A framework for oral health care value-based payment approaches

William Riley, Mark Doherty, Kailey Love

Research output: Contribution to journalArticle

Abstract

Background: Dental practice has remained relatively insulated from payment upheavals in the broader health care system. The prevailing value-based payment (VBP) models in health care are largely absent in oral health care. The authors present an oral health care value-based payment framework for dentistry. Methods: The authors developed a VBP framework for oral health care, which describes 9 distinct methods to create VBP approaches in dentistry. The framework is based on the Centers for Medicare & Medicaid Services Learning Action Network framework for health care payment reform. Results: The oral health care value-based payment framework includes 4 payment categories and 9 separate payment mechanisms. These 9 payment mechanisms range on a value continuum, each with different financial risks and rewards as well as distinct value implications. Conclusions: Although dental practice has made extraordinary advances in restorative dentistry, payers and policy makers are advocating for greater value outcomes. VBP models seek to deliver better care more efficiently by means of providing oral health providers the resources needed to increase the value proposition. With relatively minor modifications in practice patterns, VBP models can be developed and implemented for oral health care. Practical Implications: This article can be used as a road map to take steps toward oral health care VBP approaches. The framework highlights how dentistry can learn from payment reforms under way in the health care system and present a model for oral health care payment and care delivery reform, and provides recommendations to advance oral health care VBP.

Original languageEnglish (US)
Pages (from-to)178-185
Number of pages8
JournalJournal of the American Dental Association
Volume150
Issue number3
DOIs
StatePublished - Mar 1 2019

Fingerprint

Oral Health
Delivery of Health Care
Dentistry
Tooth
Health Care Reform
Health Resources
Medicaid
Medicare
Administrative Personnel
Reward
Learning

Keywords

  • dental health care services
  • health policy
  • quality of care
  • Reimbursement mechanisms

ASJC Scopus subject areas

  • Dentistry(all)

Cite this

A framework for oral health care value-based payment approaches. / Riley, William; Doherty, Mark; Love, Kailey.

In: Journal of the American Dental Association, Vol. 150, No. 3, 01.03.2019, p. 178-185.

Research output: Contribution to journalArticle

@article{058afdc7f1234f0d9a61ba91f2c8fc9b,
title = "A framework for oral health care value-based payment approaches",
abstract = "Background: Dental practice has remained relatively insulated from payment upheavals in the broader health care system. The prevailing value-based payment (VBP) models in health care are largely absent in oral health care. The authors present an oral health care value-based payment framework for dentistry. Methods: The authors developed a VBP framework for oral health care, which describes 9 distinct methods to create VBP approaches in dentistry. The framework is based on the Centers for Medicare & Medicaid Services Learning Action Network framework for health care payment reform. Results: The oral health care value-based payment framework includes 4 payment categories and 9 separate payment mechanisms. These 9 payment mechanisms range on a value continuum, each with different financial risks and rewards as well as distinct value implications. Conclusions: Although dental practice has made extraordinary advances in restorative dentistry, payers and policy makers are advocating for greater value outcomes. VBP models seek to deliver better care more efficiently by means of providing oral health providers the resources needed to increase the value proposition. With relatively minor modifications in practice patterns, VBP models can be developed and implemented for oral health care. Practical Implications: This article can be used as a road map to take steps toward oral health care VBP approaches. The framework highlights how dentistry can learn from payment reforms under way in the health care system and present a model for oral health care payment and care delivery reform, and provides recommendations to advance oral health care VBP.",
keywords = "dental health care services, health policy, quality of care, Reimbursement mechanisms",
author = "William Riley and Mark Doherty and Kailey Love",
year = "2019",
month = "3",
day = "1",
doi = "10.1016/j.adaj.2018.10.021",
language = "English (US)",
volume = "150",
pages = "178--185",
journal = "Journal of the American Dental Association",
issn = "0002-8177",
publisher = "American Dental Association",
number = "3",

}

TY - JOUR

T1 - A framework for oral health care value-based payment approaches

AU - Riley, William

AU - Doherty, Mark

AU - Love, Kailey

PY - 2019/3/1

Y1 - 2019/3/1

N2 - Background: Dental practice has remained relatively insulated from payment upheavals in the broader health care system. The prevailing value-based payment (VBP) models in health care are largely absent in oral health care. The authors present an oral health care value-based payment framework for dentistry. Methods: The authors developed a VBP framework for oral health care, which describes 9 distinct methods to create VBP approaches in dentistry. The framework is based on the Centers for Medicare & Medicaid Services Learning Action Network framework for health care payment reform. Results: The oral health care value-based payment framework includes 4 payment categories and 9 separate payment mechanisms. These 9 payment mechanisms range on a value continuum, each with different financial risks and rewards as well as distinct value implications. Conclusions: Although dental practice has made extraordinary advances in restorative dentistry, payers and policy makers are advocating for greater value outcomes. VBP models seek to deliver better care more efficiently by means of providing oral health providers the resources needed to increase the value proposition. With relatively minor modifications in practice patterns, VBP models can be developed and implemented for oral health care. Practical Implications: This article can be used as a road map to take steps toward oral health care VBP approaches. The framework highlights how dentistry can learn from payment reforms under way in the health care system and present a model for oral health care payment and care delivery reform, and provides recommendations to advance oral health care VBP.

AB - Background: Dental practice has remained relatively insulated from payment upheavals in the broader health care system. The prevailing value-based payment (VBP) models in health care are largely absent in oral health care. The authors present an oral health care value-based payment framework for dentistry. Methods: The authors developed a VBP framework for oral health care, which describes 9 distinct methods to create VBP approaches in dentistry. The framework is based on the Centers for Medicare & Medicaid Services Learning Action Network framework for health care payment reform. Results: The oral health care value-based payment framework includes 4 payment categories and 9 separate payment mechanisms. These 9 payment mechanisms range on a value continuum, each with different financial risks and rewards as well as distinct value implications. Conclusions: Although dental practice has made extraordinary advances in restorative dentistry, payers and policy makers are advocating for greater value outcomes. VBP models seek to deliver better care more efficiently by means of providing oral health providers the resources needed to increase the value proposition. With relatively minor modifications in practice patterns, VBP models can be developed and implemented for oral health care. Practical Implications: This article can be used as a road map to take steps toward oral health care VBP approaches. The framework highlights how dentistry can learn from payment reforms under way in the health care system and present a model for oral health care payment and care delivery reform, and provides recommendations to advance oral health care VBP.

KW - dental health care services

KW - health policy

KW - quality of care

KW - Reimbursement mechanisms

UR - http://www.scopus.com/inward/record.url?scp=85061612766&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85061612766&partnerID=8YFLogxK

U2 - 10.1016/j.adaj.2018.10.021

DO - 10.1016/j.adaj.2018.10.021

M3 - Article

VL - 150

SP - 178

EP - 185

JO - Journal of the American Dental Association

JF - Journal of the American Dental Association

SN - 0002-8177

IS - 3

ER -