Is the MODA Behavioral Health Incentive Program (BHIP) Bold and Reckless?

A discussion document

In December 2022, the Independent Mental Health Practices Alliance (IMHPA) began collaborating with MODA for a measurement-based care (MBC) contract and ultimately seek a value-based payment contract at the end of 3 years.

Detailed documentation, written recommendations and references were provided to MODA based on Federal, State, industry and thought leader guidance. The recommendation includes the necessary CPT codes, technology, administrative requirements, progress and outcome measures, data sharing and analysis, and initial communication requirements. The estimated cost for MBC was provided to MODA.

Mentor Research Institute (MRI) believes provider practices involved in the MODA incentive program are being led by MODA into a version of value-based contracting, one that involves a great deal of risk and very little benefit. Whereas, MODA has designed their contract to give MODA little risk and a great deal of benefit. The following a brief list of questions that providers need training if they want to avoid practicing under the rule of MODA.

1. What are fee-for-service, alternative payment, and value-based payment contracts?

2. What is the future of fee-for-services in Oregon?

3. How do we get from Fee-for-service to Value-based payments?

4. What can Go Wrong when participating in a value-based payment contract for psychotherapy services?

5. How do providers Negotiate a value-based payment contract for psychotherapy services?

6. What are “good faith” and “fair dealing” when contracting for psychotherapy services?

7. What is a Contract of Adhesion?

8. How are measurable outcome Benchmarks for psychotherapy services calculated?

9. What is Risk-Share and Risk-Adjustments in value-based payment for psychotherapy services?

10. What are the Problems Contracting parties face when creating value-based contracts for psychotherapy services?

11. Value-Based Payment Contracting for Psychotherapy Services: What Federal and State Regulations apply to such contracting in Oregon?

12. How can psychotherapists Ensure They Meet the Performance Metrics required by a value-based payment contract?

13. What are the most important Contract Negotiation Strategies?

14. What are the most important Strategies to Negotiate value-based payment contracts for psychotherapy services?

15. What is the importance of Leverage in contract negotiation?

IMHPA concluded that MODA did NOT negotiate the contract with IMPHA in good faith and fair dealing. The contract is faulty, misleading, ill-defined, and deceptive. MODA was caught deceiving the contract negotiator and IMHPA repeatedly. MRI was told by MODA contract liaison that as many as 128 group practice in several states signed the MODA contract. MODA told MRI that they asked questions that no other group practice asked.

MRI came to the following conclusions based on collaboration efforts with MODA since 2015.

• IMHPA concludes that provider practices were not engaged in good faith and transparent conversation with MODA that otherwise could have resulted in other providers declining to sign their contract.

• IMHPA and MRI worked with an auditor to evaluate the contract. Their conclusion, based on the contract proposal, was that the MODA contract has a probable to almost certain severe to catastrophic impact on public health and provider practices.

• The MODA contract has no significant value to provider practices and the public. There is a high financial and moral risk to providers if they participate in the MODA contract.

• Mentor Research identified 281 requirements and challenges that provider practices must understand if they wish to support or participate in value-based treatment. To do otherwise would be with almost certain peril.

• The MODA contract systematically turns a blind eye to these requirement and challenges (e.g., shared values, objective, controls, test scripts, and leading performance indicators). The contract is best defined as a contract of adhesion (i.e., take it or leave it). Healthplan X is currently unwilling to discuss 281 issues that are critical to public health, amending their contract language to reflect good faith and fair dealing. By ignoring these issues, MODA retains the control and power over provider practices who have no choice but to walk away from the contract. Walking away would mean they will need to accept failure, the financial loss, and loss of credibility with their providers - a bind double.

• The MODA contract is an Value-Based Payment Contract that has insignificant value to provider practices, or values that are hidden. The incentive are trivial compared to the investment of resources. Rather than invest in provider practices, MODA is assuming governance and administrative control of the contract, a contract that is a “take it or leave it” contract. The power difference between MODA is disparate and obvious.

• The MODA contract is a risk-share for which an incentive will be paid to providers if MODA limits the growth in their expenditures on Healthcare services to no more that 5%. Providers have no influence on how much MODA spends. This is referred to as a “false profit” leader. There are no risk-adjustment for subpopulation because there is benefit in conflating routine care with with urgent care and care for serious an persistent mental and behavioral health problems.

• The State of Oregon has passed legislation to create a research pressuring Healthplans to move from fee-for-service to value-based payment starting in 2021 and by 2024. The State also has proposed legislation that would initiate a research initiative that would create a value-based program that can be adopted by private practice groups; MRI questions CCO values and objective (i.e., profit). Only one CCO in Oregon is a non-profit. Fifteen others CCOs are not.

• The MODA contract is not aligned with important Federal, State, Industry or thought leader guidance. In fact, the Moda has turned a bling eye to that guidance. Provider practices who sign the behavioral health incentive contract have agreed to incentives for which have probable to almost certain risk of failure.

• MODA is avoiding and refusing to have conversations which are necessary to establish shared values, objectives, controls, tests script, or key leading indicators that are standard business practices that are necessary to ensure success to all provider practices and the Healthplan. These are standard operational support tools used in business operations.

• MODA contracting behavior is an exemplar of why value-based payment contracts for behavioral and mental health have not been successfully implemented in Oregon or nationally.