Statement of Purpose and Background: This article is based on investigation and research regarding requirements for successful implementation of Value Based Reimbursements (VBR), FFS, APM, and VBPs. This article requires study and is not written for lay people seeking a quick read to gain expert awareness. There are many purposes of this paper, the most important of which education and to encourage practice providers to ask questions and learn more about FFS, APM, and VBP contracts where measurement-based care (MBC), pay-for performance (P4P) and outcome informed care (OIC) are the touchpoints for mental and behavioral healthcare contracts design and implementation. This paper also presents for discussion what should not be done with reference to one Healthplan’s proposal. Guidance for this article 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, with a pathway to develop contracts in partnership with Healthplans. Such a pathway will require clear standards for contracting, managed within proposed legislative guidelines which protects the public interest and assures access to mental, behavioral and substance abuse treatment services. This includes commercial contracts, Medicare, Medicaid and employer insurance payers in Oregon and in ways that are not subject to Federal restrictions such a the Federal Trade Commission and Antitrust.
Living Document: This article is a living document that will be revised as new information is made available. The article is for educational and training 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.
The issues discussed in this article are potential conflicts of interests between a type of healthcare operations support business and covered entities who benefit from the services of such businesses. The opinions and concerns expressed do not represent nor should they be taken as legal advice. Any comments posted are not necessarily shared by the authors or the Board of Mentor Research Institute.
Statements, concerns and reasons for those concerns have been presented to encourage discussion among the mental health professionals, legislators, and by regulatory bodies. Healthcare X’s is one example of contracting behavior which some Healthplans are adopting in Oregon. Conclusions about Healthplan X may be revised as new information is available.