“Solutionism” in Healthcare: Moda Health’s Contracting Approach and its Consequences

A Discussion Paper

Introduction

“Solutionism” is the belief that complex social, political, or systemic problems can be effectively resolved through technical, administrative, or procedural solutions, without the need to address deeper underlying problems which must be solved before any solution can be successful.

The term solutionism was popularized by Evgeny Morozov, a technology critic and author. He introduced the concept in his 2013 book To Save Everything, Click Here: The Folly of Technological Solutionism. Morozov uses the term to critique the belief that complex societal, political, and cultural issues can be resolved solely through technological innovation or data-driven solutions, often ignoring deeper structural and human factors. His work highlights how this mindset can oversimplify problems, create unintended consequences, and reinforce corporate or political agendas disguised as progress.

Solutionism involves applying fix-oriented strategies such as technological innovation, data-driven metrics, or policy adjustments, arguing that these “solutions” will provide clear, measurable, and lasting improvements. Solutionism offers simplistic solutions which have potential but will not benefit stakeholders when the foundational contracts and policies are almost certainly ill-defined, misleading, fraudulent, and were obtained in violation of antitrust principle. In the discussion example offered here, there is evidence that Moda Health offers “solutions” and that providers are denied (1) a pathway to report health plan misconduct, (2) whistleblower protections, (3) assurance of independent investigation, (4) accountable corrective actions. Providers have no alternative’s to report unethical and illegal conduct by a behavioral health director, other than to address the same behavioral health director. There is no independent certified internal auditor.

Moda Health’s Solution

Moda's approach to value-based payments reflects solutionism, given the healthcare industry's reliance on data-driven models and administrative reforms. Moda's approach focuses on implementing technical solutions such as:

1. Measurement-Based Care (MBC): Standardizing assessments like PHQ9 and GAD7 assumes that tracking patient outcomes through structured data can improve care quality and accountability.

2. Incentive-Based Payments: Moda declined performance-based bonuses tying provider behavior to measurable targets, reflecting a belief that financial incentives can drive better care.

3. Administrative Streamlining: Moda declined proposals for unique CPT codes and simplified reimbursement systems with reduced administrative complexity will resolve barriers to provider participation.

4. Data Transparency and Reporting: Moda declined transparency standard with initiatives, assuming that support better data sharing and compliance monitoring to correct market inefficiencies.

However, if Moda’s response is narrowly focused on these solutions, without addressing foundational problems, such as unethical and unfair contracts, workforce shortages, provider burnout, and inequitable access - Moda is using solutionism to obfuscate the challenges and consequences to stakeholders, which include taxpayers, purchasers and providers. .

Allegations and Consequences

Fraud and antitrust allegations leveled against Moda Health raise significant concerns about the fairness, transparency, and legality of Moda’s contracting practices in the mental and behavioral healthcare sector. These issues go beyond standard business disputes, touching on potential violations of antitrust laws, fraud, and bad faith contracting that threaten providers, patients, stakeholders, purchasers and competing health plans.

This discussion highlights key allegations against Moda Health, describing practices that undermine the principles of fair competition, contract transparency, and value-based care. Each issue identified is followed by a potential consequence if these behaviors are allowed to continue unchecked. The goal is to illustrate how such practices will destabilize healthcare markets, reduce access to care, and misappropriate public funds, ultimately jeopardizing the integrity of the healthcare system.

By exploring these concerns, this analysis underscores the urgent need for regulatory oversight, legal accountability, and systemic reforms aimed at protecting healthcare providers, ensuring patient access, and safeguarding public resources.

1. Lack of Transparency
   Moda Health allegedly withheld critical information about incentive calculations, risk adjustment methods, and the identity of providers involved in risk-sharing agreement.

   Consequence if unchecked:
   Providers would be forced into contracts they cannot fully understand, making informed decision-making impossible. This lack of transparency would allow Moda to manipulate payment structures and clinical expectations, destabilize provider operations and reduce the overall quality of patient care. Trust in public healthcare contracts could erode, discouraging provider participation in value-based care initiatives.

2. Contracts and Unfair Terms
   Contracts allegedly contained vague terms, non-sensical performance metrics, and take-it-or-leave-it conditions.

   Consequence if unchecked:
   Providers would become locked into a cascading dependency on contracts with unpredictable financial and operational obligations. This will almost certainly lead to increased administrative burdens, reduced care quality, and potential closures of small and mid-sized practices unable to absorb financial losses caused by ambiguous terms. Patients would face decreased access to care, longer wait times, and potentially worse health outcomes.

3. Manipulation of Risk Adjustment Scores
   Moda allegedly controls the risk adjustment processes through underreporting patient complexity with an opportunity to inflate its own reimbursement claims without detection.

   Consequence if unchecked:
   Patients requiring intensive services could be underserved or even avoided by providers seeking to minimize ethical and financial risk. Providers might be forced to cherry-pick lower-risk patients, creating a two-tier healthcare system where vulnerable populations are denied access to necessary care.

4. Antitrust Violations and Market Manipulation
   Moda’s practices allegedly restricted competition by creating barriers for new providers, preventing economies of scale, undermining competition from other health plans, and monopolizing the market.

   Consequence if unchecked:
   Market competition would decrease, leading to monopolistic control by Moda. This would may result in higher healthcare costs, reduced provider autonomy, and limited service options for patients. A lack of competition could stifle innovation and prevent new care models for minority and under served populations from emerging.

5. Creation of Phantom Networks
   Moda allegedly listed providers as part of its network, without fully disclosing information that would cause providers to make a different decisions. .

   Consequence if unchecked:
   Patients could be misled into believing they have access to a broad network of care when, in reality, many providers are not actively participating. This deception could result in delayed treatment, reduced care access, and negative health outcomes for individuals relying on these networks.

6. Financial Exploitation of Isolated and Smaller Provider groups
   Contracts allegedly imposed financial risks on small provider groups while ensuring upside benefits for Moda.

   Consequence if unchecked:
   Isolated and smaller provider groups could be driven out of business due to financial insolvency, leaving patients in underserved areas without access to care. The remaining providers may face increased patient loads, contributing to provider burnout, reduced care quality, and longer wait times. Patient will be directed to “safety net” programs rather that specialized care.

7. Misrepresentation of Incentives
   Moda allegedly promised reasonable incentives but will almost certainly manipulate metrics post-contract to reduce payments.

   Consequence if unchecked:
   Providers may abandon value-based care models, opting for fee-for-service and “out-of-pocket” arrangements where payment is more predictable. This would stifle innovation in care delivery and disrupt efforts to improve healthcare outcomes through performance-based incentives. Patients would ultimately bear the burden through fragmented and inconsistent care delivery.

8. Contract Ambiguity and Take-it-or-Leave-it Terms
   Moda allegedly used coercive contracts that were non-negotiable and filled with nonsensible and vague obligations.

   Consequence if unchecked:
   Providers would lose their ability to negotiate fair contract terms, leading to a one-sided system dominated by health plans. This could result in diminished professional autonomy, constrained clinical decision-making, and reduced service availability, harming providers, stakeholders and patients.

9. Diversion of Public Funds
   Moda is diverting public healthcare funds by manipulating contracts and reimbursement structures to create a network that undermines competition among health plans.

   Consequence if unchecked:
   Taxpayer dollars intended to improve healthcare access and outcomes could be redirected toward corporate marketing and profits which are based on deception. This would undermine public trust, trigger potential legal and regulatory challenges, and weaken the sustainability of publicly funded healthcare programs.

These consequences highlight the systemic risks posed by unchecked unethical practices, emphasizing the need for transparent, fair, and collaborative contracting in healthcare.

The Limits of Solutionism in Addressing Mental Health System Challenges

Counterargument Overview

The belief that Oregon's mental health crisis can be resolved through technical and administrative fixes oversimplifies the issue. Systemic problems like provider shortages, limited training pipelines, and economic pressures cannot be fully addressed through policy adjustments or performance-based incentives. Administrative solutions may worsen care by increasing provider workload and shifted focus from patient-centered care to compliance-driven practices.

Moda’s Response as an Example of Solutionism

Moda Health’s proposed approach reflects key aspects of solutionism, reliance on structured, data-driven interventions aimed at fixing complex mental health system issues. While such solutions aim to improve care quality and provider accountability, they risk ignoring deeper systemic challenges.

Elements of Moda’s Solutionism Approach

1. Measurement-Based Care (MBC)
   Moda proposes using standardized tools like PHQ9 and GAD7 to assess patient progress. This assumes that clinical outcomes can be reliably measured and improved through data collection, despite the subjective and relational nature of mental health care.

2. Incentive-Based Payments
   Providers would receive performance-based bonuses tied to meeting predefined targets. This assumes that financial rewards alone will motivate providers, despite concerns about gaming metrics, ethical compromises, and increased administrative burdens.

3. Administrative Streamlining
   Refusing to implement CPT codes for mental health assessments to simplify billing. However, this approach could increase administrative complexity if providers face additional reporting requirements.

4. Data Transparency and Compliance Monitoring
   Moda’s focus on data transparency reflects the assumption that better reporting will improve care delivery. However, excessive reliance on data can create surveillance pressures, reduce trust, benefit health plans, and conflate treatment with assessment.

5. Technology-Driven Solutions
   The reliance on digital health platforms for data collection and analysis highlights a belief that technology can streamline mental health care. However, this may increase costs, introduce technical barriers, and raise concerns about data privacy and ethical use.

Moda Health’s Partnership with Spring Health

Moda Health’s partnership with Spring Health, launched in October 2022, aspired to deliver measurement-based mental health care to employer groups through its Behavioral Health 360 platform. While this collaboration is framed as a move toward improving mental health service delivery, it reflects a broader trend of solutionism, relying on data-driven models, administrative reforms, and technological solutions to address complex healthcare challenges. Although these strategies can enhance profitability by streamlining operations, they may not offer face-to-face contact, and can undermine the individualized and relational nature of mental health care.

“Moda has always sought to stay out front in providing best-in-class behavioral health services for our members, We chose Spring Health on the strength of their clinical model and the diversity of their provider panel. And we’re excited about how this partnership will help our members even more quickly and easily access effective care.” Dan Thoma, Director of Behavioral Health at Moda

For more information see:
Spring Health Launches New Behavioral Health Partnership with Moda Health.
https://www.springhealth.com/news/spring-health-launches-new-behavioral-health-partnership-with-moda-health?utm_source=chatgpt.com

While these initiatives are presented as efforts to enhance care quality and accessibility, they reflect a solutionist approach that aligns with Moda's financial objectives against independent private psychotherapy practices which have access to technology practices trust and which they find flexible and useful. By implementing standardized assessments and performance-based incentives, Moda intends to streamline operations and potentially reduce costs, which will enhance profitability. However, Moda’s value-based contract, focuses on quantifiable metrics that overlook the individualized and relational aspects of mental health treatment, undermine providers and compromise the quality of patient care.

The Spring Health is not viable. Providers cannot be expected to use platforms dictated by health plans. There are too many health plans and populations served require outcome measures that are meaningful and useful to providers and patient, not necessarily the health plan.

Summary

Moda Health’s reliance on solutionist strategies fall to address the foundational and systemic roots of Oregon's mental health crisis. That is, providers and patients abhor Health plan’s. Moda Health's partnership with Spring Health, initiated in October 2022, aims to provide measurement-based mental health care to select employer groups (e.g. LifeStance) through Moda's Behavioral Health 360 platform.

While these initiatives are presented as efforts to enhance care quality and accessibility, they also reflect a solutionist approach that aligns with Moda's financial objectives rather than public health. By implementing standardized assessments and performance-based incentives, Moda can streamline operations and potentially reduce costs, which could enhance profitability. However, this focus on quantifiable metrics might overlook the individualized and relational aspects of effective outcome.

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