Changes in Dentistry: Paid-for Outcomes and Value

Aetna is building an online, user-friendly database for their subscribers (see directly below). What will this mean to dentists, value-based reimbursement, and dental practice? (Image belongs to Mad Fish Digital)Aetna to Add Online Marketplace Directory By Dr.Bicuspid StaffAetna will add Brighter’s cloud-based marketplace directory to its Aetna Navigator member tool in January 2018. The directory will be available to all Aetna Dental (consumer) members, and will include a way to compare network providers, read reviews, and view referrals. It will also allow members to do the following:

• See how much out-of-pocket costs should be for services.
• Schedule appointments online.
• Receive reminders for checkups.

The portal will make it easier for patients to select a dentist based on cost and quality, a Brighter spokesperson told DrBicuspid.com. It will also allow patients to digitally spread positive reviews, which may help save on marketing costs. Comparing dentists is a paradigm shift in dentistry. Patients will enter the Aetna portal and compare characteristics, qualities, and reviews of dentists, which will change the lines on the court and create a new game. How patients select their doctor, ease of access, customer satisfaction, cost, distance to the office, cleanliness of the office, professionalism of the doctor, office setting, and so on. The portal will be able to finely segment the market according to what patients want and help dentists figure out how to make that more available. Now if you are a dentist - solo or group - and your Aetna patients are going to Dr. X down the block, you will change what you are doing so you can compete with her. That’s the way it works in a for-profit driven context. Now, when the program comes out for evidenced-based diagnosis and treatment planning, which will indicate appropriate treatment for a condition, and Aetna adds this to their arsenal, dental practice will change forever.

Value-based Reimbursement

Bobbi Brown of HealthCatalyst states, “The switch to value-based reimbursement will turn the traditional model of healthcare reimbursement on its head, causing providers to change the way they bill for care. Instead of being paid by the number of visits and tests they order (fee-for-service), providers’ payments will now be based on the value of care they deliver (value-based care). “Much of this change is long overdue and quite exciting because it’s driving improvements to the delivery of care by mandating better care at a lower cost. But for providers and health systems that can’t achieve the required scores, the financial penalties and lower reimbursements create a significant financial burden.” It was three years ago that I posted a letter that outcome and value would replace fee-for-service in dentistry. The pushback was strong. Now, outcome and value are becoming pivotal terms that are rapidly changing the dentistry landscape. Add artificial intelligence to this equation and the speed of change to a new reimbursement system will be here quickly. Another game changer. Another disruptive technology.