How Does Value-Based Care Really Work in a Dental Office?

Steven Barefoot, DDS
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Value-based care (VBC) programs are relatively new in dentistry and, as such, they are still evolving. There is no “copy and paste” or “one size fits all.” So, how does VBC really work in a dental office?

VBC program designs vary significantly and depend heavily on the goals of the program, administration of the program, and additional clinical and administrative time. Recognizing that there are differences will allow an office to make an informed decision about participation.

What are those differences? And how can you evaluate them? Let’s explore.

Beginning with the basics, a core requirement for any VBC program is that a dental office agrees to be responsible for a defined set of patients. The process of assigning patients to a particular dentist is called attribution, and the functional construct is known as a dental home.

The dental home gives assigned members a known place for managing their oral health needs, and, importantly, provides a mechanism for VBC programs to fairly and accurately measure the performance and cost of participating offices.

The goal of any VBC program is to transition care patterns from restorative to preventive, resulting in lower costs and healthier patients. Only by making this transition can we narrow the gap between the need for dental services and the ability to deliver those services.

Because dental homes are a foundational component of VBC, it is advantageous for offices to understand how they work, their importance to VBC programs, and how to maximize their benefits. That leads to two important questions:

  • How are patients assigned?
  • What tools are available to manage those patients?

For example, understanding how to access your roster of assigned patients, identifying those that are due for care, and knowing how to contact them are critical factors to getting them scheduled and ensuring they are receiving the preventive care that will keep them healthy.

Effective dental home patient management tools will minimize administrative time, maximize efficiency, and ensure your assigned patient population is receiving the oral health care they need.

As noted above, not all VBC programs are equal. One of the most meaningful differentiators is the operational mechanics of performance measurements. The difference comes down to how much additional work an office needs to do to provide the data for the VBC program measurements.

Some programs require offices to record and submit documentation to demonstrate performance. This may ensure the office is in control of the data, but the additional administrative time may be burdensome to the point that the costs outweigh the benefits.

Other VBC programs minimize the administrate burden of participation by deriving performance data from submitted claims. This type of program design can minimize the impact on the office administrative staff.

The ideal VBC program design is one that can be easily incorporated into the day-to-day operations of the office with minimal extra effort. In such a program, the office understands and embraces the VBC objective of improving population health and recognizes that outreach to its assigned patients is an important aspect of the program. The ideal program also means that any modifications made to participate in it aren’t disruptive to the patient experience. 

Although VBC programs may have different designs, there are elements common to all. One way to know if your office is ready for the transition to this new model is to determine the current state of the practice.

The national nonprofit CareQuest Institute for Oral Health has developed a free online VBC readiness assessment that allows offices to understand their current VBC capabilities in five domains:

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

CareQuest Institute also has a series of informative courses on the basics of VBC that provide continuing education credits.

Understanding the goals of VBC, understanding how different VBC programs work, and knowing your state of readiness are three key factors that will help determine if participating in a VBC program is right for you.

Dr. Barefoot is a clinical leader at DentaQuest, one of the nation’s largest oral health organizations working to improve the oral health of all. His 30-year career in dentistry includes clinical experience delivering patient care in private practice, as part of an HMO dental clinic, via mobile dentistry serving mostly Medicaid schoolchildren, and with other volunteers caring for rural communities in Honduras.

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