Moda Request For Outcome-Informed Behavioral Healthcare Proposal (January 14, 2022) From Mentor Research Institute

Moda Request for Proposal

Summary

The proposal outlines a collaborative initiative between the Mentor Research Institute (MRI), the American Mental Health Alliance - Oregon (Now IMHPA), and Moda Health. Its primary aim is to improve mental health services in Oregon through Value-Based Care (VBC), Value-Based Reimbursement (VBR), and Measurement-Based Care (MBC). The document highlights Oregon's mental health crisis, marked by a shortage of providers and increasing service demand. In response, it proposes specific solutions tied to Oregon’s mental health parity legislation (HB 3046), which requires insurers to provide adequate mental health coverage and maintain appropriate provider networks.

A central feature of the proposal is the adoption of MBC, where providers would use standardized assessments like the PHQ9 and GAD7 to monitor patient progress. To ensure providers are fairly compensated for the added workload, the proposal suggests creating unique CPT codes specifically for administering these assessments. This system would make provider payments transparent and reduce administrative burdens. MRI also recommends reimbursement rates tied to CMS standards but adjusted for Oregon’s healthcare market to reflect actual practice costs.

The Behavioral Health Incentive Program (BHIP) proposed by Moda Health would reward participating providers through performance-based bonuses. Incentives would be tied to provider participation and achieving predefined clinical outcomes. The proposal also emphasizes that such programs must respect provider autonomy and clinical judgment while safeguarding patient confidentiality.

To ensure ethical and sustainable collaboration, the proposal stresses the need for transparent contracts based on good faith and fair dealing. It warns against exploitative reimbursement models that could deter providers from joining the network. Furthermore, the proposal critiques existing industry practices, including venture capital-driven models, and highlights the risks of undervaluing mental health services.

Overall, the document advocates for a provider-centered model with competitive reimbursement rates, reduced administrative complexity, and an ethical framework that balances clinical care with financial sustainability. It underscores that meaningful collaboration and fair compensation are essential to improving mental health service delivery in Oregon.

For more information see:
Moda Outcome-Informed Behavioral Healthcare Proposal: Download PDF

DISCLAIMER and PURPOSE: This discussion document is intended for training, education, legislation or research purposes. 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