To: Fee-for-Service Transformation Program
From: [Name Removed]
Subject: Creating Value in Healthcare: Complying with Oregon Value-Based Payment Compact and Legislative Mandates
Overview
The Oregon healthcare landscape is undergoing a fundamental shift, especially in the realm of mental and behavioral health services. Historically rooted in the Fee-for-Service (FFS) model, the industry is now being propelled toward value-based care structures. Legislative initiatives such as the Oregon Sustainable Healthcare Growth Target Program and the Oregon Value-Based Payment Compact mandate that 70% of payments must transition to value-based models by 2024. These requirements not only set aggressive deadlines but also necessitate a strategic and unified approach from health plans to ensure compliance and sustainable care delivery.
Legislative Pressures and Strategic Response
Health plans are is fully committed to implementing these mandates while preparing for future policy evolutions. The shift away from FFS to value-based models, such as Pay-for-Performance (P4P), is no longer optional but a legislative requirement. The urgency of meeting state deadlines has pushed us to accelerate our timeline, bypassing the gradual approaches suggested by federal guidelines and moving directly into full P4P implementations.
Provider Engagement and Feedback
Our efforts to engage providers in this transformation have faced limited response. Despite offering multiple avenues for collaboration, there has been minimal feedback from the provider community regarding these new value-based models. In the absence of organized provider input, we have proceeded with designing performance measures based on available guidance and our own understanding of care delivery needs. Health plans are not in a position to anticipate what providers want without their active engagement. If providers wish to shape the future of these models, now is the time for them to participate proactively.
Ethical and Legal Considerations
Our value-based payment models are built around principles of transparency, fairness, and accountability. Performance benchmarks will be challenging but achievable, designed to reflect realistic goals for care quality and cost control. We recognize that smaller practices may face challenges in meeting these new standards, particularly as the reporting and audit requirements grow more rigorous. However, we are complying fully with all legislative mandates and designing metrics that serve both cost-efficiency and quality outcomes.
Transition Challenges and Provider Concerns
A common misconception among providers is that transitioning to out-of-pocket models can serve as an alternative to engaging with value-based contracts. While niche practices may find success with this strategy, the broader trend shows that most patients prefer in-network care due to affordability. As such, value-based contracts remain the most viable path for the majority of mental and behavioral health providers.
Path Forward: Proactive Provider Participation
The fragmented nature of the mental and behavioral health provider community, coupled with a lack of centralized leadership, has resulted in minimal resistance or input during this critical transition. Moving forward, health plans cannot predict or accommodate concerns that are not voiced by providers. The standards being set today will serve as the foundation for future value-based care, and any future changes will be based on collaborative engagement.
Performance Measurement and Reporting
To support providers in this transition, we are offering access to common measurement technologies for tracking quality metrics. These tools include functionalities for monitoring therapeutic outcomes, patient satisfaction, and progress tracking. Health plans will require either independent or third-party analysis of these metrics to ensure accuracy and compliance.
Branding and Messaging
While "Pay-for-Performance" accurately describes the model, positioning this as Value-Based Payment emphasizes our commitment to improving patient care. This terminology better reflects our goal of aligning payments with outcomes and highlights our role as leaders in healthcare innovation.
Call to Action
We have encouraged providers to take an active role in shaping the implementation of these models. Health plans are willing to engage in dialogue and collaboration, but without provider involvement, we will continue to develop systems that meet our legislative requirements independently.
Conclusion: Leading the Shift
As mandated by the Oregon Value-Based Payment Compact, we are moving forward decisively to implement value-based models. We invite providers to step forward, engage, and help shape a system that meets the needs of all stakeholders—patients, providers, and payers alike.
If there are any questions or if you would like to discuss this further, feel free to reach out.