Outcome Informed Care and Measurement-Based Care Adoption - Challenges in Oregon

Since 2016 AMHA-Or has been communicating with Healthplans about the topic of Alternative Payment Methods (APM). In particular, pay-for-performance (P4P) and value-based-reimbursements (VBR). AMHA has presented two contracting models that were developed with the help of Mike Crew, J.D., a noted expert in physician group practice and group contracting. In 2021, Healthplans in Oregon began investigating APMs for behavioral health as result of Oregon legislation implemented to ensure network adequacy and reimbursement parity as it affects the availability of behavioral services across Healthplans.

Based on local experience offering Measurement based care (MBC) and outcome informed care training (OIC), Mentor Research Institute (MRI), found that there are 6 factors which impact therapists’ adoption.

  1. Persuading independent practice psychotherapists to adopt MBC and OIC will cause adoption anxiety and reflexive skepticism. Many will ask "What's in it for me?" Most will "wait to see what others think." This will slow adoption while everyone waits.

  2. Given how difficult their work is, especially during a pandemic, it is important for therapists to believe in the value of OIC and that it improves their practice providing treatment. However, if a provider believes the data will be used against them, to deny treatment; or that OIC is a burden that will take time away from patients care, OIC will not be adopted.

  3. Training must present the ways in which patients can benefit from measurement and ensure that it is valuable to patients. Questionnaires must be socially and culturally appropriate.

  4. There will be intractable objections if Healthplans expect to see patient identifiable data in a therapists’ first year of active participation.

  5. The OIC training must ensure the technology is implemented and integrated into clinical practice with minimal initial effort. Complexity can only increase gradually based on psychotherapists’ levels of engagement.

  6. For a Healthplan to promote adoption, it is important to provide a significant increase in the reimbursement rate, and consider a therapists opportunity cost of NOT treating members of competing Healthplans that don’t require MBC. When there is a high demand for services, providers are willing to terminate a Healthplan contract and offer services out-of-network.

Unless these 6 factors are considered and addressed, adoption of MBC in private practice, will not be robust, regardless of reimbursement. Therapists are focused on their mental health and their patients’ mental health. Providers’ adoption of MBC and OIC must be based on clear benefits, low administrative burden, and a significant reimbursement. Providers know that MBC data is very valuable to Healthplans.

MRI has conducted surveys and has many years of experience talking with providers who were required to use specific measurement systems such as ACORN. Those systems were designed to give Healthplans the patient's data which can be used to "govern" and manage providers. MRI concluded that the current adoption of MBC and OIC in private practice is no more than 5%.