Healthy Contracts - Discussion Papers
Below is a library of discussion papers intended for training and education of Providers, Healthplan managers, legislators, attorneys and regulators. The library is organized by topic.
Transforming Fee-for-Service to Value-Based Payment Contracts
Transition from Fee-for-Service Step-Wise to Alternative Payment Contracts and then Value-Based Payment Contracts: The Good and the Bad.
https://www.mentorresearch.org/transforming-feeforservice-psychotherapy-to-valuebased-payment-contractTransforming Mental Health Services From Fee-for-Service to Value-Based Contracts: A Closer Look.
https://www.mentorresearch.org/transforming-mental-health-services-a-closer-lookBehavioral Health Quality Framework: A Roadmap For Using Measurement To Promote Joint Accountability and Whole-Person Care.
https://www.ncqa.org/wp-content/uploads/2021/07/20210701_Behavioral_Health_Quality_Framework_NCQA_White_Paper.pdf
Measurement and Value-based Payment Contracting
Measurement-Based Care: Enhancing and Undermining Mental Health Treatment Values.
https://www.mentorresearch.org/what-is-measurement-based-and-out-come-informed-careOutcome Informed Care And Measurement-Based Care Adoption - Challenges in Oregon.
https://www.imhpa.org/measurement-based-care-adoption-challengesPatient Reported Outcomes & Performance Measures (PROM-PM).
https://www.mentorresearch.org/patient-reported-outcomes-progress-measures
Contract Negotiation Issues
Asymmetrical Information - Mitigating Adverse Effects
https://www.mentorresearch.org/mitigating-asymmetrical-informationAddressing Asymmetric Power Dynamics and Ethical Concerns in Health Plan Contracts.
https://www.mentorresearch.org/addressing-asymmetric-power-dynamics-and-ethical-concerns-in-health-plan-contractsCollaboration Agreements For Value-Based Payment Services and Contracts.
https://www.mentorresearch.org/collaboration-agreements-for-valuebased-payment-contractingMedically Necessary and Reasonable Psychotherapy Services.
https://www.mentorresearch.org/medically-necessary-reasonableWho are the Stakeholders When Contracting for Mental and Behavioral Health Services?
https://www.mentorresearch.org/who-are-stakeholders-in-contractingRisk Pools: How can they be Manipulated by Healthplans?
https://www.mentorresearch.org/risk-pools-how-can-they-be-manipulated-by-healthplansHigh Case-Mix Severity Must be Considered in Value-Based Contracting.
https://www.mentorresearch.org/high-case-mix-severity-must-be-considered-in-valuebased-contractingPlain Language Collaboration Agreement and Use Case Example.
https://www.mentorresearch.org/plain-language-contract-agreement-and-use-case-exampleProvider Practice and Value-Based Payment Contracting for Psychotherapy Services: Requirements and Challenges.
https://www.mentorresearch.org/value-based-payments-psychotherapyWhy do Providers Avoid Conflicts with Healthplans?
https://www.mentorresearch.org/why-do-provider-avoid-conflicts-with-healthplansRisks, Reasons, and What to Do When Healthplan Measurement and Value-Based Payment Contracts are a Contract of Adhesion.
https://www.mentorresearch.org/risks-reasons-and-what-to-do-with-contracts-of-adhesionThe Problem When Contracts of Adhesion are Offered to Mental and Behavioral Health Providers
https://www.mentorresearch.org/problem-when-contracts-of-adhesion-are-offeredTransition from Fee-for-Service Step-wise to Alternative Payment Contracts and then Value-Based Payment Contracts: The Good and the Bad.
https://www.mentorresearch.org/transforming-feeforservice-psychotherapy-to-valuebased-payment-contractHealthy Contracts: Ensuring Ethical and Collaborative Agreements in Mental Health Services.
https://www.mentorresearch.org/healthy-contracts-ensuring-ethical-and-collaborative-agreements-in-mental-health-servicesContracts Shall Include Complete Descriptions of Reimbursement Algorithms Such that Another Auditor Following the Instructions Would Achieve the Same Results.
https://www.mentorresearch.org/complete-descriptions-of-reimbursement-algorithms-in-contractsContracts and Policies Shall be Written in Plain, Understandable Language.
https://www.mentorresearch.org/contracts-and-policies-shall-be-written-plain-languageContracts and Policies Shall Include Transparent and Shared Values, Objectives, Controls, and Key Indicators Of Success.
https://www.mentorresearch.org/including-transparent-and-shared-values-objectives-controls-and-key-indicators
“Take-It-Or-Leave-It” Unenforceable and Voidable Contracts
Problems When Contracts of Adhesion are Offered to Mental and Behavioral Health Providers.
https://www.mentorresearch.org/problem-when-contracts-of-adhesion-are-offeredWhat Can Happens if Voidable Provisions in Value-Based Contracts Go Unchallenged?
https://www.mentorresearch.org/contracts-with-voidable-provisionsPreventing the Problems Created by “Take It or Leave It” Contracts in Mental and Behavioral Health Services?
https://www.mentorresearch.org/preventing-contract-of-adhesion-that-harm-public-healthEnforceable and Unenforceable Mental and Behavioral Health Contract Requirements
https://www.mentorresearch.org/enforceable-contract-requirementsWhat Problems are Created When Healthplans Offer Providers “Take it or Leave it” Contracts of Adhesion?
https://www.mentorresearch.org/take-or-leave-contract-in-healthcare
Risk of Contract Success and Failure
Importance of Clear and Accountable Contract Requirements for Value-Based Payment Contracts.
https://www.mentorresearch.org/importance-of-clearly-written-and-accountable-contractsUnethical Tactics in Pay-for-Performance: : How Health Plans Manipulate Provider Contracts in Value-Based Care.
https://www.mentorresearch.org/unethical-health0plan-tactics-in-pay-for-performanceWhy Teachers, Counselors and Legislators Should Support the Healthy Contracts Legislation.
https://www.mentorresearch.org/why-teachers-counselors-and-legislators-healthy-contract-legislationRule of Reason Analysis Using Prima-Facia Evidence of Fraud and Violations of Antitrust and Federal Regulations (A Discussion Paper)
https://www.mentorresearch.org/rule-of-reason-analysis-using-primafacia-evidenceSuccessful and Failed Case Studies of Measurement-Based Care and Value-Based Payment Contracts: Recommended Requirements.
https://www.mentorresearch.org/successful-and-failed-valuebased-contractsWhy do Providers Avoid Conflicts with Healthplans?
https://www.mentorresearch.org/why-do-provider-avoid-conflicts-with-healthplansWhat Can Happen if Unfair, Bad Faith, Ambiguous, Ill-Defined, Unethical, or Voidable Provisions in Fee-For-Service and Value-Based Contracts Go Unchallenged?
https://www.mentorresearch.org/contracts-with-voidable-provisionsUnreasonable Constraints on Healthcare Professionals - Doe v. U.S. Health Care Systems.
https://www.mentorresearch.org/unreasonable-constraints-on-healthcare-professionalsCan Providers Legally Boycott a Healthplan? - Ethical Reasons to Legally Boycott a Healthplan
https://www.mentorresearch.org/ethical-reasons-to-boycott-a-healthplanWill Healthplans Support the Healthy Contracts Legislation
https://www.mentorresearch.org/will-healthplans-support-the-healthy-contracts-legislationWill Value-Based Payments Harm Public Health and Provider Practices? Case Example.
https://www.mentorresearch.org/value-based-contracts-in-oregonCore Psychotherapy Values and the Erosion by Healthplan Practices.
https://www.mentorresearch.org/core-psychotherapy-values-and-the-erosion-by-healthplan-practicesChallenges in Implementing Value-Based Payment Contracts Using W-2 Mental and Behavioral Health Professionals
https://www.mentorresearch.org/challenges-in-implementing-value-based-payment-contracts-using-w-2-mental-health-professionals
Good Faith and Fair Dealing
Signs of Bad Faith in Value-Based Payment Contracts for Mental and Behavioral Health Services Offered by Healthplans
https://www.mentorresearch.org/signs-of-a-bad-faith-valuebased-payment-contractGood Faith and Fair Dealing in Healthcare Contracting for Fee-For-Service, Alternative and Value-Based Payment Models
https://www.mentorresearch.org/good-faith-and-fair-dealingPlain Language Contract and Use Case Example.
https://www.mentorresearch.org/plain-language-contract-agreement-and-use-case-exampleHow Can Mental and Behavioral Health Provider Practices Recognize They are Being “Taken for a Ride”?
https://www.mentorresearch.org/in-what-ways-are-mental-and-behavioral-health-provider-practices-being-taken-for-a-rideThe Problems When Contracts of Adhesion are Offered to Mental and Behavioral Health Providers
https://www.mentorresearch.org/the-problem-when-contracts-of-adhesion-are-offeredThe Quadruple Aim: What Should Healthplans Do? & What Some Healthplans Say They're Doing.
https://www.mentorresearch.org/the-quadruple-aim
Gaming, Fraud and Antitrust
Contract “Gaming”: Reasons Why Value-Based Contracts Can Fail
https://www.mentorresearch.org/contract-gaming-reasons-why-value-based-contracts-will-failDescription of Healthcare Fraud in Measurement and Value-Based Care Contracting.
https://www.mentorresearch.org/healthcare-fraud-measurement-an-valuebased-payment-contractsBait and Switch Tactics - A Hypothetical Contract Recruitment Scenario?
https://www.mentorresearch.org/bait-and-switch-tacticsRisk Pools: How can they be Manipulated by Healthplans?
https://www.mentorresearch.org/risk-pools-how-can-they-be-manipulated-by-healthplansDescription of Healthcare Fraud by using Provider Practices as a Proxy.
https://www.mentorresearch.org/healthcare-fraud-in-measurement-and-value-based-contractingPreventing Healthplan Fraud on Mental Health Professionals.
https://www.mentorresearch.org/preventing-healthplan-fraudIs Moda Health Violating Antitrust Law?
https://www.mentorresearch.org/is-moda-health-violating-antitrust-lawValue-Based Payment Fraud: When Heathplan Misrepresentation Turns into Conspiracy.
https://www.mentorresearch.org/preventing-healthplan-fraudWhat can Happen if Unfair, Bad Faith, Ambiguous, Ill-Defined, Unethical, or Voidable Provisions in Fee-For-Service and Value-Based Contracts go Unchallenged?
https://www.mentorresearch.org/contracts-with-voidable-provisionsCollaboration Agreements For Value-Based Payment Contracting.
https://www.mentorresearch.org/collaboration-agreements-for-valuebased-payment-contractingIntersection of Mental Health, Value-Based Payment Contracts, and the Law: A Case Study of Moda Health.
https://www.mentorresearch.org/intersection-of-mental-health-and-value-based-contracts-a-case-studyHealthy Versus Toxic Contracts
https://www.mentorresearch.org/healthy-toxic-contracts-conversations-and-auditsInformed Consent Motivates Patients to Game Outcome Measures.
https://www.mentorresearch.org/informed-consent-motivates-gaming-outcome-measures
Ethics Point Portal: Definition and Benefits for Value-Based Contracts in Mental and Behavioral Health Services.
https://www.mentorresearch.org/ethics-point-portal-definition-and-benefitsEthics-Point Portals Overseen by Independent Certified Internal Auditor's: A Resource to Serve Stakeholders and the Healthplans
https://www.mentorresearch.org/ethics-point-portals-overseen-by-independent-certified-internal-auditorThe Results of Audits and Mitigation Options Should be Posted on a Public Electronic Platform Webpage.
https://www.mentorresearch.org/posted-on-a-public-electronic-platform-webpageContracts And Policies Shall Undergo 90 To 120-Day Review Period To Gather Stakeholder Feedback.
https://www.mentorresearch.org/contracts-and-policies-shall-undergo-90-to-120day-review-period-to-gather-stakeholder-feedback
Independent Certified Internal Auditor
Independent Certified Internal Auditor – Example Job Description
https://www.mentorresearch.org/independent-certified-internal-auditorA Case For The Value and Importance Of Independent Internal Auditors In Contracting For Fee-For-Service, Alternative, and Value-Based Mental And Behavioral Health Services.
https://www.mentorresearch.org/value-and-importance-of-independent-internal-auditorsHow Can an Independent Certified Internal Auditor Support Mental and Behavioral Health Contracting.
https://mentorresearch.org/how-can-an-independent-certified-internal-auditor-supportHow and Why Should the Independence of Certified Internal Auditors be Ensured?
https://www.mentorresearch.org/maintaining-independence-of-internal-auditorsIndependent Certified Internal Auditor: The Bridge Between Stakeholder and the Healthplan https://www.mentorresearch.org/auditor-shall-be-a-point-of-contact-for-stakeholders
The Independent Certified Internal Auditor Shall Audit Reports Registered in the Online Ethics Point Portal that Pertain to Mental and Behavioral Health Service Contracts and Policies
https://www.mentorresearch.org/auditor-shall-audit-reports-registeredThe Independence of Healthplan Auditors Must Comport with Standards Set the U.S. Office of Inspector General U.S. Office of Inspector General (OIG).
https://www.mentorresearch.org/why-use-oig-standardsWhat Can Certified Internal Auditors Do That Will Prevent Healthplans From “Gaming” Providers, Purchasers, and The Public?
https://www.mentorresearch.org/gaming-a-valuebased-contractWhy is Hiring an Independent Certified Internal Auditor a Good Idea?
https://www.mentorresearch.org/why-hiring-an-independent-certified-internal-auditor-is-a-good-idea
Value, Objectives, Controls, Tests of Design and Effectiveness, Key Indicators of Success
Controls in Fee-For-Service, Alternative and Value-Based Payment Contracting
https://www.mentorresearch.org/what-is-a-controlWhat is a Control Library?
https://www.mentorresearch.org/control-libraryControls, Tests of Design (TOD) and Tests of Effectiveness (TOE) in Measurement and Value-Based Contracting For Mental and Behavioral Health Services
https://www.mentorresearch.org/tests-of-design-and-tests-of-effectivenessCore Psychotherapy Values and the Erosion by Healthplan Practices.
https://www.mentorresearch.org/core-psychotherapy-values-and-the-erosion-by-healthplan-practicesImportance of Transparent Shared Values, Objectives, Controls, Key Indicators of Success, Tests of Design, and Tests of Effectiveness in Value-Based Payment Contracts for Mental and Behavioral Health Services.
https://www.mentorresearch.org/importance-of-shared-values-objectives-indicators-of-success
Ethics Point Portal
Ethics Point Portal: Definition and Benefits for Value-Based Contracts in Mental and Behavioral Health Services.
https://www.mentorresearch.org/ethics-point-portal-definition-and-benefitsEthics-Point Portals Overseen by Independent Certified Internal Auditors (CIA): A Resource to Serve Stakeholders and the Public.
https://www.mentorresearch.org/ethics-point-portals-overseen-by-independent-certified-internal-auditorThe Results of Audits and Mitigation Options Should be Posted on a Public Electronic Platform Webpage.
https://www.mentorresearch.org/posted-on-a-public-electronic-platform-webpageThe Independent Certified Internal Auditor Shall Audit Reports Registered in the Online Ethics Point Portal that Pertain to Mental and Behavioral Health Service Contracts and Policies.
https://www.mentorresearch.org/auditor-shall-audit-reports-registeredContracts And Policies Shall Be Written In Plain, Understandable Language.
https://www.mentorresearch.org/contracts-and-policies-shall-be-written-plain-language
Employee Retirement Income Security Act (ERISA)
ERISA and The History Of Conflict With Psychotherapy Practice
https://www.mentorresearch.org/erisa-and-the-history-of-conflict-with-psychotherapy-practiceAlignment of ERISA with Healthy Contracts Legislation: Supported by Federal Regulations
https://www.mentorresearch.org/aligning-erisa-with-healthy-contracts-legislation-is-supported-by-federal-regulationsUnderstanding and Overcoming ERISA Preemption Doctrine using Healthy Contracts.
https://www.mentorresearch.org/understanding-and-overcoming-erisa-using-healthy-contractsUnderstanding and Overcoming ERISA Preemption Doctrine using Healthy Contracts.
https://www.mentorresearch.org/understanding-and-overcoming-erisa-using-healthy-contracts
Healthy Contracts
Charting by Exception (CBE) is Useful and How Counselors and Psychotherapists Think.
https://www.mentorresearch.org/charting-by-exception-in-psychotherapyHealthy Contracts Legislation as Essential!
https://www.mentorresearch.org/healthy-contracts-legislation-is-essential
Legislative Opportunities
3 Ways to Improve House Bill 4069.
https://www.mentorresearch.org/3-ways-to-improve-house-bill-4069Fiduciary Responsibility in Healthplan Contracting: A Critical Examination.
https://www.mentorresearch.org/fiduciary-responsibility-in-healthplan-contracting-a-critical-examinationWill Healthplans Support the Healthy Contracts Legislation?
https://www.mentorresearch.org/contract-gaming-reasons-why-value-based-contracts-will-failDefinitions For Healthy Contract Design.
https://www.mentorresearch.org/healthy-contracts-bill-definitions
Healthplan Waste
Charting Requirements are Not Patient-Centered
https://www.mentorresearch.org/charting-requirements-are-not-patient-centeredWhat is the Value of Charting in Psychotherapy Practice?
https://www.mentorresearch.org/value-psychotherapy-chartingPsychotherapy Treatment Plans & Progress Notes can Have Chilling Effects on Patients, Outcomes, Satisfaction and Dropout. https://www.imhpa.org/charting-chilling-effect-on-patients-outcomes
Measurement-Based and Outcome Informed Care: Enhancing Mental Health Treatment Outcomes.
https://www.mentorresearch.org/comparing-measurement-basedcare-and-feedback-informed-treatmentMedically Necessary and Reasonable Psychotherapy Services.
https://www.mentorresearch.org/medically-necessary-reasonable
Audits
Medically Necessary and Reasonable Psychotherapy Services.
https://www.mentorresearch.org/medically-necessary-reasonableFive Types of Psychotherapy Audits.
https://www.mentorresearch.org/psychotherapy-practice-auditsHealthplan and Medicare Advantage Risk Scores and “Clawbacks”
https://www.mentorresearch.org/medicare-advantage-risk-adjustments-and-clawbacks
Practice Models and Considerations
The End of Fee-for-Service.
https://www.mentorresearch.org/the-end-of-feeforservicePractice Opportunities for Early and Mid-Career Psychotherapists. (5 models & 3 Ways to Get Paid)
https://www.mentorresearch.org/practice-opportunities-for-early-and-midcareer-psychotherapists
The Future of Independent Private Practice Mental Health Services Requires Legislation to Protect Stakeholders.
https://www.mentorresearch.org/the-future-of-independent-private-practice-mental-health-servicesPsychotherapist Employment Type and Tax Consequences.
https://www.mentorresearch.org/psychotherapist-employment-type-and-tax-consequencesWhat do Healthplans Want from Psychotherapists?
https://www.mentorresearch.org/what-do-healthplans-want-from-psychotherapistsOrganization Advantages and Disadvantages of Being a Member of an IPA vs. a Group Practice.
https://www.mentorresearch.org/advantages-and-disadvantages-of-being-a-ipa-or-group-practiceFinancial Advantages and Disadvantages of IPAs and Group Practices.
https://www.mentorresearch.org/financial-advantages-and-disadvantages-of-ipas-and-group-practicesSole Proprietor, W-2 and 1099: Psychotherapy Practice Employment Options.
https://www.mentorresearch.org/sole-proprietor-w2-and-1090-counseling-and-psychotherapy-practiceFormation of Independent Practice Associations to Protect Private Psychotherapy Practice.
https://www.mentorresearch.org/formation-of-an-independent-practice-associationFinancial Advantages and Disadvantages of IPAs and Group Practices.
https://www.mentorresearch.org/financial-advantages-and-disadvantages-of-ipas-and-group-practices
Venture Capital Competition with Independent Private Practice
What do Healthplans and Venture Capital Want Independent Psychotherapists to Do?
https://www.mentorresearch.org/what-do-healthplans-want-from-independent-psychotherapistsHeadway Business Model - Mental Health.
https://www.mentorresearch.org/headway-business-model-mental-healthSpring Health Business Model - Mental Health.
https://www.mentorresearch.org/spring-health-business-model-mental-healthCerebral Business Model - Mental Health
https://www.mentorresearch.org/cerebral-business-model-mental-health
Antitrust and Federal Trade Commission (FTC) - Background
Timeliness and Compliance in Mitigating Antitrust Violations for Healthplans.
https://www.mentorresearch.org/timeliness-and-compliance-in-mitigating-antitrust-violations-for-health-plansWhat is a Rule of Reason Analysis?
https://www.mentorresearch.org/what-is-a-rule-of-reason-analysisKey Antitrust Implication to Protect the Public, and Mental and Behavioral Health Provider.
https://www.mentorresearch.org/key-antitrust-acts-in-the-united-statesThe Antitrust Laws. The Antitrust Division. U.S. Department of Justice.
https://www.justice.gov/atr/antitrust-laws-and-youDealings with Competitors.
https://www.ftc.gov/advice-guidance/competition-guidance/guide-antitrust-laws/dealings-competitorsCompetition in the Health Care Marketplace.
https://www.ftc.gov/advice-guidance/competition-guidance/industry-guidance/competition-health-care-marketplace
Healthplan Discussion Papers
DISCLAIMER and PURPOSE: These discussion documents are intended for training, education, and 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