J Am Dent Assoc. 2024 Oct;155(10):825-835.e4. doi: 10.1016/j.adaj.2024.07.001. Epub 2024 Aug 12.
US health care delivery and financing arrangements are changing rapidly as payers and providers seek greater efficiency, effectiveness, and safety. The Centers for Medicare & Medicaid Services uses grants and technical assistance to drive such development through innovative demonstration programs, including for oral health care. The authors reviewed these dental demonstrations to identify common themes and identify barriers to and facilitators of implementation.
The authors compared 12 identified demonstrations across 6 domains: grant and technical assistance, stakeholders, inner care settings, outer contextual settings, interventions, and outcomes. They developed program summaries for each demonstration and interviewed key informants using a semistructured guide to review, correct, clarify, and expand on program summaries.
Common across all programs were engagement of nontraditional providers, care in nontraditional settings, payment as a critical externality for program adoption, interventions that integrate medical and oral health care, use of alternative payment models, and tracking process measures. Adoption facilitators included an engaged oral health champion and obtaining mission support and alignment among stakeholders. Common barriers included unanticipated organizational disruptions, poor information technology infrastructure, cultural resistance to nontraditional care models, and lack of providers in high-need areas.
Descriptive findings suggest that oral health care may evolve as a more accountable, integrated, and accessible health service with an expanded workforce; collaboration between providers and payers will remain key to creating innovative, sustainable models of oral health care.
The Centers for Medicare & Medicaid Services' efforts to advance health equity, expand coverage, and improve health outcomes will continue to drive similar initiatives in oral health care.
随着支付方和医疗机构寻求更高的效率、效果和安全性，美国的医疗服务提供和融资安排正在迅速变化。医疗保险和医疗补助服务中心（Centers for Medicare & Medicaid Services）利用赠款和技术援助，通过创新示范项目推动这一发展，其中包括口腔保健。作者审查了这些牙科示范项目，以确定共同的主题，并确定实施的障碍和促进因素。
作者比较了 6 个领域的 12 个已确定的示范项目：赠款和技术援助、利益相关者、内部护理环境、外部背景环境、干预措施和结果。他们为每个示范项目编写了项目摘要，并使用半结构化指南对关键信息提供者进行了访谈，以审查、纠正、澄清和扩展项目摘要。
所有项目的共同点是吸引非传统提供者、在非传统环境中提供护理、支付是计划采用的关键外部因素、整合医疗和口腔保健的干预措施、使用替代支付模式以及跟踪流程措施。采用促进因素包括口腔健康拥护者的积极参与以及在利益相关者之间获得使命支持和一致性。常见的障碍包括组织意外中断、信息技术基础设施差、对非传统护理模式的文化抵制以及高需求地区缺乏提供者。
描述性发现表明，口腔保健可能会随着更多的负责、整合和可及的医疗服务以及更广泛的劳动力而发展；提供者和支付方之间的合作将仍然是创建创新、可持续的口腔保健模式的关键。
医疗保险和医疗补助服务中心为促进公平、扩大覆盖范围和改善健康结果而做出的努力将继续推动口腔保健领域的类似举措。
