By Steve Pollock, Chief Executive Officer
In the midst of a
constantly-evolving climate in health care, one thing is constant: our pursuit
of the triple aim. In my last blog post, I discussed how ancillary benefits can
achieve the goals of the triple aim: to improve population health, advance
quality of care and reduce long-term costs. Here, I’ll discuss another way
payers and providers can solve this puzzle -- through pay-for-prevention
programs.
Pay-for-performance
programs encourage providers to keep their patients healthier through financial
incentives. A national survey found that 52 percent of health
maintenance organizations (HMOs) have implemented some form of
pay-for-performance already. Additionally, the Affordable Care Act includes a
number of provisions that encourage this goal of controlling costs while increasing
health outcomes. We’re finding that this means we need to do more than reactive
care.
Preventive care is the
solution across the board, be it medical or dental services. Oral disease is
preventable, not inevitable. Treating cavities is much more costly – to the
patient, the provider and the payer – than providing the initial services that
could have prevented the cavity in the first place.
Working with our health
plan partners, DentaQuest has found a way to weave in a pay-for-performance
program that has been successful through our PreventistrySM
initiative. In one program, we saw an increase in the number of higher-risk
children who received fluoride treatments by 30 percent after just 12 months.
As our health care needs change, we are adapting to ensure our members stay healthy and receive the treatment they need – when they need it. We are looking for opportunities to shift our focus to treating preventable health issues before they emerge, rather than waiting until patients come to providers after issues arise.