Alternative Payment Models in Dentistry

A new report from the DentaQuest Partnership for Oral Health Advancement — based on findings from a survey of 2,757 dental providers in more than 20 states — reveals that there is 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.

Some key findings from the report:

  • Half of (51%) of responding providers have never heard of APMs in dentistry, while 35% had only heard of APMs or knew a little about them.
  • APMs are increasingly being used both in Medicaid and Medicare and are even entering private insurance. Nearly 70% of Medicaid beneficiaries are enrolled in managed care plans today. 
  • Federally Qualified Health Centers (FQHCs) have a model of care and organizational infrastructure that may allow for an advantage for engaging in APMs and value-based care delivery systems.

Along with education and awareness, there is evidence that value-based care models in dentistry need to be piloted and tested. A value-based care payment approach in dentistry will involve incremental approaches since public financing plays a smaller role in dentistry than in medicine.

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