Value-based care represents transformational shifts in the way providers are paid and care is delivered. Compared to the long-established fee-for-service approach where dentists are rewarded for the quantity and cost of procedures performed, a value-based approach rewards providers for delivering high-quality, cost-efficient care. This landscape-altering change — which benefits members, providers and health plans — prioritizes better oral health outcomes at lower costs.

Value-based care solutions incentivize providers to care for an entire population with the goal to keep patients healthy and operate in a cost-efficient manner. These solutions vary across a risk/reward spectrum include:

When it comes to improving the oral health of your Medicare Advantage members, are you playing checkers or chess? While checkers serves a purpose, it’s the strategic moves, those you’d typically find in a chess match, that will help you achieve the Quadruple Aim.

The Quadruple Aim has become the standard for healthcare excellence. The Quadruple Aim builds on the Triple Aim (reduced costs, better quality/outcomes, and better member experience) by adding the fourth element, improved provider experience. Improving the provider and clinical experience has a direct correlation to positive impacts on the original Triple Aim. To design a dental benefits program that can achieve the Quadruple Aim, you need a strategy that helps you advance all four objectives simultaneously while maintaining a careful balance between them.

According to the CDC, about 20% of children ages 5 – 11 have at least one untreated decayed tooth. And children ages 5 – 19 from low-income families are twice as likely to have cavities.

Researchers exploring the disparities in oral health care, note that children from low-income families experience the greatest amount of oral disease, the most extensive disease, and the most frequent use of dental services for pain relief. Yet these children have the fewest overall dental visits. Although, a significant portion of the children qualify for public health benefits like CHIP and Medicaid, they are often unable to find providers to meet their needs.

Medicare Advantage is the fastest-growing line of business for many health plans, with enrollment growth of around 8% per year since 2014. And it’s a complex one. Medicare Advantage members represent a diverse range of life stages and needs, from individuals who are 65 and newly retired, to members who are in their 90s.

Health plans that recognize that a one-size-fits-all strategy can’t adequately address the dental expectations and requirements of this unique population and offer a member-centric approach to dental will gain a distinct competitive advantage. And while top-notch operations may not be the first thing that comes to mind when you hear the term member-centric, the caliber of your operational infrastructure and processes actually play pivotal roles in your ability to give members a personalized dental experience that improves their oral health.    

"An ounce of prevention is worth a pound of cure." This old adage still resonates today, especially when it comes to oral health. In fact, studies have shown that one dollar invested in preventive dental care can yield anywhere from $8 to $50 in savings on expensive restorative procedures. Access to quality preventive dental services isn't a given, though, especially for individuals and families on Medicaid. The infographic below highlights how innovative, prevention-led strategies can help overcome the barriers to vital oral health care.

Health plans increasingly face shrinking budgets and rising member expectations. A proactive regulatory compliance process and a fraud, waste and abuse (FWA) strategy can make a big difference in the quest to advance quality care while increasing efficiencies .  

A forward-looking approach is especially critical in the highly competitive Medicare market, where innovative dental benefits administration practices can add immense value. The right single-source dental benefits provider can help ensure that your program keeps pace with changing requirements by tracking federal regulation and legislation pertaining to Medicaid, Medicare, Commercial, CHIP and the exchanges. At the same time, a benefits provider can and should deploy leading-edge monitoring and detection and reporting methods that uncover compliance issues early and enable swift corrective action.

According to the CDC, six in 10 Americans live with at least one chronic disease. And out of every 10 deaths in the United States, seven are caused by chronic conditions. Health experts predict those numbers will only worsen in the next decade.  

Prevention has never been more important. 

And prevention, long known as a critical strategy in health care, is gaining traction in dentistry. There is a growing recognition that a healthy mouth, the result of regular preventive care and check-ups, is the foundation of a healthier life.  

The COVID-19 pandemic has introduced a unique set of challenges for Medicare Advantage and Medicaid health plans. Budgets are shrinking as membership swells, and members are faced with increasing hurdles as they try to access care. Knowing that oral health has a direct and significant influence on overall health, now more than ever it is critical to get innovative about dental. 

The right dental strategy has the potential to dramatically lower your plan costs while expanding access, enhancing quality and improving overall health outcomes for your members. How can you make this a reality for your organization? 

For the third year, health care leaders from the nation’s top Medicare Advantage health plans brought their collective brainpower to Phoenix for the Medicare Advantage Leadership Innovations conference. Tackling a range of important issues and challenges — from technology innovations to regulatory influences to evolving member priorities, speakers and attendees shared their proven strategies and best practices for driving meaningful results in a complex, ever-changing market.

When it comes to today’s Medicare Advantage members, many consider access to quality dental care a top priority. As research has shown, oral care plays a critical role in preventing, detecting and managing the chronic diseases that plague seniors today (e.g. chronic heart disease and diabetes), and provides important clues about a person’s overall health. To reach a population with a unique set of needs and access challenges, health plans need a partner that thinks differently about the network that serves them. The right network solution has the power to unlock greater care access for your members and new advantages that strengthen your health plan’s performance.