The Erosion of Provider Trust in Moda Health’s Value-Based Contract for Psychotherapy Services
A Discussion Paper
SUMMARY
Moda Health’s current contracting practices demonstrate a reliance on “solutionism” tactics that obscure deeper structural, ethical and mutual trust problems. There is evidence of systemic pattern of unfair and bad-faith contracting, data manipulation, and risk-shifting which undermines provider trust.
Research in implementation science consistently shows that trust, once broken, is difficult to regain. Health plans must take deliberate steps to ensure fairness, transparency, and accountability, recognizing that trust is built slowly but can be lost quickly through mismanagement and unethical practices. Rebuilding trust in healthcare is a long-term process requiring sustained ethical behavior, transparent policies, and collaborative engagement from insurance payers.
Without significant reforms, including transparent contract terms, equitable financial arrangements, and independent oversight, provider trust—and by extension, the success of Moda’s value-based psychotherapy contracts - appears unsustainable. This discussion paper breakdown highlights critical issues that undermine trust and ultimately threaten the success of its value-based contract for psychotherapy services.
1. Contract Ambiguity and Misleading Terms
Moda Health’s contracts contain vague, nonsensical terms, leaving providers unable to fully comprehend performance expectations and financial risks. This ambiguity fosters mistrust, as providers perceive the agreements as deceptive, setting them up for unpredictable financial obligations. Their "bait and obfuscate" tactics, where favorable terms will change change post-signing—reinforce the belief that Moda operates in bad faith.
2. Lack of Transparency and Data Manipulation
Providers are excluded from key processes such as risk adjustment calculations and incentive formula development. This lack of transparency raises concerns that Moda manipulates data to maximize its own future reimbursement while they minimize provider compensation. Without a clear understanding of the way metrics are calculated, providers cannot trust that they will be fairly evaluated or compensated.
3. Unfair Financial Risks and Administrative Burdens
The contracts reportedly shift significant financial risk onto providers while reserving financial benefits for Moda. This includes imposing high compliance costs, demanding use of specific data platforms, and requiring providers to absorb administrative burdens without adequate reimbursement. This uneven distribution of risks creates a hostile contracting environment that discourages provider participation.
4. Market Manipulation and Antitrust Concerns
Moda’s contracts allegedly create barriers to competition by creating a cascading dependency on Moda’s restrictive agreements and isolating them from potential collaborators. This monopolistic behavior not only violates antitrust principles but also diminishes provider trust by reducing market freedom and negotiation power.
5. Ethical Breaches and Perceived Exploitation
Providers must report contract-related issues directly to Moda’s behavioral health director. This creates conflict of interest and eliminates independent oversight. The arrangement compromises provider autonomy, fosters mistrust, and signals that clinical and ethical concerns will not be impartially addressed.
6. Reputational Damage and Long-Term Impact
The cumulative effect of these practices threatens to destabilize the mental health ecosystem. Providers disillusioned by exploitative contracts may choose to leave the network or avoid participation in value-based care models altogether. This could result in fewer available providers, longer patient wait times, and reduced access to care.
Implementation Science and the Role of Trust
Implementation science focuses on methods that promote the adoption, integration, and sustainability of evidence-based practices in real-world settings. Trust is essential in this process. Trust fosters cooperation, reduces resistance, and facilitates long-term engagement from key stakeholders, including healthcare providers, patients, and policy-makers. Without trust, even the most well-designed interventions are likely to fail.
A central component of trust in implementation science is relational trust, which reflects the relationship between healthcare providers and insurance payers. Providers are more willing to adopt new systems when they believe that payers will act in good faith by offering fair reimbursement, transparent communication, and supportive policies. Similarly, trust in evidence and data ensures that providers view data-driven models, such as value-based care, as tools for improving patient outcomes rather than mechanisms for controlling costs or limiting care. Process trust relates to confidence in the fairness and reliability of administrative systems, including contracts and reimbursement models. Transparent and predictable processes help build trust over time.
Challenges Health Plans Face in Regaining Trust
Health plans, insurance payers, face significant challenges when trying to rebuild trust after breaches. Historical unethical practices, including misleading contracts and data manipulation, can create lasting distrust. Once providers feel exploited, they may adopt a defensive stance and resist new initiatives, even when payers introduce improvements. Rebuilding trust becomes especially difficult when past breaches involved critical issues such as payment disputes or unethical data use.
Another barrier is information asymmetry, where payers often have greater access to financial and administrative data. This power imbalance can make providers perceive data-driven systems as mechanisms for surveillance and cost-cutting rather than patient-centered improvements. Additionally, accountability gaps arise when payers avoid responsibility by using complex contracts or ineffective grievance processes. Trust is eroded when providers must report concerns through internal systems controlled by the payer.
Inconsistent policies also damage trust. Frequent changes in reimbursement models, administrative rules, or care metrics create uncertainty and make providers wary of long-term partnerships. Stability and predictability are essential for rebuilding confidence in payer-provider relationships.
Research Insights on Rebuilding Trust
Research in implementation science highlights several strategies that health plans can use to rebuild trust. Transparency and communication are essential; payers that proactively disclose performance metrics, contract terms, and financial arrangements are viewed more favorably. Clear and consistent communication reduces suspicion and promotes collaborative relationships.
Fair and equitable contracting practices play a critical role. Providers are more likely to trust payers when contracts offer fair reimbursement, shared decision-making, and clear dispute resolution mechanisms. Studies show that trust improves when providers have meaningful voice in contract negotiations and program design.
Consistency and follow-through further strengthen payer-provider relationships. Trust is built when policies are consistently applied, promises are kept, and contract terms remain stable over time. Research suggests that stable payment models and administrative processes reduce provider burnout and encourage sustained engagement.
Finally, ethical leadership and independent oversight enhance credibility. Independent audits, third-party conflict resolution mechanisms, and external accountability systems reassure providers that payers will be held to ethical standards. Studies have found that external oversight improves trust by creating a level playing field where all parties are accountable.
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