EXPLORING THE WICKEDPROBLEM OF THE ORAL HEALTHSYSTEM:

Patient and Consumer Perspectives on Value-Based Care

DentaQuest Partnership Webinar

February 11, 2021

DOI:10.35565/DQP.2021.3025

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Question and Answer Logistics

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Learning Objectives

• Understand the role of shared decision making in person-centered, value-

based oral health care

• Learn about a prevention-focused, value-based strategy that leverages

monetary incentives to motivate healthy behavior

• Understand the value of preventive care from the patient’s perspective

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Presenters

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• Patients

• Researchers

• Stakeholders

• Policy makers

Special Issue of the Journal of Public Health Dentistry

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What does value-based care mean from a patient perspective?

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Can you share the important of patient centered care and VBC?

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Patient-Centered Care

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Person-Centered Care

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Value-Based Care

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Value(s)-Based Care

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Shared Decision Making

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How can behavioral economics be used in a VBC program?

DR. FRANCISCO RAMOS-GOMEZ

UCLA CENTER FOR CHILDREN'S ORAL HEALTH

WWW.UCCOH.ORG

Aim of recently published VBC Paper

Describe the rationale and design of the Behavioral Economics for Oral health Innovation (BEECON) trial, which tests lottery-based monetary incentives as a consumer-oriented, value-based care model for improving children’s oral hygiene.

• Ramos-Gomez, F. et al., 2020

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• Mouradian, Ramos-Gomez 2007

2 vs 8,957

Background – Conditional cash payments in other countries

Governments are increasingly using conditional cash transfer programs to reduce the negative

effects of inequities on children's development

and health.

These programs have demonstrated benefits for

children's nutrition and physical development,

but the effect of conditional cash transfers on children's behaviors has not been systematically

evaluated.

What are Self-Management Goals (SMG)?

Goals that you set with patients and their caregivers to work on in between visits (i.e. home care)

Examples:

–Brushing with fluoride toothpaste twice a day

–Limit sugary foods and drinks to meal times

–Avoid sippy cup or bottle to bed with anything other than water

The caries risk conversations help you identify which SMGs are most appropriate, present these as a “menu of options” for the caregiver

A Self-Management Goal Form is used to present these options

Caregivers should select no more than 2 goals per visit

Self Management Goals

Stages of Behavior Change

Maintenance

sustains the

behavior

change

Self-Efficacy

Self-efficacy beliefs determine how people feel,

think, motivate themselves

and behave

BEECON Data Technology Pathway

• Parent/Child

Toothbrush

• UCLA/UCSF

• BEECON Team Reports

Sonicare 4 Kids

AppPhilips Oral

HealthCare

•CoordCtrNIDCR RANDOMIZED CLINICAL TRIAL

How did we get here?

Using Behavioral Economics-informed incentives have been

shown to be effective for many health behaviors

Lottery incentives in particular have been shown to be

effective

Behavioral mechanisms

“Lottery incentives leverage the tendency of individuals to

be more motivated by immediate rather than delayed gratification, to over-react to low-probability events, and

to avoid feeling regret.”

These approaches have not been used for oral health

(Volpp, KG., et al. 2008); (Halpern, S.D., et al. 2015); (White, JS., et al. 2020.)

BEECON Pilot study findings showed that lottery incentives outperformed fixed incentives

BEECON as proof of concept

BEECON shows that incentives can motivate preventive behavior for oral health

Uses monetary incentives for a high-risk

population (Early Head Start enrollees)

Trial shows that toothbrushing behavior can be

motivated if designed to use behavioral insights

Focused on family-based incentives (gift cards)

Receipt of incentives were made conditional

on dental visit utilization

Coordinating State initiatives aimed at advancing and aligning the health equity strategy and tactical Denti-Cal workplan to reduce health disparities among specified

populations.

Managing the planning, design, implementation, training, and reporting of specified health equity initiatives within Denti-Cal programs.

•VALUE BASED CONSIDERATIONS FOR MEDICAID, THIRD PARTY PAYERS AND STATE DIRECTORS

Working collaboratively with internal and external stakeholders and with external community organizations

and agencies to address identified priority disparities

and USE INCENTIVES to improve health quality and

outcomes.

Organizing meetings of key partners and stakeholders

while documenting progress and holding key members accountable for work outcomes and emphasizing on

adoption and implementation of the “Age One Visit”.

•VALUE BASED CONSIDERATIONS FOR MEDICAID, THIRD PARTY PAYERS AND STATE DIRECTORS cont.

MEET parents caregivers and children where they are at

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How does your values and goals inform your decisions and care?

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GOALS VALUES

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What is the role of measures in a VBC approach to oral health?

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As more and more research and case studies accumulate to demonstrate the

positive impact of shared decision-making on patient experience, health

outcomes, and healthcare spend, the question remains:

Why isn’t it a more pervasive strategy in the industry?https://www.wolterskluwer.com/en/expert-insights/shared-decision-making-

inf ormed-patients-make-saf er-more-cost-ef fective-choices

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“I have dropped dentists in the past. I think that how they were able

to relate to me as a person was probably the biggest indicator of

whether I felt comfortable with what they were doing.

I suppose if you have a choice of five people

with the same skill set, it is how they are able to

deliver that skill set that is more important than

the skill set as such.”

Sbaraini, A., Carter, S.M., Evans, R.W. et al. Experiences of dental care: what do patients value?. BMC Health Serv Res 12, 177 (2012). https://doi.org/10.1186/1472-6963-12-177

QUESTIONS

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• https://www.dentaquestpartnership.org/learn/online-learning-

center/resource-library/wicked-problem-oral-health-care-system

• https://onlinelibrary.wiley.com/toc/17527325/2020/80/S2

Where can I learn more about the special issue?

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The Hidden Cost of a Hidden Smile

Video featuring Christine Collins

https://youtu.be/H_ZpFlU-ypc

MEDICAL/DENTAL INTEGRATION

MEASUREMENT

ALTERNATIVE PAYMENT MODELS

EQUITY

2021 DENTAQUEST PARTNERSHIP WEBINAR SERIES:JPHD SPECIAL ISSUE ON VALUE-BASED CARE

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Webinar Evaluation

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*Must complete by EOD Friday, February 19 in order to receive CE credit

Upcoming Webinars:

• Social Determinants of Oral Health in Practice and Education- joint

webinar with the American Public Health Association (APHA) – February 25

1-2PM EST

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