The Wicked Problem of the Oral Health Care System

A special edition of the Journal of Public Health Dentistry is dedicated to increasing awareness and education about value-based care (VBC) and the journey to systems change within oral health care. The DentaQuest Partnership for Oral Health Advancement served as the guest editorial board, identifying and selecting key articles that advance VBC awareness and illustrate the need for oral health care transformation.

In 1973, two Policy Science authors coined the phrase a wicked problem – one that is complex, hard to define, involves multiple stakeholders and is interconnected with other problems.

Oral Health Care is a Wicked Problem. Value-Based Care Can Help to Solve it.

Framing the special issue, our research leaders outline The Wicked Problem of the Oral Health Care System and describe VBC as the solution across these areas of transformation:

  1. Care Transformation. The provision of care transitions from a siloed model toward a whole-health approach based on an integrated interprofessional practice model that leverages a health home. A transformed health care system engages patients through health promotion and improved outcomes, with a focus on disease prevention, and has a concerted effort to address health inequities and social determinants of health.  This transformation includes strategies to reduce clinical variation, increase quality, improve cost savings, and enable patients to live healthier lives in an evidence-based way.
  2. Data & Analytic Transformation. Health IT systems need to be interoperable and coordinated to allow sharing of health records across all disciplines and providers to coordinate care. A robust data and analytic platform also enables outcome measurement and tracking.
  3. Payment transformation. Alternative payment models provide reimbursement based on improved access to care, quality, outcomes and cost savings. Financial incentives for providers and health systems are based on reporting data and quality measures that address preventive care and effective care coordination. These measures are evaluated at patient, health system, and population-levels.

The oral health environment is at the early stages of transitioning to VBC, and the results of this transition will strengthen health equity and reduce disparities by redistributing resources aimed at oral health care.

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