Workforce Solutions Jam | Payment Reform
The Promise and Potential of Value Based Purchasing for a Thriving Workforce
Payment is a primary lever for addressing gaps in equity of behavioral health salaries, building pathways for the future workforce and creating reimbursement that supports an expanded workforce. Shifting incentives to focus on outcomes rather than volume can improve job satisfaction and retention by enabling providers to spend more time with patients, engaging in comprehensive care coordination, and participating in integrated care teams. Payment reform can ensure more stable and predictable funding streams, allowing organizations to invest in workforce development, training, and innovative care approaches, ultimately leading to a more effective and thriving behavioral health workforce.
Key highlights of this webinar include:
- Learn what value-based purchasing really means and its potential to improve outcomes and reduce administrative burden.
- Explore the role of emerging payment and delivery reforms in addressing workforce challenges, aligning quality measurement, behavioral health integration with primary care, and supporting whole person health.
- Understand how states have typically structured alternative payment models (APMs) for behavioral health services and considerations for new APM efforts for care coordination offered by behavioral health providers.
- Discuss how managed care organizations have worked with behavioral health provider organizations to structure APMs and how behavioral health providers have responded to these efforts.
- Review value-based payment initiatives implemented by a health insurance company in Pennsylvania focused on the success of providers, stabilization of workforce, and achievement of improved outcomes.
- Learn how behavioral health providers in Minnesota are building and implementing value-based delivery and payment strategies through the state’s Integrated Health Partnership, the state’s only dedicated Behavioral Health accountable care organizational model.
Resources
RTI International: Behavioral health parity – Pervasive disparities in access to in-network care continue
- Health Care Payment Learning & Action Network
- LAN Framework
- LAN Accountable Care Curve
- Exploring Value-Based Payment for Substance Use Disorder Services in the United States (SAMHSA)
Relevant CMMI Model Links
State Examples
- 1115 Waiver Demonstrations (e.g., Virginia Addiction and Recovery Treatment Services Program)
- Medicaid Health Homes (e.g., Michigan Opioid Health Home)
- Certified Community Behavioral Health Centers (CCBHCs)
Speaker Information
Lori Fertall is the Director of Value-Based Programs at Community Care Behavioral Health, a non-profit behavioral health managed care organization that is part of the Insurance Services Division of UPMC headquartered in Pittsburgh, Pennsylvania. In this position, she is responsible for the creation, implementation, evaluation, and reporting of value-based purchasing arrangements with behavioral health providers. Previously as Community Care’s Director of Quality Management, she implemented quality management programs and performance improvement projects across the company and its provider networks. She regularly presents to a variety of local and national audiences at conferences on topics such as value-based purchasing, quality improvement, and payer/provider relationships. Prior to joining Community Care, Lori worked at various health and human service agencies in clinical and program development roles. She earned a master’s degree in Business Administration from Point Park University, a bachelor’s degree in Social Work and Women’s Studies from West Virginia University, and a Lean Six-Sigma Green Belt from UPMC.
John O’Brien has more than 30 years of experience in behavioral health systems design, financing, and implementation. He has worked with Medicaid, mental health, and substance abuse authorities in numerous states to develop federal Medicaid waivers, Medicaid state plan amendments, and federal grant applications. A former Senior Consultant at TAC, Mr. O’Brien directed the organization’s work on substance use disorders (SUDs) with an emphasis on helping states increase access to services, integrate SUD treatment and primary care, and reduce unnecessary costs by using Medicaid and other sources to support effective systems. He was the subject matter expert for several states in their efforts to implement systems of care for children and families with serious mental health conditions and on community integration strategies for adults with serious mental illness.
Mr. O’Brien has worked for the U.S. Department of Health and Human Services in leadership roles with the Centers for Medicare and Medicaid Services (CMS) and the Substance Abuse and Mental Health Services Administration (SAMHSA). At CMS, he led the Innovation Accelerator Program for Substance Use Disorder and Primary and Mental Health Integration and coordinated the agency’s efforts on developing guidance regarding parity for Medicaid and the Children’s Health Insurance Program. Mr. O’Brien played a significant role in the implementation of Medicaid expansion under the Affordable Care Act and in developing the Home and Community Based Services regulations. At SAMHSA, he was Senior Advisor to the Administrator on Health Care Reform.
Jin Lee (Jinny) Palen is the Executive Director of the Minnesota Association of Community Mental Health Programs (MACMHP) and Convergence Integrated Care, a clinically integrated network of community mental health centers across Minnesota. Her background includes public health research and analysis, community engagement, legislative advocacy, government relations, public policy, and community leadership. Prior to her role with MACMHP, Jinny was Minnesota Association of Community Health Centers (MNACHC) Public Policy Staff. Jinny stays active in her local neighborhood community clinic and AAPI community. Jinny worked for the Minnesota Department of Health in the Health Economics Program, Tobacco Prevention and Control, and the Legislative Affairs Office. Jinny was a Legislative Policy Fellow of the Partners for the Americas Policy Exchange Fellowship in 2014. She has a Bachelor of Arts in Biology from the College of Saint Benedict, St. Joseph MN, and a Master of Public Health degree from the University of Minnesota.
Samantha Repka is a Research Associate at the Duke-Margolis Institute for Health Policy where she focuses on issues related to care delivery and payment reform, behavioral health including substance use disorder, and other public health issues. Previously, Samantha worked at the New York City Department of Health and Mental Hygiene, where she served as a Director of Public Policy. Prior to her time in NYC, she was a Senior Manager at AcademyHealth and a Teach for America Corps Member. She holds a Master of Science in Public Health and a Bachelor of Science in Public Health from the University of North Carolina at Chapel Hill.
Background
The National Council for Mental Wellbeing launched the Center for Workforce Solutions in 2023 in partnership with The College for Behavioral Health Leadership and Health Management Associates. The partnership is leveraging Collective Impact to address the workforce crisis, and using a cross-sector approach to address the long-standing challenges for expanding and solidifying the behavioral health workforce.