Resources for primary contractors, behavioral health managed care organizations, providers and stakeholders.
Overview of the Office of Mental Health and Substance Abuse Services (OMHSAS) VBP Strategy and Requirements.
Value Based Purchasing (VBP) is the Department’s initiative to transition providers from volume to value payment models for the delivery of behavioral health services. The Department has encouraged initiatives that include value-based payment arrangements and shared risk. Value-based programs and payment models are critical for improving quality of care, efficiency of services and reducing costs.
In January 2018, the Office of Mental Health and Substance Abuse Services (OMHSAS) implemented contract amendments (chart below) that require an increasing percentage of Behavioral Health Managed Care Organization (BH-MCO) payments over time to fall within approved VBP models.
OMHSAS' Definition of VBP Payment Models
Performance-based Contracting - Contracts in which payment is linked to provider performance and require providers to undertake specific activities or meet certain benchmarks for services. These contracts may include incentives and penalties, caseloads and Pay for Performance.
Bundled & Episodic - A single bulk payment for all services rendered to treat an individual for an identified condition during a specific time period. These payments also include case rates.
Shared Savings - Supplemental payments to providers if they are able to reduce health care spending for a defined patient population relative to a benchmark. The payment is a percentage of the net savings generated by the provider.
Shared Risk - An arrangement of shared financial responsibility between payer and provider that allows for cost control, efficiency of service use and quality. In this arrangement, both financial savings and losses are shared.
Capitation - A payment arrangement for health care service providers that pays a set amount for each enrolled person assigned to them, per period of time, regardless of whether the person receives services during the period covered by the payment.
Capitation + Performance-based Contracting - This payment arrangement adds performance based contracting as a supplemental incentive to a capitation contract.
The provision related to VBP is outlined in Program Standards and Requirements
(Appendix U, page 419). Primary Contractors are required to submit plans to OMHSAS each year outlining proposed payment methods, as well as annual submission of actual VBP arrangements to support evaluation of previous year’s outcomes.
Contains materials, resources, and trainings conducted by OMHSAS.
General Resources Documents that could be of interest to a broad audience, including BH-MCOs, primary contractors, and providers, but wouldn’t generally be used to design/implement a specific VBP model. These general resources are targeted toward a wide-ranging audience interested in: the national movement toward VBP; explanations of different VBP models; and payment and delivery system reforms being implemented in Medicaid for behavioral health services.
Overview of VBP Models
Behavioral Health Payment & Delivery System Reforms
BH-MCO and Primary Contractor Resources
These materials are targeted toward organizations with the lead responsibility for designing, implementing, and monitoring VBP approaches. Includes more in-depth documents that payers could use to design a VBP model.
Performance Based Contracting
Bundled/Episode of Care Payments
- Health Care Payment Learning & Action Network: Clinical Episode Payment
- A number of payers have designed and/or implemented specific bundled or episode of care payments for behavioral health-related services provided to Medicaid beneficiaries.
- Arkansas has implemented episode of care payments for attention deficit hyperactivity disorder and oppositional defiance disorder.
- Ohio has planned episode of care payments for attention deficit hyperactivity disorder and oppositional defiant disorder.
- Tennessee has episode of care payments in place for attention deficit hyperactivity disorder and oppositional defiant disorder.
- The Centers for Medicare & Medicaid Services has developed clinical pathway and rate design tools for medication assisted treatment.
Capitation/Population Based Payments
Provider ResourcesThese materials are targeted toward behavioral health providers contracting with BH-MCOs under VBP arrangements. They provide practical information for how to succeed in a VBP environment.
If you would like to suggest a resource for inclusion on this website, or have encountered troubling accessing a referenced document or hyperlink, please contact OMHSAS VBP Resource Account at RA-PWOMHSASVBP@pa.gov