Oral health care CDA overview
A care delivery area (CDA) is an innovative value-based payment (VBP) arrangement. See the VBP Roadmap for Coordinated Care Organizations.
The purpose of the oral health VBP care delivery area is to encourage innovative and value-based payment models between CCOs and providers of robust oral health services, including integrated finance and delivery systems. In addition to meeting the overall goals of the care delivery area requirement, OHA expects oral health VBPs to promote an integrated approach to providing physical, oral, and behavioral health services at the level of care delivery (as opposed to purely financial integration). An oral health VBP for the purposes of the care delivery area requirement should not reinforce existing silos among oral and physical and behavioral health, or create new silos (for example, an arrangement with a primary care provider delivering oral health services without a link to the dental provider system, such as a referral to a dental home). In addition, oral health VBPs are encouraged to support the following OHA oral health policy goals:
- Decrease the oral health disease burden by focusing on prevention
- Increase equitable access to oral health services
- Focus on addressing oral-health-related barriers to social and economic success (for example, poor oral health's effects on employment and social integration)
- Support community-based delivery models (for example, oral health in Head Start or long-term care facilities)
- Increase culturally responsive oral health care
Alternative Payment Models in Dentistry - A Provider Perspective
CareQuest Institute for Oral Health
- A 2021 report based on findings from a survey of 2,757 dental providers in more than 20 states.
Key points: Survey findings suggest a need for provider awareness and education about alternative payment models and that COVID-19 has created opportunities to advance alternative payment models within the oral health care system.
A Framework for Oral Health Care Value-based Payment Approaches
Riley, W. et al., Journal of the American Dental Association, 2019, Volume 150, Issue 3, p.178-185
Key points: An oral health care VBP framework for dentistry, including four payment categories and nine separate payment mechanisms.
A Model for Better Health, Better Access, and Better Value: Advantage Dental's Approach
CareQuest Institute for Oral Health
- A white paper that summarizes Oregon's Advantage Dental's approach to incentivize dental providers to achieve better outcomes.
Key points: Oral health model of care emphasizing prevention over surgery, care in the community, and population health management, with documentation of their results.
Moving Toward Value-Based Payment in Oral Health Care
Center for Health Care Strategies, February 2021
Key points: This brief, produced with support from the DentaQuest Partnership for Oral Health Advancement, summarizes oral health VBP models, examines challenges and opportunities, and provides considerations for expanding VBP in oral health.
Texas Improves Access to Routine Oral Health Services for Very Young Children
National Academy of State Health Policy
- An overview of how Texas included the dental home model into their Medicaid program with VBP payment approaches.
Key points: Texas’s First Dental Home and its enhanced bundled payment has increased access to preventive dental service and improved the oral health of Medicaid-enrolled children ages 6 to 35 months.
Key points: The nonprofit CareQuest Institute for Oral Health provides education and resources including a tool for measuring organizations' readiness for VBP.
Value-Based Payment and Contracting Approaches for Caries Management: Implications for State Medicaid Programs
Medicaid Innovation Accelerator Program Children’s Oral Health Initiative
Key points: Provides brief descriptions of relevant oral health VBP articles and tool kits
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