How Value-Based Care Benefits Members, Providers and Plans

Value-based care represents transformational shifts in the way providers are paid and care is delivered. Compared to the long-established fee-for-service approach where dentists are rewarded for the quantity and cost of procedures performed, a value-based approach rewards providers for delivering high-quality, cost-efficient care. This landscape-altering change — which benefits members, providers and health plans — prioritizes better oral health outcomes at lower costs.

Value-based care solutions incentivize providers to care for an entire population with the goal to keep patients healthy and operate in a cost-efficient manner. These solutions vary across a risk/reward spectrum include: 

• Fee-For-Service Plus: a fee-for-service model with additive incentives
• Bundled Payments: payments based on a fixed amount for each care episode
• Shared Savings: providers earn based on quality/cost performance
• Risk Share: providers share in both upside and downside risk
• Capitation Payments: payments based on a fixed amount per patient for a set period

Let’s explore how value-based care can benefit different stakeholders. 

Enriching member value and experiences

In a value-based oral health environment, members receive more personalized, coordinated care with an emphasis on prevention and a whole-health focus. This approach results in a better member care experience and engages members more directly and deeply in the quest to improve their own health.

How? Value-based oral health care benefits members by creating:

• A strong emphasis on prevention, which helps keep members healthy, avoid more costly treatment and reduce the likelihood of expensive emergency care. A focus on prevention also encourages members to proactively engage in the improvement of their oral health.
• The development of personalized care plans based on data from each member’s risk assessment. These individualized plans help ensure oral health issues are identified early before they become more serious.
• Proactive outreach to better understand members’ needs and gauge their level of satisfaction with the quality of care they’re receiving from providers. Proactive outreach strategies also enable dental benefits managers to help coordinate the delivery of care to ensure members receive the personalized care and experiences they value.
• A whole-health approach, which includes medical-dental care integration, member education and improved opportunities for chronic condition management. These components, again, help avoid more serious issues and the need for costlier treatment.
• A dental home structure, which aligns members with select high-performing providers who deliver superior, cost-effective care. A close, long-term relationship with these providers enables members to receive more personalized care and a better overall care experience.
• Innovations that increase care access and improve the cost-effectiveness of emergency care such as teledentistry platforms. 

Better opportunities and outcomes for providers and health plans

While it requires a commitment to modernize traditional mindsets, behaviors and systems, a successful transition to value-based dental care is also highly beneficial for providers and health plans.

For providers, the focus on the quality and value of care enables them to create more personalized care plans and support a whole-health approach. This results in more engaged patients and stronger patient-provider relationships. In addition, providers benefit from:

• The financial advantages of predictable monthly revenue, additional financial incentives for performance and the opportunity to gain patients through dental home assignments.
• The opportunity to drive quality and operational efficiencies at the practice in relation to competitors.
• Appropriate payment and incentivization for preventive care relative to more invasive care
• Enhanced collaboration with a dental benefits administrator in advancing the goal of improving oral health and value.

For health plans, there are several closely interrelated benefits:

• A value-based approach helps health plans achieve the Quadruple Aim of better health outcomes, lower costs, improved member experience, and improved provider experiences.
• This leads to healthier, happy members. And when the employees of a health plan’s customer are healthy, they’re more productive and more engaged.
• Collectively, these benefits help health plans attract and retain members, while setting their businesses apart in a highly competitive marketplace.

The creation of a value-based oral health environment represents a transformational change that positively benefits members, providers and health plans.

Contact us to learn how DentaQuest is leveraging strategic dental innovations to help health plans successfully make the transition to value-based oral health care and achieve the Quadruple Aim.