Key Informant Interviews

Evaluation of BHST Part One: Performance and Value-Based Contracting

Key Informant Interviews: Interviews with community stakeholders, Mind OC staff, Be Well staff, and Orange County Health Care Agency staff aimed to gather insight as to the facilitators, barriers, and recommendations associated with the planning of a performance and value-based contracting system.

Focus Groups6: Interviews with providers intended to gain an understanding of satisfaction with the operationalization of “value of behavioral health services” and to determine how switching to the proposed value-based payment contract is received by stakeholders.

• Semi-structured key informant interviews based on Consolidated Framework for Implementation Research (CFIR) constructs were conducted with 18 individuals about performance and valuebased contracting. • Barriers, facilitators, and recommendations were pulled from the transcripts. • Early project planning to ensure vision alignment may improve steps taken to reach project goals. • Transparent and frequent communication is important to keep stakeholders abreast of progress, educate stakeholders, and find/maintain an internal champion to support the project.

We conducted directive qualitative analyses to analyze key informant interviews. Stage 1 – The evaluation team developed tailored interview guides based on the Consolidated Framework for Implementation Research (CFIR) model.

Stage 2 – Interviews (N = 18) were conducted with 7 Mind OC staff, 1 Be Well staff, 2 community stakeholders, and 8 Orange County Health Care Agency staff. Stage 3 – The evaluation team developed an initial codebook based on the Consolidated Framework for Implementation Research (CFIR) and the interview guides to help pull out themes from the interviews.

Stage 4 – The evaluation team started qualitative analyses to identify facilitators, barriers, and recommendations associated with the planning of a performance and value-based contracting system.

Key themes pulled from the interviews are consolidated in Figure 2.1. Please note that these themes are not comprehensive.

• Cosmopolitanism: Guidance from the state is needed to help determine funding sources and set policies for performance and value-based contracting • COVID-19: Disrupted relationship building and capacity of community members/providers • External Policies and Incentives: Commercial plans operate on profitability; no incentive for vendor to bill commercial plans over county as commercial plans can deny claim

• Relative Priority: Competing priorities challenge the focus on performance and value-based contracting (e.g., CARES Act dollars, system transformation) • Compatibility: Providers have previous knowledge of valuebased payments in other aspects of their work; providers are supportive of value-based payment models • Leadership Engagement: Important to leverage County

Leadership as internal champions; external subcontractors alone cannot move this work along • Networks & Communications: Adaptation of materials and communication styles to meet the understanding and language-base of differing sectors

Consolidated Framework for Implementation Research (CFIR) –BHST Part One: Performance and Value-Based Contracting

Please note domain boundaries are flexible as numerous aspects of this project span across domains

• Engaging: Multi-method approach to engagement including Be Well Result

Area meetings, Be Well mailing list, word of mouth, kickoff meetings, and presenting during local organization meetings (e.g., NAMI)

• Innovation Source: Informed by efforts in other states and other counties in California that are implementing payer agnostic/ value-based contracting • Evidence Strength & Quality: Lack of established behavioral health metrics in contracting – causes difficulty in translating community wants into metrics • Relative Advantage: Belief that performance and value-based contracting will better meet community needs and increase access to care in a more costeffective way • Planning: Important to consider costs beyond treatment costs, including costs to legal system and costs to healthcare systems in general when conducting return on investment analyses to plan for true value-based care

Innovation Characteristics The interacting core components that make up an innovation Process The actions or steps taken, whether formally planned or spontaneous, aimed at reaching innovation goals Outer Setting The wider economic, political, and social context that influences the innovation Inner Setting The context in which the innovation takes place/exists, including characteristics of that context

Characteristics of Individuals Values, opinions, and norms of the targeted users/affected individuals of the innovation

Facilitator Recommendation Barrier

• COVID-19 disrupted relationship building and community engagement plans. Capacity to engage in a new project was limited among community stakeholders who were managing the

COVID-19 pandemic and related stressors. Additionally, the COVID-19 pandemic disrupted the initial plan of engagement strategies. This included competing priorities that came about in response to COVID-19, such as CARES Act dollars which shifted some focus away from this project. • Communication and education are at the heart of project success. Establishing and maintaining transparent relationships is integral for success. Adapting communication styles to different sectors (e.g., public vs. private payers) is necessary to share knowledge about what performance and value-based contracting is and why it is valuable. For instance, there is a need to define "quality" in a way that is translatable across different types of audiences.

facilitators of the project. Providers and Orange County Health Care Agency staff are supportive of a shift towards value-based contracting; however, in the behavioral health field, there are not established