OBJECTIVES : Mental disorder is a behavioral or psychological syndrome that affects nearly one in five U.S. adults. The quality of mental health services has worsened over time and are delivered across primary and specialty care through a poorly coordinated fee-for-service arrangements. This review aims to outline the potential of Value-based contracting (VBC), a risk-sharing agreement between a payer and provider, as a tool to improve mental health care.

METHODS : A targeted literature search of published studies in last 10 years was performed using PubMed, EMBASE and Cochrane Library databases. Also, relevant grey literature in mental health and contracting arrangements were searched. The outcomes included mortality, suicidal rate, inpatients re-admissions, medication adherence, treatment satisfaction and total healthcare spending.

RESULTS : A total of 24 publications met the inclusion criteria. Nearly 70% indicated that VBC led to a significant reduction in re-admissions and total healthcare spending by linking patients’ health care costs to the value of the service rather than cost of acquisition. Significant improvement in medication adherence and treatment satisfaction owing to timely follow-up was also observed. VBC provides an opportunity to address funding gaps in the behavioral healthcare system by increasing accountability of healthcare providers. However, there was limited evidence for mortality and number of suicides.

Sixty-two value-based contracts were executed and publicly announced in the United States between 2009-2019, out of which 41 contracts (66%) were based on cardiology, neurology and endocrinology while only 2 contracts (3%) were related to mental health, thus indicating severe under-utilization or under-reporting of such contracts.

CONCLUSIONS : VBC coupled with adjunct incentives for quality can improve the outcomes of mental disorder patients by aligning incentives across provider and payers while maintaining cost-efficiency. However, generalization of findings is limited due to lack of adequate reported VBC in mental health. Increased usage of these arrangements and further research would be warranted.