Dental Health Services Victoria’s Value Based Oral Health Care Model
Background: The public dental health care system in Victoria (Australia) operates on an output-based-funding model which incentivises volume rather than patient outcomes and rations services via waitlists. DHSV has successfully implemented a novel VBHC model co-designed with patients in public dental sector. DHSV’s VBHC model offers the highest recognition of what patient’s value while defining health and care outcomes and how this can be achieved in a public dental setting with limited available resources
Aim: DHSV’s VBHC initiative aims to achieve value from a patient perspective by influencing the public dental system to shift away from a supply-driven health care system organised around volume, output and what clinicians prescribe, towards a patient-centered system organised around what patients need and value. The core value of the initiative is improving patient outcomes without raising costs, or lowering costs without compromising outcomes, or both. By examining and measuring variation in public dental sector, DHSV aims to reduce waste and re-invest savings to see more people who currently don’t access care.
Patient description: DHSVs patient segment includes vulnerable communities particularly people with social security benifits and socioeconomically disadvantaged people such as people without homes, people with disabilities, people experiencing mental health issues, refugees, people seeking asylum and people identifying as of Aboriginal or Torres Strait Islander origin. Access to treatment and outcomes of treatment are worse for these people than the disease experience. The available public dental funding is not sufficient to treat all patients in a single year.
Methods: DHSV’s VBHC model is co-designed with patients by adapting the original Porter and Lee’s model and contextualising it to the oral health environment of Australia. Value-stream mapping was undertaken using lean methodology with patients, consumers, clinicians and key stakeholders to understand the current state of dental services and map the future, and ideal state. An explorative qualitative method using focus groups, combined with an Appreciative Inquiry approach was used to understand patient experience of accessing oral health care and what a holistic, patient-centered understanding of value looks like. Patient journeys were co-designed with consumers representing different patient segments. A range of patient evaluation tools (e.g. experience mapping, empathy mapping, tactile toolkit, photo elicitation) are used to build rapport with patients and families, understand value from patient’s perspective and evoke patient stories, explore their emotions and experiences. Each patient is risk assessed and appropriate care pathways are organised around specific dental conditions. Patient relevant outcomes for dental conditions were developed in close collaboration with ICHOM. At a workforce level, a comprehensive Change Management Framework and a Respectful Workplace Framework was implemented that included the introduction of ground-breaking policies, initiatives and events that aligned with the VBHC agenda. In collaboration with consumers, government departments, politicians and stakeholder organisations a new outcome based funding model is being co-designed. Implementation of of E-health is under consideration and AI tools are being developed in collaboration with an international IT company to collect outcome data and undertake data analytics.
Preliminary results: DHSV has co-designed a novel VBHC model with its patients and is using this model to re-design the way public dental services are delivered and focus on improving patient needs and outcomes. DHSV’s VBHC model is unique as it captures both patient and population level outcomes. This is an important tenet of pubic dentistry which centres on equity of access to health care, health outcomes and efficient use of resources. DHSV’s VBHC model has enabled patients and clinicians to become shared decision makers in achieving value and influencing improved oral health outcomes. This has been achieved by co-designing care with patients which has resulted in clinicians having a deeper understanding, knowledge and respect for value from a patient perspective. In addition, co-designing process have resulted in significant advances with respect to aligning clinician’s view of value (informed by evidence) and patients’ perspective of what value is. The clinical team sees the patient through the whole cycle of care, tracks patient and clinical outcomes longitudinally for identified clusters of dental conditions, focuses on value as defined by patients and have applied the learning for continuous improvement. Clinically integrated care delivered through coordinated interdisciplinary teams aligns with IPUs and builds on each other’s expertise to achieve shared goals which are patient centric and defined by patient needs over the full cycle of care. DHSV is using the ICHOM outcome measures to analyse the effectiveness of its services and prioritise high-value care (that contributes to improved oral health outcomes). Through a comprehensive audit of its services, DHSV has successfully eliminated services that are low-value, fragmented, disjointed and poorly coordinated. Through the Change Management and Respectful Workplace initiatives, there is a strong organisational culture of respect, capability and value.