BHST Part One: Performance and Value-Based Contracting Recommendations

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

The following are recommendations related to factors that are external to Orange County, such as state and federal level policies and regulations. • Continue monitoring the progress of CalAIM as it relates to value-based contracting. As the rollout of CalAIM continues, it is important to ensure that efforts to incorporate quality-based metrics and incentive structure in the context of the BHST Part One: Performance and Value-

Based Contracting project are cohesive with future State level changes (or that the BHST Part

One: Performance and Value-Based Contracting efforts have the evidence backing to inform

CalAIM).

based contracting. As the state moves forward with CalAIM, they may be able to offer insight into sustainable funding sources to support performance and value-based contracting in Orange

County.

The following are recommendations related to factors internal to Orange County, such as community engagement.

• Maintain clear communication with involved stakeholders and report progress back to the community. Relationships and buy-in are at the core of this project. Providers, County staff, private and public payers, and the community all have a vested interest in project progress.

Maintaining clear and open communication lines across sectors and sharing the established metrics for value-based contracting will improve relationship building and knowledge sharing. It can also help to establish champions to support the project. • Adapt communication approaches for different audiences. Private payers, public payers, and community stakeholders at times use different language/terminology to reference the same things. Creating structured approaches that reflect their language/terminology is key to ensuring cross-sector collaboration.

• Prioritize learning early on what the wants, desires, and goals are of each private payer. This facilitates tailoring communication approaches to find a middle ground which meets the needs of the health plan while also establishing agreed upon contract metrics. It can also help reestablish relationships with payers if there is internal staff turnover. • Return to the community regularly with project progress. Using data that is collected on the data dashboard and translating that back to the community helps to maintain buy-in.

The following are recommendations that relate to metrics for value-based contracting and value-based payment contracting/incentivizing.

• Create methods to increase the sharing of data. Identification of a unified data sharing platform can promote transparent sharing of data and identified quality indicators, which may support choosing easily measurable value-based metrics that are meaningful to both Providers and the

Community. It can also facilitate more streamlined reporting.

• Allow for flexibility in the structuring of contracts. Everchanging policies, regulations, and turnover can affect the long-term success of contracts. Contracts should be structured in a way that allows for flexibility when, for instance, providers change.

The following are recommendations that relate to planning and education and technical assistance.

Although many people support a transition to performance and value-based contracting, the vision for how to achieve this goal varies. With diverse stakeholders involved, varying visions can pull the project in different directions, stalling progress. Early discussions to establish a clear vision in plain language with concrete yet flexible steps to get there is key.

• Be cognizant of which services to approach private payers with first. Commercial plans have varying levels of familiarity with different behavioral health services. Some may be completely new to their billing process and therefore may be challenging for payers to understand/see the value in. Take this into consideration in the initial planning stages to facilitate early conversations with private payers. It may be helpful to start discussions with services that the commercial plans are more familiar with.

and community members) understand what “incentivizing” means. Setting foundational education efforts will support long-term culture shift that is necessary to enable transitioning away from existing traditional contract structures. • Establish meeting/training schedules with providers and payers. Ongoing training to ensure stakeholders understand the metrics and goals of the performance and value-based payment contract can help address challenges early. Trainings may also offer valuable feedback on metric reporting and suggestions for future contract changes.