Training 1 — Foundations of Healthy Contracting in Behavioral Health: Foundations of Healthy Contracting…
Purpose:
Introduces behavioral health professionals to the legal, ethical, and structural foundations of “healthy contracting” as behavioral health shifts from fee-for-service (FFS) to value-based payment (VBP).
Core Themes:
Legislative and regulatory gaps make providers vulnerable to coercive or unclear contracts.
“Healthy contracts” emphasize fairness, transparency, and definitional clarity (e.g., “medical necessity,” “efficiency”).
Legal-policy alignment ensures contracts reinforce parity and ethical care.
The shift from FFS to VBP carries risks of inequitable risk transfer unless contracts incorporate risk adjustment and clarity.
Healthy contracts serve as ethical instruments safeguarding patients and providers.
Takeaway:
Contracts are moral as well as legal tools, clarity and transparency are ethical imperatives ensuring patient-centered, sustainable systems.
Training 2 — Patient-Centered and Measurement-Based Care in Contracting: Patient-Centered and Measurement…
Purpose:
Explores how measurement-based care (MBC) can drive patient-centered value-based contracting while avoiding inequities and “solutionist” simplifications.
Core Themes:
MBC aligns reimbursement with outcomes through standardized tools and patient-reported data.
Successful contracts feature transparent metrics, equitable risk sharing, and robust data systems.
“Solutionism” (oversimplified, payer-driven metrics) distorts care and undermines ethics.
Stepwise implementation is essential—pilot, evaluate, expand.
Contracts must account for case-mix severity and social determinants to prevent penalizing high-acuity providers.
Takeaway:
MBC can improve transparency and quality only when contracts respect complexity, adjust for risk, and reject reductionist efficiency measures.
Training 3 — Ethical Contracting in Mental Health: Ethical Contracting in Mental Health Services
Purpose:
Examines contracting as an ethical practice grounded in fairness, good faith, and plain language—illustrated by analyses of Moda Health’s unethical contracting behavior.
Core Themes:
Ethical contracts embody beneficence, justice, and nonmaleficence.
Plain language is an ethical requirement; ambiguity enables exploitation.
Good faith and fair dealing are legal and moral duties—contracts must be transparent and balanced.
Moda Health case studies demonstrate power asymmetry, coercive risk transfer, and systemic exploitation.
Macro-level incentives (profitable failure) reveal that unethical contracting is structurally reinforced, not accidental.
Takeaway:
Ethical competence in contracting equals clinical competence; professionals must advocate for clarity, fairness, and enforceable accountability to sustain integrity and trust.
Training 4 — Contracting with Underserved & Minority Populations4 Contracting with Underserved and Minority Populations
Purpose:
Focuses on equity in contracting. Ensuring value-based models don’t deepen disparities among minority and underserved groups.
Core Themes:
One-size-fits-all metrics ignore social determinants and penalize high-acuity providers.
Case-mix adjustment is an equity mechanism ensuring fairness and sustainability.
Provider empowerment and whistleblower protections are essential to report inequitable practices.
Contracts must embed justice principles, transparent risk sharing, and protections for providers serving vulnerable groups.
Equity-focused clauses (e.g., risk adjustment, oversight, reporting mechanisms) counter structural racism and systemic neglect.
Takeaway:
Equity-centered contracting is a moral imperative. Justice must be built into contract design, not treated as a downstream correction.
Training 5 — Negotiating and Implementing Healthy Contracts5 Negotiating and Implementing …
Purpose:
Provides applied negotiation and implementation strategies to prevent exploitation and ensure accountability, using the 2024 Oregon Health Authority complaint against Moda Health as a case study.
Core Themes:
Recognize risks: disproportionate risk-shifting, ambiguous definitions, and unilateral payer control.
Beware “better, cheaper, faster” rhetoric—it conceals cost-shifting and care compromise.
Insist on plain language, defined metrics, and mutual accountability.
Incorporate safeguards: documentation, dispute resolution, independent audits, and whistleblower protections.
Build collective leverage and regulatory oversight to counter systemic manipulation.
Takeaway:
Negotiation is an ethical act; by embedding transparency, rejecting unilateral clauses, and leveraging collective advocacy, professionals can secure sustainable, patient-centered contracts.
Synthesis Across the Series
Together, these five trainings form a coherent curriculum advancing from conceptual foundations (Training 1) through clinical integration and ethics (Trainings 2–3) to equity and negotiation practice (Trainings 4–5).
Each module reinforces that ethical, equitable, and transparent contracting is both a clinical and moral obligation—the cornerstone of sustainable value-based behavioral health systems.