MRI is a Non-profit Organization
Supporting Therapists Since 1997
Donations Appreciated
Value-Based Ethical Contracting Practice
These comprehensive series of courses has 5 courses which can be taken in any order.
Training 1 — Foundations of Healthy Contracting in Behavioral Health1 Foundations of Healthy Contra…
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 Contracting2 Patient-Centered and Measurem…
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 Health3 Ethical Contracting in Mental…
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 …
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.
MRI is a Non-profit Organization
Supporting Therapists Since 1997
Donations Appreciated
Instructors
Michael Conner, PsyD
An engineer and psychologist, Dr. Conner practices clinical, family and medical psychology. Dr. Conner is expert in crisis intervention, emergency psychiatric services, dangerous behavior, residential treatment and outdoor behavioral health. He provides professional training in psychotherapy charting, auditing, ethics, crisis intervention, dangerousness, parenting and other mental health topics.
In 1989, Dr. Conner began pioneering research in the use of computers in personality assessment and training. This included the development and operation of computer-based test interpretation and associated ethical issues. He developed a computer-based mental health screening tool for primary medical care at Kaiser Permanente. This system accurately evaluated and recommended medications based on the decisions processes of psychiatrists. Other projects included Internet-based screening questionnaires for adolescents at risk.
Michaele Dunlap, PsyD
Michaele Dunlap, PsyD began practice as a Masters’ level professional in 1985. She was licensed as a psychologist in 1991. She practices at Mentor Professional Corporation, formed in 1992 to support supervision for new psychologists and facilitate professional collaboration. Her clinical focus is on adults, couples, and families; She works with addictions, trauma recovery, life and health challenges, personal and relationship growth. She consults regarding relationship difficulties in closely held businesses, provides consultation to mental health professionals, and to human services organizations.
Dr. Dunlap has organized continuing education events for mental health professionals since 1989. She has been a presenter at numerous continuing education events. Her presentation topics have included: Clinical records keeping; Jane Loevinger’s Theory of Ego Development; the MRI ConnectingCare model; Aspects of psychologists self-care; Dealing with managed care; Oregon’s Duty to Report law; Risks of disclosure in mental health services; Ethical practice in mental health; Identifying and dealing with nightmare clinical situations; The pragmatics of dealing with HIPAA regulations; Women’s chemical dependence and recovery; Internet marketing for mental health professionals; and mental health private practice development.