A message to the community from Unity Center for Behavioral Health

The COVID-19 pandemic has created significant financial challenges for hospitals and health systems across the country. Here in Oregon, Unity Center for Behavioral Health’s hospital owners have certainly felt its impact. Our work to reduce Unity Center’s annual operating loss began prior to COVID-19 and is more important than ever.

Our hospital partners believe in the mission and model of Unity Center. They continue to pledge their commitment and support for Unity Center. However, there is a limit to losses our hospital owners can sustain. To improve our financial sustainability, we are working to reduce our current annual operating loss of $22 million by at least $10 million.

We have been working responsibly and diligently for many months to assess the viability and impacts of several cost-saving scenarios. There are three key areas we are focused on: the business model of our Psychiatric Emergency Services, or PES; Medicaid reimbursement rates; and reducing expenses. Having patients waiting for an extended period of time for a bed at OSH, and for whom we are under-reimbursed relative to the cost of providing care is still a challenge that has not been resolved, but we are proactively focused on the efforts described below.

First, we are making changes to the PES business model. We believe in the PES, and it will continue to be an essential part of Unity Center, but we need to improve its financial sustainability. We have learned a lot in the last three years about how the PES model in this community with our unique needs works in practice. We are seeking to recalibrate our business model based on what we now know.

For example, we are working to create an observation level of care in the PES for patients who may require a longer length of stay. Since the PES is intended to provide short-term acute care, reimbursement for care provided to patients in the PES stops after 19 hours. An observation level of care would allow for continued reimbursement for patients no longer requiring acute, emergency care, but who would benefit from an extended stay and observation to ensure they are stabilized.

Second, we are engaging in open and productive conversations with Care Oregon about reimbursement rates for the care we provide at Unity Center to patients covered by Medicaid. We have a positive and collaborative relationship with Care Oregon and are grateful for their willingness to work in partnership to address this challenge. The vast majority of our patients are Medicaid recipients. While behavioral health is poorly reimbursed on the whole, this is especially true for Medicaid reimbursement.

Third, we are looking closely at all of our costs to ensure we are responsibly stewarding the investment our hospital owners have made in Unity Center and the generous gifts of the philanthropic community.

In addition to our work on financial sustainability, we must work hand in hand with the behavioral health community to address the need for increased access to residential treatment facilities, intensive outpatient and day treatment programs, and step-down community services. These pieces of the behavioral health system in Oregon are, in large part, missing. The lack of access to sub-acute care and step-down community services inhibits our ability as a behavioral health community to ensure people have the support and services they need to continue on their path to recovery after leaving an acute care setting.

For this reason, we are supporting an early stage proposal form Cascadia Behavioral Health to develop a multi-partner triage and assessment unit that encompasses a network of services and serves as a single point of access for the community. This plan would be a collaborative effort with several partners coming together and is still in the early stages of proposal. As it is envisioned, it would include an on-site sobering center and an adjacent urgent walk-in clinic for people whose clinical needs can be managed in a less restrictive and expensive environment than Unity Center’s PES. You will hear more from Cascadia Behavioral Health on this plan in the coming months.


As we move through these changes and seek to better care for people suffering from mental and behavioral health issues, we will continue to make safety our first priority. We are caring for a vulnerable population, and we take that responsibility very seriously. We expect to have public agencies and the media hold us accountable. We welcome that accountability and are committed to constant improvement.

Finally, our community values the proactive sharing of information that we have practiced in the past three years. The COVID-19 crisis reminds us that we are all in this together. As a result, we have reactivated UnityFacts.org and will again be sharing news and information here regularly.

Thank you for visiting UnityFacts.org, and we invite you to check in with us as we work to improve both our financial sustainability, and also the continuum of mental and behavioral health care in our community.


Melissa Eckstein, MSSW, MBA, LCSW, president, Unity Center for Behavioral Health