A patient-centered, evidence-based care model with a personalized focus on improving patient health outcomes through wellness, prevention and management of chronic disease is the way to go.
Oral health is an important, and often overlooked, part of overall health and wellness. Research continues to show the importance of the oral-systemic connection in our overall health. The future of dentistry is a holistic model—patient-centered, evidence-based care with a personalized focus on improving patient health outcomes through wellness, prevention and management of chronic disease.
The mouth is not separate from the rest of the body. Yet, care models are bifurcated to separate the two. Dentists and physicians alike know periodontitis and other oral diseases connect to chronic inflammatory processes in the body such as diabetes, heart disease, stroke and poor pregnancy outcomes. Nevertheless, the dental model often perpetuates reactive care by covering and treating oral health based on volume, not value, and missing opportunities to collaborate with our medical partners.
Emphasizing the quality of care resulting in improved patient oral and health outcomes is the future of dentistry and its support system. As the practice of dentistry evolves to meet changing patient needs, evolving payor models and rapidly advancing technology, the following must be considered:
How Do We Define the Quality of Care?
All health care should be effective, efficient, equitable, integrated, people-centered, safe and timely. The World Health Organization (WHO) defines the quality of care as “the degree to which health services for individuals and populations increase the likelihood of desired health outcomes.”1
As the shift in health care moves from sick care to well care, it is time dentistry delivery and payment models shift as well.
We all need to take a closer look at how best to focus on improved patient outcomes through strategic services and interventions, especially for our patients with chronic disease. In a value-based care system, payments are used to incentivize clinicians to improve patient outcomes by focusing on interventions or treatment known to lead to better health.2 Value-based reimbursement must incorporate payment models that allow providers to focus on assessing risk and managing disease rather than treating the symptoms or sequelae of the disease. This has the potential to improve quality and reduce unnecessary costs. There are several creative and innovative programs today aimed at improving outcomes through incentives for the patient or provider. These programs reward patients for compliance and good habits with premium reductions and benefit providers with an increased fee schedule or bonus for delivering preventive services. These incentives are a step in the right direction but for long-term success, dentistry needs evidence-based measures to determine short-term outcomes coupled with incentives to improve health outcomes. Dentistry continues to advance in the areas of clinical quality measurement and the development of evidence-based clinical treatment guidelines.
Intersecting the Parallel Processes for Patients’ Benefit
With the different training, treatment codes, payment models and electronic record systems, medical and dental systems—and subsequently, the care—run parallel. There are few opportunities to intersect. Nevertheless, finding ways to bridge medical and dental systems is crucial for holistic dentistry to succeed. I believe medical and dental payors are perfectly positioned to participate in bridging this gap.
Government Employees Health Association (GEHA) is a dental and health benefits provider for one of the nation’s largest employers, the federal government. GEHA offers coordinated benefits to its members and champions value-based care for those who serve our country. GEHA's Dental and Medical Directors work closely to identify ways to provide targeted, integrated health and well-being solutions at the best value as it relates to the entire person. At GEHA we are actively looking for ways to use this partnership to share information and resources to identify and support the members most at risk for disease.
How Do We Support Targeted Interventions for Those Most at Risk for Oral and Systemic Disease?
Payors are the hub of medical and dental health information for both patients and providers and are in a position to support targeted interventions specific to those patients most at risk for disease. The payor has an important part to play in support of moving toward value over volume by sharing information with providers and members, support outreach and programs that incentivize patients and providers.
Payors can support providers by sharing information in a meaningful way, identifying high-risk patients, encouraging compliance with known practices that lead to overall health and wellness and catering payment systems to compensate dentists for interventions known to treat the patient holistically. Outreach across all systems—dental or medical—should be consistent and patient-oriented.
It is crucial holistic conversations happen from all sides, including between the patient and the payor, to better educate on improved health outcomes and proactive disease management.
For example, GEHA is uniquely situated to help providers and patients proactively manage care—including both dental to medical—because it provides both dental and medical benefits. The organization has a proactive care management team responsible for reaching out to high-risk patients to ensure they have the resources to be in control of their care. Additionally, GEHA educates its entire health team on the importance of holistic dentistry to ensure its employees who interact with members understand the value of connecting the mouth and the body.
While payors have a critical role in supporting a holistic approach due to their access to data, patients, providers, nothing is more important than the relationship between the provider and the patient and it is crucial for success of any value-based care model.
Providers, medical and dental, must continue to communicate with their patients about the importance of oral health and the connection with the rest of the body.
As the health care industry moves toward value-based care, partnerships and collaboration are vitally important. These partnerships and collaboration efforts are not only bidirectional but a composite of many influences. Dentists and payors must work together to refocus the payment modality to support dentists when focusing on disease prevention and management.
The great news is that a wave of change has started and the momentum to put the mouth back in the body is gaining as the focus on improved health outcomes as it relates to oral health is properly prioritized.