Pay for performance in oral healthcare

Value based care and pay for performance contracts are quickly seeping into healthcare.

Here’s an example. In 2019, a large Dutch insurer decided to pay its doctors and psychiatrists treating depression and mood disorders, on how much better the patient feels, rather than on the number of counseling sessions. (Not surprisingly, the Dutch Association of Psychiatrists argued against this form of compensation by saying that the recovery path for mood disorders is highly unpredictable.)

Does this approach have any possibilities in oral healthcare? Perhaps.

Take periodontal care as an example. Currently, dental insurers reimburse the dentist for a certain level of scaling and root planing over a year. This reimbursement is commonly issued without any measure of the patient’s improvement in periodontal health.

But what if the dental insurer chose to follow the Dutch model in paying for performance? The patient’s self-perceived oral health would guide the level of scaling paid by the dental insurer, rather than some arbitrary number of sessions. If the patient reported he/she continued to have inflamed gums, or bleeding while brushing, their insurer would continue to support more periodontal care. Otherwise, if the patient felt their gums were healthier, the insurer would sponsor fewer visits or perhaps even lower insurance premiums.

Pay for performance is radical thinking for some, but it appears both timely and necessary action for many others.