08:45 AM

When We Pay for Performance, Prevention is Key

By Steve Pollock, Chief Executive Officer

In the midst of a constantly-evolving climate in health care, one thing is constant: our pursuit of the triple aim. In my last blog post, I discussed how ancillary benefits can achieve the goals of the triple aim: to improve population health, advance quality of care and reduce long-term costs. Here, I’ll discuss another way payers and providers can solve this puzzle -- through pay-for-prevention programs.

Pay-for-performance programs encourage providers to keep their patients healthier through financial incentives. A national survey found that 52 percent of health maintenance organizations (HMOs) have implemented some form of pay-for-performance already. Additionally, the Affordable Care Act includes a number of provisions that encourage this goal of controlling costs while increasing health outcomes. We’re finding that this means we need to do more than reactive care.

Preventive care is the solution across the board, be it medical or dental services. Oral disease is preventable, not inevitable. Treating cavities is much more costly – to the patient, the provider and the payer – than providing the initial services that could have prevented the cavity in the first place.

Working with our health plan partners, DentaQuest has found a way to weave in a pay-for-performance program that has been successful through our PreventistrySMinitiative. In one program, we saw an increase in the number of higher-risk children who received fluoride treatments by 30 percent after just 12 months.

As our health care needs change, we are adapting to ensure our members stay healthy and receive the treatment they need – when they need it. We are looking for opportunities to shift our focus to treating preventable health issues before they emerge, rather than waiting until patients come to providers after issues arise.