Use Value-Based Care to Improve Outcomes and Reduce Costs
It’s clear that dentistry is not immune from challenges to traditional healthcare delivery and payment models that arise from outside influences. Changes in market demand and technological and environmental disruptors such as COVID-19 are forcing the industry to reimagine itself.
What’s less clear, to many, is the important role dentistry can play in the value equation both during and after the pandemic.
Even before the coronavirus began to spread in early 2020, oral health value-based care (VBC) was gaining significant traction in the United States. In fact, Medicaid dental claims related to VBC represented a third of all government reimbursements in 2017 after a steady increase over five years.
Government agencies, dental benefits companies, and commercial and private dentists are moving toward VBC. We’re seeing significant shifts in the industry, including the rise in automated subscription platforms, because of consumer habit changes, actual and perceived affordability of dental care, and the convergence of medical and dental benefit structures. The economic stress the COVID-19 pandemic has placed on the health system is, of course, a factor too.
Given those influences, respected organizations are moving to endorse VBC for oral health, the most recent being the National Association of Community Health Centers (NACHC). Shifting away from fragmented dental care into a coordinated, integrated care model, NACHC is well positioned to lead transformation into a value-based system.
But community health systems aren’t the only oral healthcare providers moving toward value. Ultimately, VBC constructs will become a mainstay for those working and operating in dentistry, so today’s practitioners should be considering how to find their place in the drive to value.
How are you handling these changes? Where’s your place in the shift toward VBC today? Where do you want to be in the future?
Prioritizing Holistic Health
The VBC model prioritizes preventive care and taking care of the whole patient. In dentistry, it’s been defined as the improvement of oral health outcomes divided by the cost to achieve those improvements. To us, this underscores the importance of integration and supporting oral healthcare quality as a key part of overall health care.
Taking a holistic view of patient health through interprofessional collaboration can pay off for the patient, the provider, and the payer. A recent study of integrated health system data found that for every 1% increase in access to dental services by diagnosed diabetics, there was a 0.2% decrease in the cost associated with uncontrolled diabetes, which carries a cost double to triple that of controlled diabetes.
VBC opportunities focused on medical-dental integration present significant opportunities for dentists to contribute to overall health improvement and impact care costs for their patient populations, potentially sharing in the success of cost savings from medical care delivery.
A core characteristic of successful VBC is the utilization of minimally invasive care (MIC) that reverses or slows early disease stages. Using MIC to create remineralization or periodontal attachment gain is particularly valuable, notably at the population level, in improving systemic health and impacting cost.
Care teams and organizations driving value and cost savings have found great benefit with initiating and implementing MIC processes, and not just for safety measures detailed as part of the nation’s COVID-19 response.
These proactive processes promote patient wellness through management of chronic disease. In turn, this process drives enhanced outcomes beyond today’s approach of largely reactive interventions, reducing the need for more invasive and thus expensive procedures.
The Evolution of Value-Based Care
There are barriers and professional philosophies entangled with the evolution of VBC. Publications and editorials call attention to a lack of consensus on measurement, limited knowledge of VBC, concern with financial risk, and provider apprehension about patients’ willingness to improve their health.
Regardless of the challenges, many care teams and oral health organizations have found success with VBC models. Most likely, this is because VBC can enable resilience and adaptability for any dentist. For instance, the slower chair turnover and lower daily encounters from COVID-19 care interruptions have less of a financial impact when provider success relies on achieving goals, preventive care, and education delivered outside the dental chair.
One main characteristic shared by these successful programs is the understanding that today’s VBC designs are not the same as the capitated processes of health maintenance organization (HMO) programs, which did not result in widespread outcomes improvement or budget predictability for patient costs.
Today, VBC designs aim to help prepare for a future where patients are using services more but require less costly treatments to stay healthy. Figures 1 and 2 illustrate this using 2018 national Medicaid dental claims to compare alternative payment models (APMs) to fee-for-service (FFS) reimbursement. The analysis shows APMs cost less overall and have higher utilization than FFS.
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