Payer Extends Value-Based Contracting to Dental Provider Group

Blue Cross Blue Shield of Massachusetts (Blue Cross) is expanding its value-based care model into its dental plan through value-based contracting with the dental provider group 42 North.

In 2019, Kaiser Family Foundation published five ways that Medicare could improve its dental healthcare policies, calling attention to the lack of dental healthcare for seniors.

The problem is not restricted to Medicare beneficiaries, however. In 2018, the California Dental Association pointed out that dental insurance plans are not held to medical loss ratio standards and that this is causing dental healthcare quality to suffer.

Instead of instituting a medical loss ratio requirement, Blue Cross’s Dental Blue plan in Massachusetts is implementing value-based contracting to improve access to dental plan coverage and pursue positive patient outcomes.

"We don't know of any other dental plan in the country offering this type of program,” said Rich Greenhalgh, vice president of specialty benefits at Blue Cross in the press release. 

“We've seen outstanding results from our value-based payment model for our medical plans, including lower health care costs and better health outcomes for our members, and we think there is great potential for strong results for Dental Blue members as well.”

Blue Cross’s value-based care model is called Alternative Quality Contract and originally only applied to provider contracts.

The value-based contract is upside risk. The payer will analyze quality measures pertaining to its members’ oral health and overall health to determine the dentist group’s viability for additional payment.

The Alternative Quality Contract, based on which Dental Blue plan designed its value-based contracting arrangement with 42 Dental, was the subject of a study by Harvard Medical School in July 2019. 

The study observed results from 8 years of the model’s existence, spanning 2009 through 2016.

The Alternative Quality Contract began to slow down healthcare spending on medical claims in the 8-year period until, eventually, savings surpassed spending. Enrollees with five years in the program saw a little over two percent savings, while enrollees that joined in 2010 and experienced all eight years in the program saw almost 12 percent savings by 2016.

"This new incentive arrangement aligns with our focus on improving our members' total health because we will reimburse the dental practices for integrated, coordinated care that supports members' oral and overall health,” said Blue Cross Executive Director of Professional Services Bob Lewando, DDS, MBA, a periodontist.

Blue Cross’s Dental Blue plan also serves members with chronic diseases by covering additional dental cleanings and periodontal treatments that aid in the members’ chronic disease management. Specifically, Blue Cross Dental materials have mentioned the correlations between poor oral health and respiratory diseases, cardiovascular diseases, and diabetes.

Nationwide, employers have been looking to integrate dental as well as vision and pharmacy benefits into their medical benefits packages. According to a 2019 study by Anthem, 67 percent of employers interviewed were actively integrating dental benefits into their health plans, second only to the percentage of plans that intended to incorporate vision benefits into their benefits packages.

But demand for dental healthcare has been particularly high in Massachusetts in 2020, AP News reported, as evidenced by the state’s dental health plan enrollment. As of February 2020, 104,000 Bay Staters enrolled in dental healthcare through the state’s Massachusetts Health Connector program around 20 percent of whom enrolled solely in dental health insurance through the state health insurance market.

The Dental Blue plan has shared in the state’s flourishing. The Dental Blue plan is the fastest growing dental plan in the state of Massachusetts according to the press release, with nearly a million members.

Expanding value-based care into dental healthcare is still relatively new, but it is something payers may begin exploring as employers and members vocalize their interest in high quality, low cost dental health plan options.