Medical and dental care in the United States are like estranged colleagues: nominally on the same team but rarely, if ever, in touch with each other. Some value-based payment arrangements may start to mend the rift, which could both improve overall health and reduce healthcare costs.
“Health system leaders now have evidence that was not around five years ago showing (that) investing in dental care can have offsetting medical care cost savings,” says Marko Vujicic, Ph.D., chief economist and vice president at the American Dental Association’s Health Policy Institute. Vujicic has published research showing that periodontal care can lower the healthcare costs of people with Type 2 diabetes.
One notable value-based dental agreement is between Blue Cross Blue Shield of Massachusetts (BCBSMA) and 42 North Dental, a large dental group headquartered in Waltham, Massachusetts, outside Boston, comprising 24 practices. The two organizations signed a value-based contract, which they announced in February.
Under the agreement, BCBSMA will pay an incentive to 42 North Dental for the provider’s delivery of dental services to members with several conditions, including diabetes, some heart conditions and oral cancer, says Robert Lewando, D.D.S., MBA, executive director of BCBSMA’s Dental Blue plan. Pregnant women are also included. The additional services include extra dental cleanings and periodontal treatments, according to Lewando.
In September 2019, 17.8% of BCBSMA’s patients with diabetes received periodontal treatment at 42 North Dental, says Michael Scialabba, D.D.S., vice president of clinical affairs at 42 North Dental. By January 2020, that percentage had edged up to 20.5%. Scialabba wants it to improve to 50%. Incentive payments will be commensurate with 42 North Dental’s ability to improve that and other metrics, says Lewando.
Scialabba says 42 North Dental promotes the program in several ways: posters, automated messages and, among the staff, at team huddles. He notes that each practice includes periodontists and oral surgeons, in addition to general practice dentists, which encourages accountability across the team. “If you have five other colleagues in the group practice, you get criticized a lot. It holds you to a higher standard,” he adds. Typically, each 42 North Dental practice has about a dozen BCBSMA patients with these conditions, so the numbers aren’t overwhelming,
Lewando says the agreement with 42 North Dental is a pilot project. If it’s successful, he hopes to expand it to all 6,300 dental providers in Massachusetts that have contracts with BCBSMA.
DentaQuest, a dental and vision benefits company headquartered in Boston, has set up value-based metrics for 323,000 members in Oregon’s Medicaid program; the metrics are designed to emphasize preventive care, such as additional cleanings for people with diabetes. The program has been in place since 2012.
Advantage Dental, which is part of DentaQuest, contracts with 200 dentists to provide dental assessments, sealants and fluoride varnish to 50,000 children in schools and other settings in Oregon. Dentists are rewarded for achieving certain metrics, such as providing children and adults with access to dental services, timely dental assessment for children in foster care and comprehensive dental care for adults with diabetes. Kevin Boie, chief operations officer at Advantage Dental, says the practice has seen a 35% increase in dental sealants delivered to children over the past four years.
Aine Cryts is a healthcare writer based in Boston.