Behavioral Health System Transformation: Performance and Value-Based Contracting

An Orange County MHSA Innovation Project, through Mind OC

This component of the Behavioral Health System Transformation (BHST) Innovation involves the development of Performance / Value-Based Contracts. This time-limited project runs from October 2019 through June 2022. The goal of shifting toward value-based contracting is to improve quality of and access to culturally responsive and inclusive behavioral health (mental health and substance abuse) services for all Orange County residents, regardless of insurance type.

The Health Care Agency (HCA) has contracted with Mind OC to work collaboratively and with community stakeholders to plan for strategies for value-based contracting. Mind OC is a 501(c)3 non-profit organization created to facilitate Be Well OC, a movement driven by a coalition of over one hundred public/private/faith based/academic institutions united to build a system of Mental Health and SUD Care for all residents of Orange County regardless of payor source.

Planning and Organizing

Overall Project Activities

  • Engage wide participation of stakeholders, community partners, providers and county staff to participate in planning activities and discussions
  • Explore feasibility of braiding public, private and philanthropic/non-profit funds to create a universal reimbursement rate/structure
  • Identify and operationalize community values and preferred, measurable performance standards
  • Develop contracts incentivizing community defined and performance-based and regulatory standards
  • Streamline reporting processes to comply with multiple sets of regulations and new performance outcome standards
  • Prepare local providers for new performance standards and contracting through technical assistance
  • Leverage existing partnerships and collaborations, in recognition that many activities are already underway in the community
  • Share learning made available through templates, contracts, RFPs, white papers and presentations
  • Report out to stakeholders on learnings from State meetings and related initiatives that are relevant to the BHST work

Communication and Coordination

Continuous feedback to and across the two following areas will be vital.

  • Community Planning: Ongoing meetings with consumers & family members to identify community values and preferred performance standards
  • System Assessment & Capacity Building for Financial Design: Ongoing meetings with HCA Behavioral Health, CalOptima, local private insurance plans, and related organizations (providers, etc.) to identify potential system-level metrics that could drive quality improvement and explore potential rate structures, braiding strategies, provider requirements, and incentives, as well as legal, fiscal and regulatory requirements that support behavioral health system change 

The following information is intended to provide overall clarifications regarding common questions about this project. We will continue to add to these as the project moves forward and will provide more detailed responses to questions not addressed here. This information is intended for stakeholders, community partners, providers, and county staff. 

Answers to Common Questions

This component of the Behavioral Health System Transformation Innovation involves the development of Performance / Value-Based Contracts that move from payment for volume and costs toward payment for outcomes and value.

Contract templates that include value-based payments and identify performance metrics and incentives related to behavioral health services.

The goal is to make it easier to get and provide high quality behavioral health care services that are culturally responsive and inclusive, regardless of a client’s insurance type.

Your participation in the process is vital, along with all stakeholders – and consumer, peer, and family member engagement is especially important.

Mind OC and HCA will make every effort to successfully engage the widest array of county and county contracted staff, community partners and stakeholders, but we must also rely on our community partners to support additional and deeper engagement. We need to all work together to ensure the diversity of participants, including factors such as ethnicity and race, culture, Veteran status, LGBTQ, limited-English speaking/monolingual communities and many others.

Stipends, and other supports such as meals and transportation will be available as appropriate to support client, family, and community engagement.

  • The exact structure for measurement and incentives will be determined as part of the stakeholder engagement process, but, broadly speaking, it is anticipated that metrics and incentives will be geared toward supporting improvement and achievement of benchmarks, with a transparent plan for reevaluating over time.
  • We expect metrics and associated incentives to address structural, process, outcome, client-reported, and other elements. Metrics and associated incentives will include health outcomes, health factors, clinical care, social determinants of health, care transitions, as well as client, family, and community experience.
  • Any measures valued by the stakeholders will be considered.
  • Once elements of the overall design, including metrics, are established, there will be an effort to align applicable compliance, funding, data sharing, and other requirements and programs.
  • We will look to other efforts across California and the nation.

This project is meant to explore opportunities for improvement and transformation. Please keep in mind that there are significant challenges in all systems of care and this project is designed to be a step toward and part of the planning for solutions. Other efforts will still be needed and this project can be part of that solution.

Meeting Notes and Materials

February 2020 Kickoff Slides – DOWNLOAD

February 2020 Kickoff Meeting Summary:

March Be Well Coalition Meeting Summary and Survey Results

Orange County Behavioral Health System Transformation and Value Based Payments: Findings from Key Informant Interviews [Forthcoming]

October 2020 Update to the OAC [Forthcoming]

Please contact Nicole Ramirez ( for additional information or to engage with this project.

Funded by the County of Orange Health Care Agency, Behavioral Health Services, Innovation Projects, Mental Health Services Act/Prop 63