Massachusetts Blues Plan Signs Nation’s First Value-Based Care Contract with Dental Management Group


This was announced in February as the country's first value-based contract between a payer and a dental group practice.


Adults 45 years and older with poorly controlled diabetes are nearly three times more likely to experience severe periodontitis than members of their age cohort without diabetes, according to the U.S. Centers for Disease Control and Prevention.

The federal agency says one-third of people with diabetes have severe periodontitis, which is a loss of attachment of 5 millimeters or more of the gums to the teeth.

Boston-based Blue Cross Blue Shield of Massachusetts (BCBSMA) and Waltham, Mass.-based 42 North Dental had patients with diabetes, as well as pregnant women and patients with heart conditions and oral cancer. This was announced in February in the country’s first value-based contract between a payer and a dental group practice. BCBSMA offers dental and medical insurance, in addition to other products, while 42 North Dental supports 22 dental practice brands in 70 New England locations.

Related: Data is the Foundation for the Shift to Value-Based Care

Under the agreement, BCBSMA will pay an incentive payment to 42 North Dental in early 2021 in return for dental providers demonstrating measurable quality improvements in the oral and overall health of the payer’s dental members, says Bob Lowando, DDS, executive director of Dental Blue at BCBSMA. The additional services for members include extra dental cleanings and periodontal treatments, which help patients manage their health conditions while reducing their medical costs, adds Lewando.

Michael Scialabba, DDS, vice president of clinical affairs at 42 North Dental, says the dental practice group saw 18,000 unique BCBSMA-insured Massachusetts patients in 2019. Patients who only have BCBSMA dental coverage must get a letter from their primary care physician confirming they have one of the conditions, he adds.

In September 2019, 17.8% of BCBSMA’s patients with diabetes received periodontal treatment at 42 North Dental, says Scialabba. In January, that metric increased to 20.5%. Scialabba wants to improve that metric by 50%.

Incentive payments will be commensurate with 42 North Dental’s ability to improve that and other metrics, says Lewando.

BCBSMA does mail and phone-based outreach to members who have dental and medical coverage, in addition to educating dentists, dental hygienists, and office staff about the value of additional cleanings and services for patients with these conditions. For members who only have BCBSMA dental plans, the payer relies on 42 North Dental to capture this information about patients each year.

Two early learnings, per Scialabba:

  • Educating patients, dentists, dental hygienists, and staff is key. 42 North Dental promotes the program on posters in treatment rooms, he says. Patients also learn about the program through automated messages and phone calls from staff. In addition, each morning, there’s a team huddle where everyone discusses the day’s patients. That’s when dentists, hygienists, and staff members discover the appropriate patients to target for conversations about the additional services. The number of patients per dental practice isn’t overwhelming, he adds; there are typically 10 to 12 BCBSMA patients with these conditions attributed to each practice.

It typically takes seven educational or outreach “touches” to enroll a patient in this or any new program, says Scialabba.

  • Change management is essential. Convincing 42 North Dental’s dentists to engage with patients about this program-or any new program-isn’t easy. Still, Scialabba calls on the dentists on his team to recommit to the goal they made to continuous learning at dental school graduation. Tracking and communicating monthly about four metrics-instead of twenty-also helps, he adds.

Scialabba says 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.

Lewando says this is a pilot with 42 North Dental. If the program is successful, he hopes to expand it to all 6,300 dental providers in Massachusetts. BCBSMA’s Dental Blue plan has one million members, most of whom also have the payer’s medical coverage.

Aine Cryts is a writer based in Boston.

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