Breaking the Cycle of Unfunded Mandates: The Urgent Need for Health Plan Investment and Collaboration in Value-Based Mental Health Care
Introduction
The Oregon Value-Based Payment (VBP) Compact, signed by 63 health care organizations, represents a collective pledge to transform health care payment models by tying reimbursement to care quality rather than service volume. While this commitment is commendable, its success hinges on health plans' willingness to fund the critical infrastructure required for value-based mental health care. Current practices suggest a troubling pattern where health plans impose uncompensated administrative tasks on providers, undermining care quality and disrupting service delivery. Two in-depth analyses from Mentor Research Institute, Solutionism in Healthcare: Moda Health’s Contracting Approach and Consequences and Erosion of Trust in Moda Health Value-Based Contracts, illustrate how health plans' reluctance to invest in necessary supports perpetuates systemic dysfunction.
The Problem of Platform Fragmentation
Health plans often require providers to use proprietary data platforms designed for utilization review rather than clinical decision-making. Providers must navigate numerous platforms, each unique to a specific health plan, creating operational chaos. As Solutionism in Healthcare points out, this fractured approach reflects a superficial application of technology that prioritizes data extraction over patient-centered care. Providers become administrative intermediaries, responsible for entering and managing patient data, while receiving no compensation for these tasks.
The Trust Deficit in Contracting
Health plans’ failure to fund core components of value-based care, such as measurement and reporting, has led to widespread distrust among providers. Erosion of Trust in Moda Health Value-Based Contracts highlights how shifting contractual expectations, coupled with inadequate reimbursement, have eroded providers’ willingness to participate in health plan-led initiatives. This trust deficit is compounded when health plans make unilateral platform requirements or impose new administrative obligations without prior consultation or financial support.
Inadequate Clinical Metrics
Standardized measures like the PHQ-9 and GAD-7 dominate the value-based care landscape, despite offering limited clinical value. While these tools are useful for assessing general symptom burden, they fall short of capturing the complexity of mental health treatment. Providers need broader measurement systems that inform therapeutic progress, address functional impairments, and guide individualized care plans. Without health plan funding for diverse, clinically relevant tools, measurement becomes an exercise in data collection rather than meaningful care improvement.
The Financial Cost of Compliance
Administrative complexity creates a hidden financial burden on providers. Health plans expect providers to handle data collection, analysis, and reporting without direct reimbursement. This model effectively offloads the operational costs of compliance onto providers, diverting resources from patient care. Both Mentor Research Institute papers argue that this practice violates the spirit of value-based care and jeopardizes the success of the Oregon VBP Compact.
Essential Health Plan Responsibilities
To realize the promise of value-based mental health care, health plans must commit to funding the following essential components:
Paying for Measurement: Providers should be reimbursed for administering clinical tools, including validated screening and outcome measures.
Paying for Analysis: Interpreting patient data should be compensated as a distinct, billable service.
Paying for Reporting: Generating and submitting performance reports must be treated as a reimbursed operational task.
Conclusion
The Oregon VBP Compact’s success depends on health plans recognizing that unfunded mandates undermine provider engagement and service delivery. Investment in provider-led infrastructure, training, and technology must become a central feature of future contracts. Without this commitment, value-based care will remain a theoretical goal rather than a transformative reality in Oregon’s mental health care system.
For more information see:
Solutionism in Healthcare: Moda Health’s Contracting Approach and Consequences and Erosion of Trust in Moda Health Value-Based Contracts.
https://www.mentorresearch.org/solutionism-in-healthcare-moda-healths-contracting-approach-and-consequencesErosion of Trust in Moda Health Value-Based Contracts.
https://www.mentorresearch.org/erosion-of-trust-in-moda-health-value-based-contracts
DISCLAIMER and PURPOSE: This discussion document is intended for training, education, and or research purposes only. The information contained herein is based on the data and perspectives available at the time of writing. It is subject to revision as new information and viewpoints emerge.
For more information see: https://www.mentorresearch.org/disclaimer-and-purpose