Designing episode of care bundles to improve children's oral health care

Objectives

There is growing momentum to introduce value-based payment (VBP) approaches into dentistry to help improve population oral health status. However, there are very few VBP models available for dentistry. This study designs and analyzes the feasibility of introducing oral health episode of care (EOC) bundles for use by policy makers, payers, and dental providers.

Methods

An oral health EOC bundle is a standardized care process based on a set of best practices that has the potential to improve patient care quality when all bundle items are provided. We used a panel of dental experts to guide the design of two preventive EOC bundles for children, a comprehensive examination bundle and a periodic examination bundle. We then conducted a 12-year retrospective longitudinal analysis to simulate the completion rate of the EOC bundles for children receiving Medicaid benefits in Arizona from 2008 to 2019.

Results

An average of 805,229 children were enrolled annually in the Arizona Medicaid program across the 12-year period. Approximately 31% of the Medicaid enrolled children had a preventive dental visit twice a year, and 23% completed two preventive EOC bundles. On average, 126,602 (16%) of patients started the comprehensive examination bundle and 279,194 (35%) of patients started the periodic examination bundle. Overall completion rates for the Comprehensive Examination and Periodic Examination Bundles were 73% and 79% respectively.

Conclusions

It is feasible to design a preventive oral health EOC bundle for children. The findings have implications for developing VBP approaches for oral health care.