2.3 Benefits of collaborative practice

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(ii) Financing. Payments can be based on the services provided or a negotiated wage.

In the United States, providers in collaborative practice have the same financing mechanisms available to them as do providers who are not in such practices: private insurance, Medicare and Medicaid and other government programs, Health

Maintenance Organizations (HMOs) and patients paying out of pocket.

The above study (Mertz et al. 2011) of the collaborative practice in American dentistry evaluated the potential of collaborative practice models in the provision of primary care within the oral health delivery system in the United States. The various rationales for designing collaborative practice models were placed into three broad categories: access, cost and quality.

Improved access to oral healthcare - Collaborative practice is believed to increase access in two ways: First, it increases access if collaborating providers who work at separate sites in underserved communities, particularly in rural areas, can provide care at places that are closer to where patients live, learn and work. While a dentist can provide more comprehensive care, an allied health professional can provide first contact and primary services and administer a referral when needed, thereby moving patients, who may otherwise have forgone the care they needed, into the delivery system. In a second scenario, if collaborating providers are at the same location, their collaboration can increase the volume and efficiency of services and facilitate access to services.

Reduced Costs and Increased Productivity - In terms of cost containment, the assumption is that the use of lower-cost labor that is adequately trained to provide particular services should result in significant cost savings without jeopardizing the quality of care. Earlier studies indicated that when dental auxiliaries were added to the practice to perform routine tasks, the increase in productivity ranged from 30 to 80 percent, along with increasing efficiency of care (Baltutis & Morgan 1998).

Better quality of services - The final critical benefit from collaborative practice is that of quality of care, because collaborative practice, if implemented correctly, is believed to increase trust and accountability among providers, facilitate continuity of care resulting in better clinical outcomes for patients and improve overall health system performance. In addition, collaborative practice seems to improve participating providers’ relationships by enhancing mutual trust and accountability.

Nevertheless, concerns about the quality of care provided by mid-level providers are at the heart of the arguments opposing the expanded scope of practice of emerging professions. So far the pilot projects evaluating the effectiveness of adding new providers across a wide range of professions have shown that new models of care did not compromise quality (Fulton et al. 2011).

According to the Systematic Review of Oral Health Outcomes Produced by Dental Teams Incorporating Midlevel Providers, there were no conclusive results of an increase in treated decay, or a decrease of decay incidence in practices that incorporated mid-level providers such as dental therapists versus a practice that employed dentists and their traditional team including dental hygienists and assistants (Wright, et al., 2013).