title: Perspectives on evolving dental care payment and delivery models.
abstract: BACKGROUND
  Health care reform is well under way in the United States as reflected in evolving delivery, financing, and payment approaches that are affecting medicine ahead of dentistry.
  
  
  METHODS
  The authors explored health systems changes under way, distinguished historical and organizational differences between medicine and dentistry, and developed alternative models to characterize the relationships between these professions. The authors explored a range of medical payment approaches, including those tied to objective performance metrics, and their potential application to dentistry.
  
  
  RESULTS
  Advances in understanding the essential role of oral health in general health have pulled dentistry into the broader discussion of care integration and payment reform. Dentistry's fit with primary and specialty medical care may take a variety of forms. Common provider payment approaches in dentistry-fee-for-service, capitation, and salary-are tied insufficiently to performance when measured as either health processes or health outcomes.
  
  
  CONCLUSIONS
  Dentistry can anticipate potential payment reforms by observing changes already under way in medicine and by understanding alternative payment approaches that are tied to performance metrics, such as those now in development by the Dental Quality Alliance and others.
  
  
  CONCLUSIONS
  Novel forms of dental practice may be expected to evolve continuously as medical-dental integration and payment reforms that promote accountability evolve.
authors.forename: Marcie S
authors.initials: MS
authors.lastname: Rubin
authors.forename: Burton L
authors.initials: BL
authors.lastname: Edelstein
mesh_terms: D003695:Delivery of Health Care / Q000191:economics / Q000458:organization & administration* / Q000592:standards; D018588:Fee-for-Service Plans / Q000458:organization & administration; D006801:Humans; D017146:Models, Organizational; D011787:Quality of Health Care / Q000458:organization & administration; D012051:Reimbursement Mechanisms / Q000458:organization & administration*; D014481:United States; D000070376:Value-Based Health Insurance / Q000458:organization & administration
keywords: Financing; delivery of health care; health policy; health systems design