Creating systems aligned with the triple-aim and value-based care.

HealthPartners is an integrated health care system in the upper Midwest striving to provide value-based care that aligns with the triple-aim care. The dental delivery system at HealthPartners is focused on prevention by utilizing risk assessment tools (caries, periodontal disease, and oral cancer) built in to our record system. Integration with medical delivery system is facilitated by a shared electronic health record. Measurement is critical to determining if we accomplish our goals. The dentist compensation system is aligned with our care agenda. Implementation strategies, lessons learned, and future directions are discussed in the context of journey to achieve the triple-aim and value-based care.

Integrated Medical-Dental Delivery Systems: Models in a Changing Environment and Their Implications for Dental Education.

Models and systems of the dental care delivery system are changing. Solo practice is no longer the only alternative for graduating dentists. Over half of recent graduates are employees, and more than ever before, dentists are practicing in groups. This trend is expected to increase over the next 25 years. This article examines various models of dental care delivery, explains why it is important to practice in integrated medical-dental teams, and defines person-centered care, contrasting it with patient-centered care. Systems of care in which teams are currently practicing integrated oral health care delivery are described, along with speculation on the future of person-centered care and the team approach. Critical steps in the education of dental and other health care professionals and the development of clinical models of care in moving forward are considered. This article was written as part of the project "Advancing Dental Education in the 21st Century."

Dental Group Practice and the Need for Dentists.

This study compared the number of patients treated per year by general dentists and dental hygienists in solo practice and by those employed by a large group practice. Information on the annual number of patient visits to solo general dental practitioners comes from the 2013 American Dental Association (ADA) Survey of Dental Practice. Patient visits were divided by 2.5 to estimate the number of patients treated annually. The data on group practices come from HealthPartners (HP) of Minnesota, a large not-for-profit medical and dental Health Maintenance Organization that accepts insurance contracts based on global budgets and is financially at risk. In 2013, solo general dentists averaged 1,350 patients, while the average HP general dentist treated 2,052 patients. HP general dentists thus treated over 700 more patients annually than did solo practitioners. This large difference has major implications for the future of the dental delivery system and dental education. This article was written as part of the project "Advancing Dental Education in the 21st Century."

Managing for Quality Rather than Profit.

HealthPartners is a collection of medical, dental, pharmacy, hospital, and health promotion and research units in the upper Midwest. The dental component includes 24 dental clinics and a network of 2,500 dentists in a PPO plan, supported by a quality management team. An important feature of this network of clinics and dentists is the opportunity for pooling and analyzing data on oral health- care outcomes. These data are used to mentor the entire office team, to drive systemwide improvements in treatment protocols, and as part of providers' compensation. The management function is centralized but entirely within our very large group practice.

Continued Competency. Dentistry's "road not taken".

Large group practices and any other arrangement of dentists who depend on the quality of care provided by their associates have an inherent interest in continued competency as a means of raising the standards for the entire group. Doing it together offers advantages. The dental component of HealthPartners is a multispecialty, multi-clinic system with about 60 dentists. Regular components of dentists' experience include mentoring, both conducting and experiencing chart audits, and participation on quality assurance teams. Because continuous competency is grounded on the organization's computer system, regular outcomes data are available for comparison against both evidence-based guidelines and norms of what others are accomplishing. The approach to continued competency goes beyond the knowledge and skills of individual dentists to include the entire delivery system, the office team, patient behavior patterns, network relations, and even equipment.