Update on Alternative Payment Models in Oral Health Care

Published 12/06/2022

In this article in Decisions in Dentistry, CareQuest Institute researchers update a previous analysis to compare spending and service utilization of fee-for-service (FFS) models to alternative payment models (APMs) through 2019. Consistent with earlier findings, cost per patient remains lower and service utilization remains higher under APMs compared to FFS.

The authors also found that patients in APMs are more likely to receive preventive services, like silver diamine fluoride and sealants, and less likely to visit the emergency department for a dental condition. The research analyzes dental care spending and utilization by Medicaid patients from ages 0 to 89.

Fee for Service vs. Value-Based Care 

Rising health care costs have inspired new payment models that emphasize value and quality of care as alternatives to traditional fee-for-service models based on volume of care. Dentistry has been slower to adopt APMs compared to medicine — a recent provider survey shows that 51% of dental providers had never heard of APMs — but state Medicaid programs have been piloting dental APMs. 

The authors conclude:

As awareness of, and experience with, value-based care and value-based purchasing grows in both medicine and dentistry, these trends are expected to gain momentum. It is vital that dentistry continues to adapt to shifts in payment transformation to create a more equitable, accessible, and integrated health system for everyone.

Read the article and take the CE course in Decisions in Dentistry

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