Payer Establishes Culturally Specific Alternative Payment Model

CareOregon and the Alliance for Culturally Specific Behavioral Health Providers have developed an alternative payment model that seeks to empower culturally specific provider services.

The newest update to the payment model expanded payments for culturally specific providers by as much as 20 percent overall to better reward the time and expertise required for offering culturally-specific care and health equity in care. The expansion included both a boost to payment rates and an increase in Health Related Service reimbursement.

CareOregon’s membership consists of approximately a quarter of all Oregon Health Plan beneficiaries, the state’s Medicaid program, as well as Medicare beneficiaries.

“For CareOregon, this partnership has been a chance to really learn about the work of Alliance providers and how they approach care,” said Lauren Schmidt, CareOregon behavioral health innovation specialist. “And realistically, to show up for a conversation that the Alliance has been taking on for decades. We’re hopeful that addressing payment models will help support culturally specific providers so they can continue to serve our communities.”

CareOregon has been working with the Alliance for Culturally Specific Behavioral Health Providers since 2019. The two organizations have created a sustainable payment model that is specifically designed to support the work of culturally aligned providers.

According to a graphic included in the press release announcement, the process for establishing this new payment model began with conversations that the partners had in 2021. 

The discussions touched on three main areas: efforts to provide support at the population level, efforts at the member level that go beyond Medicaid services, and traditional treatment services. The traditional treatment services were being reimbursed through an enhanced fee schedule that took into account language and cultural competency.

For efforts related to outreach and engagement, the partners will work collaboratively on payment solutions and the payment models will vary based on the Alliance for Culturally Specific Behavioral Health Providers agency involved. 

The graphic indicated that the partners will leverage Medicaid’s Health Related Services dollars to partially fund the population level and member level payment models.

For the traditional treatment services, the partners will use an enhanced fee schedule with a percentage that is uniform across Alliance for Culturally Specific Behavioral Health Providers agencies. CareOregon’s rate workgroup will establish the fee schedule but both organizations will have input.

The graphic noted a ten percent boost of fee-for-service equivalent for bilingual and bicultural service delivery for the traditional treatment services.

“In our community, we don’t just serve a patient. We serve their entire family,” said Holden Leung, chief executive officer of Asian Health & Services Center and co-chair of the Alliance for Culturally Specific Behavioral Health Service Providers. 

“Our providers can spend several hours with a family helping them understand a diagnosis, how it impacts their family member and how they can play a caregiving role. We work mainly with immigrants and refugees, so having providers from those cultures who speak the languages our patients speak, it really opens the flood gates and patients look to us to help address their health in a holistic way. That makes it hard to check a box or report on services the same way that more mainstream providers can.”

CareOregon noted that the development process is constantly evolving and that the contract process will continue to adjust in response to the partners’ conversations.

Payers have been taking many different approaches to diversify the mental and behavioral healthcare workforce. These efforts are particularly critical for pursuing health equity in mental and behavioral healthcare. For example, Blue Shield of California funded an internship program that provides opportunities for underrepresented adults to experience mental healthcare careers.

LA Care Health Plan has taken steps to reinforce the local provider workforce as a whole by offering recruitment grants for provider practices and clinics. The payer’s goal was to improve health equity in California.

Cigna Foundation sought to address the shortage more generally by instituting a grant program that is available to students from pre-K and kindergarten through post-secondary and adult education.