Statement of Purpose and Background: The article or paper is based on experience, investigation and research regarding requirements for successful implementation of value-based reimbursements (VBR), fee for service (FFS), alternative payment methods (APM), and value-based payment (VBPs). These articles require study and are not written for people seeking a quick read to gain expert awareness.
There are many purposes of these papers, the most important are to educate and encourage care providers to ask questions, to learn more about FFS, APM, and VBP contracts. In those contracts measurement-based care (MBC), pay-for performance (P4P) and outcome informed care (OIC) are the touchpoints for design and implementation of mental and behavioral healthcare contracts. Several papers are intended to promote discussion about potential issues and problems specific to one health plan’s contract proposal and negotiation. Guidance for the articles has been drawn from provider practices, professional associations, thought leaders, industry consultants, the Oregon Health Authority (OHA), the Department of Health and Human Services Health Payment Center Learning Action Network (HPC-LAN), and the Oregon Value-Based Payment Compact (ORCompact). The purpose of this document is to offer readers and decision makers basic understanding of important issues that pertain to FFS, APM and VBP contracting, to support a pathway to develop contracts in partnership with Health plans. Such a pathway will require clear standards for contracting, managed within proposed legislative guidelines which protect the public interest and assure access to mental, behavioral and substance abuse treatment services.
Legal Opinions: These papers and article are not legal opinions. They are propositions offered for discussion and debate. Reader’s should seek legal advice before accepting and acting on the propositions, assertions and conclusions. Any suggestion of unethical, illegal or criminal behavior is not intended to be disruptive to healthcare or health plan operations.
Living Document: This article is a living document that will be revised as new information is made available. The article is for educational, legislative, training and research purposes. Questions and feedback can be submitted by contacting MRI.
Disclaimer: The paper is intended to raise issues that relate to the legal and ethical relationships of mental health practices and healthcare operations support services. This article is a living document that will be revised as new information is made available. The article is for educational discussion and training purposes. Questions and feedback can be submitted by contacting MRI. Proposed corrections, clarifications and objections will be incorporated for discussion, education and training.
The opinions and concerns expressed do not represent nor should they be taken as legal advice. Arguments and conclusions are not assertions of criminal activity or other violation of law. Any comments posted are not necessarily shared by the Board of Mentor Research Institute.
Statements, concerns and reasons for those concerns are presented to encourage discussion among the mental health professionals, health plans, purchasers, employer, legislators, and regulatory bodies. Moda Health is one case example of contracting behavior which some health plans may adopt in Oregon. Conclusions about Moda Health are tentative and may be revised as new information is made available.