Value-Based Care

At DentaQuest, we talk with people every day who are both in need of dental care and concerned about the cost of their care. We process claims for a long list of important services provided to children and adults experiencing tooth decay.   
 
While necessary, these covered services are delivered in response to an already present dental disease. Fillings and extractions address the impact of disease but do not address or eliminate its cause — or, said another way, restorative care is more costly and preventive care is more valuable.
 
In a value-based system, quality and outcomes improve while costs remain the same or fall because the healthier a person is, the less they require expensive services. 
 
A key driver in the success of a value-based system is aligning new payment models that reward care and outcomes and not the volume of services. The industry is increasingly moving in that direction.

What Is Value-Based Care? Value-based care (VBC) is a care delivery model in which providers are rewarded for quality health outcomes rather than the quantity of care delivered. In this approach, providers focus on improving the health of a population of patients by offering care that is focused on prevention, best evidence and personalization. This shift allows care teams to maximize “chair time” and productivity and the industry to better integrate with the overall health care system.   Today, more than 40 states are working to adopt value-based payment initiatives, up from just 15 in 2014. In a recent DentaQuest report, most dentists (73%), physicians (82%) and employers (87%) agreed that dental insurance should prioritize healthy outcomes over volume of care. More than half of employers surveyed said they were interested in implementing value-based care benefit design for dental coverage.   In the value-based care model, payors reimburse providers based on the quality of care instead of the volume of care. Already, payors are starting to move away from the outdated fee-for-service model and toward alternative value-based payment models, such as capitation or global payment, bonus and incentive payments and shared savings models with or without shared risk.   Achieving true value-based care in oral health care won’t happen overnight, but DentaQuest is uniquely positioned to help to drive this change by: Redesigning payment models to reward providers for keeping patients healthy Enabling providers and their dental teams to develop individualized, interactive care plans that allow the patient and their families to play a more active and engaged role in improving their own oral health

Providers See Value-Based Care and Medical-Dental Integration in Dentistry's Future The transition to value-based care isn’t as easy as flipping a switch, but a recent DentaQuest survey reveals that many providers see the prevention-focused model as the future of dentistry. Read blog » Lessons from the Pandemic: What COVID-19 Is Teaching Us About Value-Based Care Now, more than ever, we need to accelerate our efforts toward value-based care if we are going to emerge from the pandemic with a strong and resilient oral health system. Read blog post » Steve Pollock on The Case for Value Over Volume DentaQuest CEO Steve Pollock describes why paying for value over volume in oral health care is necessary for a healthier future. Watch video »

• Leadership
• Structure, Systems, Operations
• Care Pathways and Provider Buy-in
• Data and Analytic Technology and Personnel
• Financial Viability and Strength