CareOregon is in the midst of planning a multi-year investment to improve and expand mental and behavioral health care. But as the pandemic entered its second year, provider services eroded alarmingly.

"We have a plan for transformation, but we are in a crisis right now," said Jill Archer, Vice President of Behavioral Health Services. "We can't transform a decimated system where we can't even get people in for care."

CareOregon's Board of Directors asked what could be done immediately. CareOregon took that question to providers, who greeted it with surprise and pleasure. "We can't believe you're asking," one responded.

After the board approved the $7.5 million emergency fund in April, staff reviewed proposals from behavioral health providers. We moved quickly, sending most of the funds to providers' hands by the end of July (with about $700,000 to be disbursed in 2022). Grants ranged from $15,000 to $500,000, paid as recruiting and retention bonuses and more.

Rural areas like Medford and Oregon coastal cities used grants to pay first and last months’ rent in an effort to draw mental health care professionals who wanted to work there but couldn’t afford to relocate.

Investments from laptops to wellness activities increased worker productivity and satisfaction. Pay differentials helped those who work with more-complex patients.

Teaching trauma-informed care helped staff to better treat members; training them in stress management helped staff treat themselves better.

Providers who received grants serve nearly 85% of the highest-need Oregon Health Plan members in the Portland tri-county area, and Columbia, Clatsop, Tillamook and Jackson counties.

“The emergency fund kept providers and their finances stable,” said Shah. “Key partners didn’t have to close their doors.”

About a third of the medical calls to Portland's 911 system are for low-risk medical needs. Before CHAT was introduced, all 911 calls typically got the same level of response: an ambulance and transport to an ER.

Now, two CHAT medics in an SUV respond to a portion of these lower-level calls. The program operates in downtown and outer Southeast Portland, where many such calls originate.

CHAT medics can deliver immediate care, devote the time to determine what further services are needed, then transition the individuals to that care – be it dental, urgent care or, in fact, the ER.

If the community members are insured, CHAT medics guide them on using their benefits, such as preventive care from a primary care provider or dentist. If they are uninsured, the medics help connect them to resources for enrolling in a health plan, including OHP.

Behind the scenes is a solution-focused partnership and a responsive, multidisciplinary team of CareOregonians committed to CHAT's success. Throughout most of 2022, CHAT and CareOregon will continuously refine and evaluate the effectiveness of this less costly, flexible and more-personalized alternative to the classic emergency medical response.

“Up until now,” said Fire Chief Sara Boone, “we haven’t had a mechanism to allow us to spend the time needed to assess and treat community members on scene and connect them with appropriate care and resources.”

The pilot program’s goals align with health care’s Triple Aim: improve health outcomes, lower health care costs and improve member experience with the health care system.

CareOregon Boys & Girls Club en Rockwood

Play ball, tackle academics, meet with mentors, tap into family supports. Boys & Girls Clubs go all out to put young people on the path to a great future, which made the Portland Metropolitan Area clubs a natural fit for CareOregon. In late November, we announced a 10-year, $2 million collaborative partnership with the Rockwood location, 454 SE 165th Ave. The newly renamed CareOregon Boys & Girls Club at Rockwood is right where we want to be; a higher percentage of residents in nearby ZIP codes qualify for the Oregon Health Plan than anywhere else in the state.

Centros de salud en escuelas

Through our Provider Emergency Relief fund, CareOregon invested $5 million in strengthening our provider network. This included health centers at two high schools in the North Clackamas School District; our $250,000 grant supported staffing. After two years of delayed health care, children's need for health and wellness care is especially great, said Carol Keep, RN, of Clackamas County. Operated by the Clackamas County School-Based Health Center program, the new facilities opened in fall 2021 to serve students K-12. Physical health screenings and routine care, cleanings by a dental hygienist, and mental health services are offered, regardless of insurance or immigration status.

“At a time when many families are struggling to meet their basic needs, increasing access to no-cost health services at school is one way we are partnering with community to remove barriers so all families can be as healthy as possible.”
– Robert McConville, Vice President of CareOregon Metro

Oregon Health Care Interpreters Association

Good health care relies on patients and providers communicating well. With a $250,000 two-year grant to the Oregon Health Care Interpreters Association, CareOregon is helping build workforce capacity and clearer communication between care teams and English-learner members. The money is enabling current and prospective interpreters to complete training courses and undergo state credentialing - priorities of the Oregon Health Authority (OHA).

“Good communication creates the bond between patient and provider that promotes health awareness, timely access, treatment compliance and a healthy lifestyle.”
– James Mason, PhD, CareOregon Chief Equity, Diversity & Inclusion Officer

Employee resource groups (ERGs)

After staff expressed strong interest, in early 2021 the company rolled out its program for employee resource groups. The five employee-led affinity groups are among the ways CareOregon is working to promote a diverse and inclusive environment, cultivate a sense of belonging, and support personal and professional development.

Sabbaticals

The idea of offering sabbaticals came from a CareOregon Board of Directors member who sits on the compensation committee; she suggested them as a means of strengthening retention, engagement and work-life balance. After exploring the possibility, leadership and the full board agreed, and set a January 1, 2022 program launch date. The first level of sabbaticals, available to those with five or more years' tenure, pays 25% of salary for four to 12 weeks. The first sabbaticals are beginning July 2022.

Remote personal and professional development

HR's Organizational Development and Learning team added breadth and depth to CareU, our online home for classes and leadership development programs such as Aspiring Leaders. The library of on-demand offerings includes subjects that range from leading a remote team to breathing exercises that reduce stress. Jonathan Weedman, Vice President, Population Health, led an especially timely live remote class: Resiliency 101. As employees at many organizations rethink their purpose and position, "it's a critical course," noted Mara Kershaw, Director, Organizational Culture and Development.

"The long-term employees know what the CareOregon in-person culture is like. The new employees don't. How do we help them experience the culture - that, I believe, was part of retaining employees? It's not the same trying to build that connection through a little square on the computer."
– Chantay Reid, Vice President, CareOregon Human Resources 

Top Workplace

The company's exceptional culture again won attention in an annual survey of workplaces. For the sixth year running, CareOregon was named by The Oregonian/OregonLive as a Top Workplace, based on the news organization's survey of our staff. "That means," says Reid, "our employees are declaring us an employer of choice."

When the COVID-19 pandemic began, adults and children alike had limited or no access to dental care. Even as clinics reopened, many families reported hesitation and anxiety about in-person visits. Meanwhile, some dental clinics and systems were slow to adopt video appointments and were only able to offer telehealth visits by phone.

A few months into the pandemic, CareOregon Dental helped some partners implement teledentistry triage and prevention services, and then developed the pilot program. For the first time, dental partners offered video appointments, gaining the experience they needed to continue the service long-term.

After the pilot's completion in late 2021, CareOregon Dental met with dentists, hygienists and outreach staff to discuss key takeaways. They found that pediatric dental telehealth offers benefits to both members and dental clinics:

• Families have a new, more convenient path for child dental checkups when hands-on care is not necessary.
• Video appointments foster relationships. Children are more comfortable with dental clinic staff at their next in-person appointment.
• Dental partners now use video appointments to triage dental issues and help parents determine whether they need to bring in their kids.
• Clinics are also employing teledentistry for emergency triage or in cases of staff shortages.

A second program phase will begin in mid-2022. The aim is to offer this preventive teledentistry model and learnings to CareOregon Dental's provider network by end of the year.

"Being able to provide telehealth services focused on prevention for our younger patients has been an exciting new endeavor. We have been able to increase our reach to patient populations who may have been avoiding in-office visits for several reasons, and we believe we are giving these children and their parents an equally valuable service as the one they would receive in our clinics."
— Shannon Eckes, Dental Hygienist, Neighborhood Health Center

During COVID-19, how to encourage high-risk members to get care, including vaccines? Using data, CareOregon's enterprise-wide Population Health Partnership team ultimately decided to focus on three groups: pregnant members, medically complex vaccinated adults who were eligible for boosters, and vaccinated parents with unvaccinated children.

Along with the cross-departmental Rapid Response Team, staff devised a new approach of texting the targeted members to alert them that our staff would be reaching out soon with a personal phone call. For vaccinated parents, the team texted resources for accessing child vaccinations.

These efforts were among those in our COVID-19 High Risk Outreach Playbook, which the Institute of Medicaid Innovation honored as one of the top 25 projects nationally for addressing health inequities during the pandemic.