Behavioral health care CDA overview
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care delivery area (CDA) is an innovative value-based payment (VBP) arrangement. See the
VBP Roadmap for Coordinated Care Organizations.
Behavioral health care is a significant priority for the Oregon Health Authority. Oregon has one of the highest rates of mental illness in the nation, and one in ten Oregon adults suffers from a substance use disorder (SUD). Less than half of Oregonians experiencing mental illness, and only 11% of those experiencing SUD, receive treatment.
The behavioral health care CDA fosters innovative pilot VBP arrangements for behavioral health care across settings of care. This includes services to treat mental health and addictive disorders, including problem gambling and SUD. These services may be delivered in settings included, but not limited to:
- Community mental health programs and behavioral health clinics or organizations
- Residential treatment facilities
- Assertive community treatment programs
- Outpatient addiction treatment centers
- Primary care, specialty care, and oral health care settings
- School-based health centers
- Hospitals
- Emergency departments
A behavioral health care CDA VBP should not reinforce existing silos between behavioral and physical health, or create new silos. For example, arrangements with primary care providers delivering behavioral health services should still include a link to specialty behavioral health, as services are needed.
Behavioral health care CDA VBP models may support important state policy goals, such as:
- Addressing opioid use disorder and dependency
- Using best practices to outreach to culturally specific populations
- Increasing access to primary care and integrated care
- Prioritizing access for pregnant women and children ages birth through five years
- Increasing care coordination for individuals with severe and persistent mental illness, children with serious emotional disturbances, individuals in medication assisted treatment for substance use disorder, and members of prioritized populations
- Reducing admissions, readmissions and length of time in the emergency department
- Increasing access to community-based services
- Increasing access to supported employment services
- Fully implementing system of care for the children’s system
- Increasing wraparound services to all children and young adults who meet criteria
Oregon behavioral health care delivery area briefs
Recorded webinars
VBP for Behavioral Health Providers: How Do We Keep from Being Left Out? (OHA and Health Management Associates) – This provider-focused webinar includes how VBP can support outcomes-focused models of behavioral health care; strategies of patient attribution and risk stratification to guide selection of cost-effective interventions; and the applicability of care management fees, pay-for performance and total cost-of-care VBP models.
Designing and Implementing Value-based Payment for Substance Use Disorders (OHA and Health Management Associates) – This CCO-focused webinar discusses considerations for VBP in SUD care, including a comparison of integrated and specialized settings; available services array; metrics for priority populations; and providers’ technical assistance needs.
Resources
The Addiction Recovery Medical Home Alternative Payment Model
Alliance for Addiction Payment Reform
- An addiction recovery payment model that aligns incentives to promote integration and improved outcomes for patients, payers and health systems long-term.
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Key points: Considerations to help states advance VBP models and suggestions to support Medicaid managed care plans and providers with program implementation.
Behavioral Health Provider Participation in Medicaid Value-Based Payment Models: An Environmental Scan and Policy Considerations
Center for Health Care Strategies
- This report focuses on VBP levers to encourage integration of SUD treatment into primary care. It describes how states and health plans are exploring VBP and offers considerations for implementing these models.
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Key points: Describes oversight considerations.
Case Rate Toolkit: Preparing for Bundled Payments, Case Rates and the Triple Aim
National Council for Behavioral Health
- Designed to help specialty behavioral health providers prepare for bundled payments/case rates, this tool kit provides step-by-step guidance on how to convert from a fee-for-service payment model to this new approach. Includes definitions of bundled payments versus case rates, with distinctions and definitions, and approaches to setting and managing case rates.
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Key points: Behavioral health payment model focused on bundled payments and case rates.
Exploring Value-Based Payments to Encourage Substance Use Disorder Treatment in Primary Care
Center for Health Care Strategies
- Examines how states and health plans are exploring VBP to promote SUD treatment in primary care and offers considerations for implementing these models.
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Key points: Discusses provider capacity in integrated SUD treatment.
Moving toward Value-Based Payment for Medicaid Behavioral Health Services
Center for Health Care Strategies
- Describes how states and Medicaid managed care organizations are incorporating VBP arrangements into behavioral health services including building on physical health VBP models.
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Key points: Identifies key challenges in implementing VBP models in behavioral health settings related to quality measurement.
The Patient-Centered Opioid Addiction Treatment (P-COAT)
American Society of Addiction Medicine
- An overview of the Patient-Centered Opioid Addiction Treatment Payment (P-COAT), a VBP model to improve outcomes and reduce spending for opioid addiction.
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Key points: Highlights privacy and data-sharing constraints.
Payment Model for Medication Assisted Treatment (MAT)
Center for Medicare and Medicaid Services (CMS)
- Overview of the CMS Clinical Pathways and Payment Bundles for MAT; examins models being used in Massachusetts and Vermont.
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Key points: Behavioral health payment model for MAT.
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