title: Value-based payment in implementing evidence-based care: the Mental Health Integration Program in Washington state.
abstract: OBJECTIVE
  To assess the role of value-based payment (VBP) in improving fidelity and patient outcomes in community implementation of an evidence-based mental health intervention, the Collaborative Care Model (CCM).
  
  
  METHODS
  Retrospective study based on a natural experiment.
  
  
  METHODS
  We used the clinical tracking data of 1806 adult patients enrolled in a large implementation of the CCM in community health clinics in Washington state. VBP was initiated in year 2 of the program, creating a natural experiment. We compared implementation fidelity (measured by 3 process-of-care elements of the CCM) between patient-months exposed to VBP and patient-months not exposed to VBP. A series of regressions were estimated to check robustness of findings. We estimated a Cox proportional hazard model to assess the effect of VBP on time to achieving clinically significant improvement in depression (measured based on changes in depression symptom scores over time).
  
  
  RESULTS
  Estimated marginal effects of VBP on fidelity ranged from 9% to 30% of the level of fidelity had there been no exposure to VBP (P <.05 for every fidelity measure). Improvement in fidelity in response to VBP was greater among providers with a larger patient panel and among providers with a lower level of fidelity at baseline. Exposure to VBP was associated with an adjusted hazard ratio of 1.45 (95% confidence interval, 1.04-2.03) for achieving clinically significant improvement in depression.
  
  
  CONCLUSIONS
  VBP improved fidelity to key elements of the CCM, both directly incentivized and not explicitly incentivized by the VBP, and improved patient depression outcomes.
authors.affiliation: Weill Cornell Medical College, 402 E 67th St, New York, NY 10065. E-mail: yub2003@med.cornell.edu.
authors.forename: Yuhua
authors.initials: Y
authors.lastname: Bao
authors.forename: Thomas G
authors.initials: TG
authors.lastname: McGuire
authors.forename: Ya-Fen
authors.initials: YF
authors.lastname: Chan
authors.forename: Ashley A
authors.initials: AA
authors.lastname: Eggman
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Ryan
authors.forename: Martha L
authors.initials: ML
authors.lastname: Bruce
authors.forename: Harold Alan
authors.initials: HA
authors.lastname: Pincus
authors.forename: Erin
authors.initials: E
authors.lastname: Hafer
authors.forename: Jürgen
authors.initials: J
authors.lastname: Unützer
mesh_terms: D000328:Adult; D015331:Cohort Studies; D003156:Community Mental Health Services / Q000458:organization & administration*; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration*; D003866:Depressive Disorder / Q000175:diagnosis / Q000191:economics / Q000628:therapy*; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care / Q000191:economics* / Q000379:methods; D011785:Quality Assurance, Health Care; D012189:Retrospective Studies; D000070376:Value-Based Health Insurance / Q000191:economics*; D014861:Washington