A framework for oral health care value-based payment approaches

Area of Science:

• Oral health care economics
• Health services research
• Dental policy

Background:

• Dental practice payment models have largely remained separate from broader healthcare system reforms.
• Value-based payment (VBP) models, prevalent in general healthcare, are notably underutilized in oral health.
• This disconnect presents an opportunity for innovation in dental care financing.

Purpose of the Study:

• To introduce a novel value-based payment (VBP) framework specifically designed for the dental industry.
• To outline a structured approach for implementing VBP in oral health care settings.
• To provide a roadmap for aligning dental payment with broader healthcare payment reform initiatives.

Main Methods:

• Development of a VBP framework for oral health care, incorporating 9 distinct payment methods.
• Adaptation of the Centers for Medicare & Medicaid Services (CMS) Learning Action Network framework for health care payment reform.
• Categorization of payment mechanisms along a continuum of financial risk and reward.

Main Results:

• The proposed framework comprises 4 distinct payment categories and 9 unique payment mechanisms.
• These mechanisms offer a spectrum of value, with varying financial implications for providers and payers.
• The framework facilitates a transition towards more value-driven oral health care delivery.

Conclusions:

• Despite advances in dental care, there is a growing demand from payers and policymakers for improved value.
• VBP models can enhance the efficiency and value proposition of oral health care by equipping providers with necessary resources.
• Implementing VBP in dentistry requires minimal practice pattern adjustments and offers significant potential for reform.