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Ask the VBC Expert: What Have We Learned About Value-Based Care During the Pandemic?

Steven Barefoot, DDS, the VBC Expert, is the Clinical Manager of Value-Based Payments at DentaQuest. In that role, he provides clinical input to develop new care programs, manage the design of quality measures and respond to questions from providers participating in value-based programs. Every month, he answers a question about value-based care and its place within dentistry.

It’s undeniable that the COVID-19 pandemic impacted virtually every aspect of our lives. As well as people, businesses discovered their vulnerability to circumstances well beyond their control. Due to the nature of their operations and the uniqueness of the services they delivered, the dental industry felt these impacts profoundly and disproportionally.

The COVID-19 virus, SARS-CoV-2, spreads through close contact between people. As we breathe, respiratory droplets form and carry the virus from person to person. In a dental setting, dental providers are, by necessity, close to their patients and the aerosol created by dental instruments linger in the air for extended periods. This creates an ideal environment for transmission of the virus.

These factors contributed to a precipitous drop in dental visits. Many states expressly prohibited anything but emergency dental visits. Dental practice revenues dropped just as precipitously, jeopardizing the financial viability of many offices. Although larger practices and dental service organizations felt the same pressures, in many cases, they were better equipped to weather the pandemic due to greater financial reserves.

However, many dental practices are small operations dependent on a steady cash flow to remain in operation. As such, they were more vulnerable to financial stress. Compounding the problem was the fact that the dominant reimbursement model in dentistry is fee-for-service (FFS). Being reimbursed separately for each service performed has long been the standard of dental reimbursement. However, during an event like a pandemic, when the services drop to zero, so does the reimbursement.

But not all dental reimbursement is FFS. A key component of value-based care (VBC) programs is the use of alternative payment models (APMs). There are many types of APMs and they share the same goal: to facilitate the move away from FFS to reimbursement methods that support population health management. For example, some models pay a fixed fee each month for each patient regardless of the number of services a particular patient may receive — this is commonly known as capitation. From an oral health perspective, this allows the dentist to tailor care to the individual patient without concern for the number of services billed. From a business perspective, these payments represent a steady, reliable revenue stream for dental practices. APMs with multiple revenue paths offer resiliency over reimbursements that have only one method.

The pandemic accelerated the development and adoption of APMs that had a capitation component. Proactive dental insurance companies saw dental providers eager to enroll in their programs and enjoy the financial security that comes from predictable revenue. As dental businesses learn more about VBC with its APMs, adoption of such programs is expected to accelerate.

The pandemic also highlighted non-financial benefits of VBC. Offices realized that risk assessment of their patient population, another key component of VBC, was not only necessary but relatively straightforward. In a pandemic, the patients with the most severe need are given priority just as they are in VBC. Given the contagious nature of COVID-19, another element supportive of VBC, teledentistry, was a way to perform remote risk assessments. Again, without the pandemic, the exposure of teledentistry in the market would have been slower.

It’s hard to say there was anything good about the pandemic. Instead, we might say the pandemic facilitated the adoption of good programs, like VBC, that are the future of dentistry.

Editor’s Note: Dr. Barefoot has clinical experience delivering patient care in private practice, as part of an HMO dental clinic, via mobile dentistry serving mostly Medicaid schoolchildren, and with other volunteers caring for rural communities in Honduras. His 30-year career in dentistry is complemented by a series of other non-dental endeavors that include medical research at Methodist Hospital of Indiana and business development, analysis and analytics in a range of areas.