Importance 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
A Discussion Paper
Transparent shared values, clear objectives, effective controls, key indicators of success, and rigorous tests of design and effectiveness are crucial components of successful measurement and value-based payment contracts in mental and behavioral health services. These elements ensure that Healthplans and Providers practices work collaboratively towards common goals, maintain high standards of care, and continuously improve their services. By focusing on these requirements, stakeholders can create a sustainable and effective value-based healthcare system that benefits stakeholders. The stakeholders include Healthplans, purchasers, employers, taxpayers, patients, provider practices, the Oregon Health Authority (OHA), public health, and the broader community. According to the Institute of Internal Auditors (IIA) the essential requirements for any risk-share or joint venture for value-based contracting are:
Transparent Shared Values: Shared values between health plans and provider practices are essential for fostering mutual trust and collaboration. In the context of mental and behavioral health services, shared values ensure that both parties are committed to patient-centered care, ethical practices, and continuous improvement. This alignment helps create a unified approach to addressing the complex needs of patients, promoting a holistic and compassionate care environment.
Transparent Clear Objectives: Clearly defined objectives set expectations and guide efforts towards common goals. In value-based payment contracts, objectives might include improving patient outcomes, increasing access to care, reducing healthcare costs, and enhancing the quality of services. When health plans and providers agree on these objectives, they can align their strategies and resources effectively, ensuring that both parties work towards achieving these goals.
Effective Controls: Controls are mechanisms put in place to ensure that processes and operations within value-based payment contracts function as intended. Effective controls help prevent fraud, reduce errors, and ensure compliance with regulatory requirements. In mental and behavioral health services, controls can include protocols for patient confidentiality, treatment guidelines, and financial management practices. These controls are vital for maintaining the integrity of the services provided and safeguarding the interests of patients and providers.
Key Indicators of Success: Key indicators of success are metrics used to evaluate the performance and outcomes of value-based payment contracts. These indicators might include patient satisfaction scores, increased values, treatment adherence rates, reduction in hospital readmissions, improved health, and appropriate costs. By monitoring these indicators, health plans and providers can assess the effectiveness of their initiatives, identify areas for improvement, and make data-driven decisions. In mental and behavioral health, such indicators are particularly important for demonstrating the impact of treatments and interventions on patient well-being.
Tests of Design: A test of design evaluates whether controls are appropriately designed to achieve their intended objectives. This involves assessing the control's design to determine if it is capable of preventing or detecting and correcting material misstatements or operational failures. The test of design examines factors such as control objectives, control activities, documentation and evidence, and implementation. The goal is to determine if the control, as designed, can effectively mitigate the identified risks.
Tests of Effectiveness: A test of effectiveness, as defined by the IIA, evaluates whether controls are operating as intended and are effective in achieving their objectives. This test involves examining the actual operation of the controls over a period to ensure they function consistently and reliably. It includes operational testing, sampling, assessing error rates, and outcome analysis. The purpose is to confirm that the controls are not only well-designed but also operate effectively in practice to achieve the intended risk mitigation.