A value-based care program in dentistry centered on caries risk assessment: Preliminary results

Area of Science:

• Oral Health
• Public Health
• Value-Based Care

Background:

• The Benefits and Rewards for Utilization, Services and Healthy Outcomes (BRUSH) program is a value-based oral healthcare initiative implemented in four US states (2021-2022).
• BRUSH targets Medicaid beneficiaries up to age 21, utilizing a Caries Risk Assessment (CRA) strategy to manage oral health.
• The program incentivizes providers to lower or maintain low caries risk levels over time.

Purpose of the Study:

• To evaluate the effectiveness of a value-based dental program using Caries Risk Assessment (CRA) in managing oral health outcomes.
• To determine changes in caries risk over a 24-month period in young Medicaid beneficiaries.
• To identify predictors of changes in caries risk and procedures performed within the program.

Main Methods:

• Analysis of deidentified insurance claims data for 2,706 patients in Florida with 2-year follow-up.
• Incentivizing providers based on initial CRA and subsequent risk level changes over 12 months.
• Statistical analyses, including multiple regression, were used to identify factors influencing changes in risk level and procedures.

Main Results:

• The program successfully lowered caries risk in 64% of high-risk patients over 24 months.
• Overall, 65% of patients across all baseline risk levels experienced reduced or maintained low caries risk.
• Patients with lowered caries risk were significantly less likely to require restorative procedures (P < .00001).

Conclusions:

• A value-based dental program incorporating Caries Risk Assessment (CRA) is effective in reducing or maintaining low caries risk.
• Successful value-based care programs can improve oral health by decreasing caries experience.
• Long-term implementation of such programs has the potential to reduce healthcare costs.