but we are hopeful that, with successful outcomes, we will be able to expand its reach in the future.