Oregon Health Authority’s Value-Based Payment (VBP) Roadmap: Progress Using Solutionism
A Discussion Paper
Solutionism is the belief that complex social, economic, or systemic problems can be solved primarily through technical, administrative, or policy-driven solutions, often without addressing deeper structural issues or unintended consequences. Coined by technology critic Evgeny Morozov, solutionism refers to the oversimplification of deeply entrenched problems, where policymakers or organizations implement "fixes" and publish progress that fail to consider real-world complexity, adverse effects, and refusal to grapple with a trajectory of a probable to almost certain moderately several to catastrophic problems.
In healthcare, solutionism manifests when policy initiatives, such as value-based payment (VBP) models, are introduced as sweeping reforms without adequate consideration of market realities, power imbalances, financial feasibility, or the unintended burden placed on providers and patients.
The solutionism mindset will oversimplify problems, create unintended consequences, and reinforce corporate or political agendas disguised as progress.
The Oregon Health Authority’s (OHA) Value-Based Payment (VBP) Roadmap exemplifies solutionist thinking by presenting VBP contracts as a one-size-fits-all solution to healthcare inefficiencies, cost containment, and quality improvement, while failing to address structural problems such as contract transparency, financial risk allocation, and regulatory oversight. The roadmap assumes that merely shifting from fee-for-service (FFS) to VBP models will inherently lead to improved care quality, cost savings, and better health outcomes, yet it does not adequately account for how health plans exploit contractual loopholes to maximize their own financial gain at the expense of providers and patients.
Example of OHA Solutionistic Thinking
Assumption That Financial Incentives Alone Will Improve Care
The roadmap assumes that aligning financial incentives with quality measures will naturally lead to better patient outcomes. However, real-world applications of VBP contracts have shown that health plans often manipulate incentive structures to reduce payouts rather than reward providers for delivering quality care. This results in:
Unattainable performance benchmarks that providers must meet before receiving incentive payments.
Delayed or denied reimbursements based on selective interpretation of quality measures by health plans.
Increased pressure to prioritize data entry and compliance over direct patient care, as providers must navigate excessive documentation requirements to qualify for full payment.
Rather than ensuring quality improvement, these financial mechanisms frequently serve as cost-containment strategies for health plans, forcing providers to absorb greater financial risk while payers retain profitability.
Failure to Address Market Power Imbalances
The roadmap assumes that all providers have equal bargaining power in negotiating VBP contracts, yet health plans like Moda Health hold significant leverage over independent providers. This imbalance is exacerbated by:
Take-it-or-leave-it contracts that providers must accept without room for negotiation.
Unilateral contract amendments that allow health plans to change payment terms at will.
Non-transparent incentive structures that shift financial risk onto providers while benefiting payers.
Without legislative safeguards against coercive contracting, providers are left in vulnerable positions where they must choose between accepting financially risky contracts or losing access to patient populations dependent on their services.
Unrealistic Administrative and Data-Tracking Burdens on Providers
The roadmap does not fully account for the administrative complexity and financial costs associated with VBP participation. Many providers face significant operational burdens when transitioning to VBP models, including:
Complex reporting requirements for tracking patient outcomes, quality metrics, and compliance.
High costs associated with electronic health record (EHR) upgrades and data analytics tools.
Unfunded mandates, where providers are forced to comply with new VBP requirements without adequate reimbursement for the additional administrative workload.
Rather than reducing inefficiencies in healthcare, VBP models often introduce new layers of bureaucracy, diverting provider focus away from patient care toward data management and compliance tracking.
Lack of Regulatory Enforcement and Independent Auditing
While the roadmap outlines principles of transparency and accountability, it lacks enforcement mechanisms to ensure health plans comply with fair contracting standards. Without mandatory independent audits and public reporting requirements, health plans are able to:
Manipulate risk adjustment scores to decrease provider reimbursement.
Misrepresent patient severity data to justify lower payments.
Deny claims and incentive payments through opaque contract language.
The absence of external oversight allows payers to redefine financial and quality metrics to their advantage, contradicting the roadmap’s stated goal of aligning incentives for improved healthcare outcomes.
Ignoring the Need for Provider-Led, Patient-Centered Reform
The roadmap was developed without meaningful input from independent providers, relying instead on health plan-driven policy frameworks that prioritize payer financial interests over clinical realities. This leads to:
A lack of shared values, objectives, and contractual controls that ensure fair agreements.
Disempowered providers who must comply with arbitrary metrics rather than focusing on individualized patient care.
Limited patient choice, as VBP contracts favor large health systems over independent practitioners, reducing competition and care accessibility.
A truly effective reform strategy would center provider and patient needs, ensuring that value-based models are designed with realistic performance metrics, clear financial protections, and mechanisms for accountability.
The Consequences of a Solutionist Approach
The Oregon Health Authority’s Value-Based Payment Roadmap represents a classic case of solutionism, offering a technical policy framework that ignores structural power imbalances, administrative burdens, and regulatory enforcement gaps. Instead of ensuring that VBP models function as intended, the roadmap has enabled health plans like Moda Health to manipulate contracts, shift financial risk onto providers, and reduce competition. This has led to:
Erosion of provider trust in value-based contracts.
Increased financial precarity for independent mental health and behavioral health professionals.
Reduced access to care as providers exit contracts due to unsustainable terms.
Limited oversight and accountability, allowing payers to continue exploitative practices unchecked.
To move beyond solutionist policy failures, Oregon must:
Implement independent auditing and enforce contract transparency to prevent health plan abuses.
Ensure fair contract negotiations by addressing power imbalances and preventing unilateral amendments.
Protect providers from financial exploitation by requiring legislative oversight and Ethics Point Portals for reporting fraud.
Mandate stakeholder involvement in VBP model design, ensuring that independent providers have a voice in contract development and implementation.
Without these reforms, the OHA’s VBP Roadmap will continue to be a flawed, solutionist approach that prioritizes policy optics over real-world healthcare improvements. Moving forward, a provider- and patient-centric framework is necessary to create truly effective and equitable healthcare financing models.
References
Healthy Contracts - Discussion Papers
https://www.mentorresearch.org/healthy-contracts-categorized
Definitions for Healthy Contacts
https://www.mentorresearch.org/healthy-contracts-bill-definitions
Exposing Asymmetric Power: Moda Health’s Unethical Approach to Value-Based Contracting.
https://www.mentorresearch.org/exposing-asymmetric-power-moda-healths-unethical-approach-to-valuebased-contracting
DISCLAIMER and PURPOSE: This discussion document is intended for training, education, legislation 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