Journal of the American Dental Association (1939) · 2025
A value-based care program in dentistry centered on caries risk assessment: Preliminary results.
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Featherstone John D B, Mascarenhas Ana Karina, Sarkari Cherag D
Аннотация
BACKGROUND: The Benefits and Rewards for Utilization, Services and Healthy Outcomes program (known as BRUSH) (Liberty), a value-based oral health care program, was implemented in 4 US states from 2021 through 2022 using a caries risk assessment (CRA) strategy. This value-based care program provides oral health care for Medicaid beneficiaries up to the age of 21 years.
METHODS: Deidentified data from patient insurance claims that included CRA levels with 2-year follow-up for 2,706 patients in Florida were available for analysis. Providers were incentivized to manage caries on the basis of an initial CRA and were rewarded financially if risk levels were lowered or maintained as low over 12 months. Statistical analyses were performed to identify changes in CRA over time in relation to demographic and clinical variables. Age, sex, and variables that were statistically significant in bivariate analyses were included in multiple regression models to identify predictors of change in risk level or procedures performed over the 24-month period.
RESULTS: Results of data analysis from 2,706 patients showed that over the 24-month period, the program lowered caries risk in 64% of high-risk patients. For all risk levels at baseline, 65% had lowered risk or maintained low risk, suggesting good oral health outcomes over 24 months. Those with lowered risk were less likely to undergo restorative procedures (P < .00001).
CONCLUSIONS: A value-based dental program based on CRA can reduce or maintain caries risk at a low level for patients over a period of 2 years.
PRACTICAL IMPLICATIONS: A successful value-based care program improves the oral health of people through reduced caries experience and, over time, will reduce costs.
METHODS: Deidentified data from patient insurance claims that included CRA levels with 2-year follow-up for 2,706 patients in Florida were available for analysis. Providers were incentivized to manage caries on the basis of an initial CRA and were rewarded financially if risk levels were lowered or maintained as low over 12 months. Statistical analyses were performed to identify changes in CRA over time in relation to demographic and clinical variables. Age, sex, and variables that were statistically significant in bivariate analyses were included in multiple regression models to identify predictors of change in risk level or procedures performed over the 24-month period.
RESULTS: Results of data analysis from 2,706 patients showed that over the 24-month period, the program lowered caries risk in 64% of high-risk patients. For all risk levels at baseline, 65% had lowered risk or maintained low risk, suggesting good oral health outcomes over 24 months. Those with lowered risk were less likely to undergo restorative procedures (P < .00001).
CONCLUSIONS: A value-based dental program based on CRA can reduce or maintain caries risk at a low level for patients over a period of 2 years.
PRACTICAL IMPLICATIONS: A successful value-based care program improves the oral health of people through reduced caries experience and, over time, will reduce costs.