OCA work group debates how to measure and time a behavioral health investment benchmark

Office of Healthcare Affordability staff on Wednesday outlined options for a statewide behavioral health investment benchmark and sought input from work group members on how to measure and phase in any requirement.

OCA staff framed the policy task as choosing between expressing the benchmark as a share of total medical expense (TME) or as a per member per month (PMPM) amount, and deciding whether the final benchmark should emphasize annual incremental improvements, a long‑term goal, or a combination of both. Staff also previewed a claims‑based code set and recommended rules for counting non‑claims payments toward behavioral health spending.

The benchmark framing matters because it affects what the requirement would reward and how progress is tracked. “In addition, setting the benchmark based on TME communicates that increased spending on behavioral healthcare should reallocate the healthcare spending pie, rather than contribute to an increase in total spending,” said Debbie Lindas, healthcare delivery system group manager at the Office of Healthcare Affordability (OCAH). Lindas presented the staff recommendation that OCA’s focused benchmark include outpatient and community‑based claims and certain non‑claims payments that can be plausibly attributed to behavioral health, such as practice infrastructure and population‑health payments made to behavioral‑health providers.

Staff described tradeoffs between the two main measurement approaches. A PMPM metric, staff said, can better…