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.
Maintaining that balance isn’t easy. If, for example, you have a dental solution that leads to better outcomes but is too expensive, it won’t help your pursuit of the Quadruple Aim. On the flip side, if your dental solution does a great job of reducing costs, but worsens your member and provider experiences, you can’t achieve the Quadruple Aim.A savvy dental benefits partner can provide you with strategies and solutions that go far beyond transactional tasks such as claims processing. The right partner will also provide dental innovations with the power to improve the health and experience of your entire member population while enabling great provider experiences too.
Here are a few of the most strategic dental moves Medicare Advantage plans can make to achieve the Quadruple Aim.
Make the Best First Move
The opening moves of a chess game are critical to gaining the control that puts you on a winning path. The initial stage of your Quadruple Aim pursuit is no different. It requires a strategic game plan that thinks years into the future.
To get moving, team up with your dental partner to assess your current benefits program against the objectives of the Quadruple Aim. Determine whether your dental plan is optimized to help you drive better health outcomes, reduce costs and improve patient and provider experiences. Then consider how you can use dental innovations as strategic levers to adjust and coordinate your performance across the board. You can think about this as “adjusting the dial” up or down on each of the Quadruple Aim objectives to achieve specific goals, while still maintaining that balance.
Accelerate Your Advantage
Many consider the “middlegame” to be the most exciting part of chess. This is when you make a series of well-orchestrated moves that collectively give you an advantage.
In the middlegame of the Quadruple Aim, your dental benefits administrator should combine all the right fundamental claims processing, member servicing, utilization management and network optimization moves with strategic dental innovations. Together, they will set you up to improve member population health and enrich member and provider experiences. These dental innovations might include:
- Medical-dental integration programs that coordinate dental medicine with primary care and behavioral health to drive positive member outcomes and reduce the total cost of care.
- Dental homes, which cultivates close, long-term relationships between members and high-performing providers to improve member access to quality care that is both effective and efficient.
- Teledentistry, which improves member access to care, supports prevention and helps reduce more costly, otherwise unnecessary emergency care events.
At DentaQuest, we created a Medicare Advantage Center of Excellence (COE) to focus trained teams on the sole mission of delivering these kinds of differentiated Medicare Advantage innovations to our health plan partners. The COE is charged with serving the specific needs of Medicare Advantage members in many operational areas, including customer service, claims, utilization management and grievances/appeals.
Perfect Your Endgame
Unlike a game of chess, your pursuit of the Quadruple Aim doesn’t end. It is an enduring North Star that inspires and guides you to continuously improve.
One action that can help your ongoing pursuit is moving away from traditional dental economic models that reward providers for volume over value. The traditional and outdated fee-for-service model puts the focus on treating dental disease after it occurs versus preventing it before it happens, a practice that works against every goal of the Quadruple Aim.
In contrast, new strategic value-based reimbursement models empower Medicare Advantage plans to focus on prevention to meet the Quadruple Aim. These alternative payment approaches integrate provider incentives and disincentives aimed at improving quality and containing costs, strategically combining rewards and penalties based on performance metrics such as outcomes, cost controls, use of technology and other tools.
Play to Win
The Quadruple Aim benefits all stakeholders, including members, providers and health plans, and the right dental strategy is essential to your ability to achieve it. By creating a proactive game plan to move all four Quadruple Aim objectives forward at once, turning up the dial on strategic dental innovations that increase your advantage and embracing modern value-based payment models, you will be well positioned to find success.
Reach out to learn how we can help you create a Quadruple Aim game plan.
Have questions about how to create your Quadruple Aim game plan? Reach out to one of our experts to learn about strategies that can help your Medicare Advantage plan stand out from the crowd at https://dentaquest.com/health-plans/contact-us/