By Rick Valachovic, DMD, MPH, Clinical Professor and Director of the NYU Dentistry Center for Oral Health Policy and Management

The age of value-based care has begun. The result will be an overhaul of how we think about, deliver, and are reimbursed for health care. These sweeping changes represent an extraordinary opportunity for dentistry—not only to define what value-based care means for oral health, but also to reshape health care to include what medicine has so often overlooked: the mouth.

Value-Based Care in a Nutshell

For anyone new to this discussion, at its core, value-based care aims to reward the quality rather than the quantity of care delivered. This prevention-focused approach incentivizes providers to improve the health of their patient populations by using personalized preventive care to ward off disease before it happens. This approach represents a sea change from the typical fee-for-service model that rewards providers for the number of procedures or treatments delivered after a patient becomes ill or experiences pain. Reimbursement models that focus on quality are person-centered and risk-based, so they inherently promote equity, target social determinants, and reduce health care disparities. The result is a healthier overall population at a reduced cost.

Value-Based Care and Oral Health Care

The value-based care movement is international, making strides in countries such as Brazil and the Netherlands, as well as in the United States. In 2022, 41% of U.S. health care payments involved alternative payment models, and another 18% of payments linked quality and value to fee-for-service reimbursements. Alternative payment models have gained the greatest traction in Medicare Advantage followed by Medicare and Medicaid—public programs which play much larger roles in medicine than in dentistry. Do our professions risk being left behind?

In 2020, the CareQuest Institute for Oral Health surveyed almost 3,000 dental providers in more than 20 states. It found 51% of respondents had never heard of alternative payment models in dentistry. Their report noted an increase in dental payments linked to alternative payment models from 27% of all Medicaid dental claims in 2013 to 33% in 2017. Additionally, some federally qualified health centers have implemented an integrated dental model emphasizing value-based care.

That represents progress but on the margins. Traditional Medicare does not cover most adult dental care, and in many states, fewer than half of dentists are enrolled as Medicaid providers and many of those are not seeing any Medicaid patients. We need to do more to push dentistry in the right direction.

Academic dentistry could help, but our commitment to value-based care also lags behind that of our medical peers. In a 2022 survey of dental school deans, 65% of respondents reported that value-based care was not currently in the didactic curriculum and only 25% said their schools were considering implementing value-based care in their clinics. Similarly, a 2022 study showed a need for more training and guidance among dental school faculty to effectively bring value-based care into didactic and clinical instruction.

An Opportunity at Our Fingertips

In addition to its potential to reduce health care spending, value-based care blazes a path for medical-dental integration. The focus on value gives oral health professionals an opportunity to demonstrate how the integration of dental and primary care can improve patient outcomes. You might say it is our chance to show that the money is where the mouth is.

Control of type 2 diabetes is one case in point. A recent study in The Journal of the American Dental Association showed that overall health care spending for Medicaid patients with the disease decreased by 14% when they regularly received periodontal treatment. A decrease of 12% occurred for similar patients with commercial insurance. Value-based care should incentivize this type of integrated care and make it the rule, rather than the exception.

In a recent article in JAMA Internal Medicine, Ira Lamster, DDS, MMSc, clinical professor, Stony Brook School of Dental Medicine, and Lisa Simon, MD, DMD, fellow in oral health and medicine integration, Harvard School of Dental Medicine, suggest some specific ways dentists could enhance primary care by seizing the opportunities latent in our unique access to patients who come in for regular dental cleanings. They note past successes with screening for tobacco use and poor diet, adding that dentists can perform services such as hypertension and depression screenings without additional infrastructure. Further, screenings for conditions such as colorectal cancer, HIV, and type 2 diabetes can occur with minimal additional resources.

The shift to value-based care in health care primes the landscape for this kind of thinking. When conversations occur about shaping value-based care, we need to be sure we are present and ready to make the case for medical-dental integration.

Barriers to Value-Based Care in Oral Health Care

Of course, implementation of value-based care in oral health care is not without its challenges. The predominance of small dental practices, compatibility issues with electronic health records, the limited use of diagnostic codes in dentistry, and the current structure of dental insurance all present barriers. Most significantly, state and federal quality and reporting programs lack standardized oral health measures that would help us define what we mean by “quality,” hindering our ability to develop uniform ways of addressing such things as compensation and accountability. But these barriers are not insurmountable—and they are not new. The rise of value-based care has simply brought them to the fore.

Embracing the Value-Based Care Paradigm

The barriers we face leave us with quite a to-do list that includes devising outcome measures, increasing our use of diagnostic codes, and developing collaborative partnerships to foster interprofessional care. But the first order of business is to increase understanding and acceptance of value-based care among those in our own community. This is where dental education can play an essential role. We must incorporate value-based care into our curricula, determining what to teach and how to teach it. If we take these steps, the next generation of dentists will be prepared to practice in a value-based care environment enhanced by medical-dental integration. The sooner we embrace this paradigm shift, the sooner we can make it a reality.