Alternative Payment Model Based on Value and Quality Rather than Quantity Arrives in the Dental Industry

DentaQuest provides flexible and customized dental solutions for Medicaid and CHIP, Medicare Advantage, and small and large businesses and individuals throughout the U.S. Their clients range from state governments to leading health plans, and they manage dental and vision benefits for more than 27 million Americans. With the goal of making oral health care affordable and easier to access, they focus on prevention, which they call, ‘Preventistry.’

Now, they are taking the idea of prevention and person-centered care one step further. They have entered into a first-of-its-kind agreement in Texas with Brident Dental (an affiliate of Western Dental) to administer a contract under the state’s Medicaid program using a value-based care and payment model.

The Centers for Medicare & Medicaid Services (CMS) began emphasizing value-based healthcare over quantity of provider visits in 2008. The CMS defines value-based care as those programs that reward providers with incentive payments for quality of care they provide to people with Medicare. When the Affordable Care Act (ACA) was implemented in 2010 it began to emphasize quality care and established several value-based programs that rewarded providers. Value-based programs are important because they reward providers based on the quality, rather than the quantity of care they give patients.

Timeline for value-based programs. Source: Centers for Medicare & Medicaid Services

Texas Health and Human Services Commission has encouraged partners, including DentaQuest, to work with providers to begin transitioning to value-based programs. Over time, these types of contract structures are expected to reduce administrative paperwork and promote a focus on disease prevention and oral health maintenance.

The contract with Brident Dental, which supports 34 affiliated dental offices in 11 Texas counties, will run through 2019. It represents an initial step towards a shift from a fee-for-service payment model to an alternative payment model (APM) that rewards value and outcomes. Under this APM contract, Brident Dental’s reimbursement levels are tied to quality metrics and overall cost of care. The contract with Brident Dental’s affiliated dental providers requires quarterly monitoring to ensure that providers are meeting appropriate guidelines for providing preventive services to patients.

Brident is an affiliate of Western Dental, one of the nation’s largest dental providers, serving approximately 2.4 million patient visits annually in 249 affiliated offices throughout California, Arizona, Nevada, and Texas. Brident offers general dentistry, orthodontics, oral surgery, pediatric dentistry, periodontics and endodontics in its offices.

“Our mission has always been to offer quality dental care that is convenient, affordable and accessible to all. We are pleased to work with the state of Texas and our dental partners in the Medicaid program on a value-based program with DentaQuest as we continue to carry out that mission.” said Dr. John Luther, Chief Dental Officer of Western Dental

DentaQuest stressed that no dental practices will be required to switch to a value-based model. The model is being introduced first to a small number of practices that are willing and best situated to begin the change from a fee-for-service model, but they hope that other practices will follow their lead.

“As a ‘double bottom line’ company, DentaQuest has invested millions of dollars in research and evaluation of payment and care models, and with Brident Dental, our care improvement initiatives come to life in Texas. We applaud Texas Medicaid for taking the lead to promote value-based alternative payment models as a critical step to achieving person-centered care, and we are confident the Brident Dental program will not only help control costs, but will also result in better patient care,” said Joe Vesowate, Regional Vice President, DentaQuest.

Source:  Elation Health, DentaQuestCenters for Medicare & Medicaid Services

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