Appendix C: Interview Discussion Guide Questions

Value‐based Oral Health Care: Payer Interview Guide Discussion Questions

The questions below are meant to serve as general guideposts for the discussion. We may ask additional follow‐up questions throughout the interview to clarify a response or obtain more information.

Introduction  Please describe your current roles/responsibilities as they pertain to oral health. o What is your typical beneficiary demographic (age, race/ethnicity, coverage)?

VBOHC Knowledge and Engagement  How would you describe the trend towards value‐based care in oral health in your network? o How would you describe the current payer interest in VBOHC?  How has your organization engaged in value‐based oral health? o How does your organization utilize quality measures to improve patient care, determine value for procedures/treatments?  How do you prioritize which quality measures are implemented?  What types of data points would be of most interest to your organization (e.g., structure, process, outcome, patient‐reported)?  How do current guidelines and evidence affect your prioritization or use of quality measures?  What quality‐related partnerships or collaborations has your organization engaged in? o What payment models related to oral health has your organization engaged in?  What methods do you use to incentivize dental providers to engage in value‐based care? o What are some challenges or barriers that are preventing payers from implementing value‐based payment models related to oral health?  What support would be needed (e.g., federal, provider, patient) to overcome those barriers?  Do you have any recommendations on how to address those barriers or challenges?  How would you describe the level of interest in VBOHC among dental providers? o What percent of participating providers are engaged in VBC? How do you anticipate this trend to change over the next 5‐10 years? o Are there barriers limiting provider participation? o Do you provide any resources or education around VBOHC for dental providers?  Which population(s) are the top priority for quality improvement in oral health care at your organization? o How do you identify these priority populations? o How do you anticipate VBOHC will impact these populations? o What are potential barriers to developing or implementing VBOHC initiatives to address disparities? o What would you suggest to reduce those barriers?

Diagnostic Coding and Interoperability  We have heard that dental systems lag compared to medical systems in consistently collecting diagnostic codes. Can you talk about your experiences with dental diagnostic coding? o What improvements are needed to enhance the dental information technology infrastructure? o What is needed to improve coding standardization?  Does your organization require diagnostic codes on claims submissions? o What codes are required? o For what purposes are codes required (e.g., service authorization)? o What are the benefits of dental providers submitting ICD‐10 codes? o Are there any gaps in diagnostic codes? o What opportunities would increase use of diagnostic codes by dental providers? o For organizations that don’t require diagnostic codes on claims submissions:  Has your organization considered implementing diagnostic code requirements in the near future? Why or why not?

Closing  As we discussed in our introduction, the US health care system is increasingly beginning to adopt value‐based oral health care through tactics such as medical‐dental integration, alternative payment models with oral health incentives, etc. How do you view this change with regards to how it will impact your organization?  How will value‐based oral health care affect population health overall/in your beneficiary population? o How will this shift towards value‐based care impact health equity?  What might be potential unintended consequences on vulnerable populations (e.g., realignment of resources)?  What are your concerns about transitioning to value‐based oral health care?  What is needed for value‐based oral health care to be widely and successfully implemented?

Value‐based Oral Health care: Provider Interview Guide Discussion Questions

The questions below are meant to serve as general guideposts for the discussion. We may ask additional follow‐up questions throughout the interview to clarify a response or obtain more information.

Introduction  Please describe your current roles/responsibilities. o What type of setting do you work in?  General dentist and chief dental officer o What is your typical patient demographic (age, race/ethnicity, coverage)?

VBOHC Knowledge and Engagement  How would you describe your level of knowledge regarding value‐based oral health care? o What would you say was the most significant source of your knowledge and experience in value‐based oral health care (e.g., DDS/DMD education, continuing dental education, specialty/professional society resource, study club, etc.)?  How much would you say your education prepared you for value‐based care in the clinical setting?  What recommendations do you have for how your education or other dental schools could improve their efforts to prepare students?  What resources, materials, or specific issues and topics did you find the most helpful?  How does your practice engage in value‐based care? o How do you track oral health quality measures?  What quality measures or data points are most important for you in providing care for your patients?  If not, what might incentivize you to use measures?  What support or resources would you need to start collecting data on quality measures (i.e., technology support)?  How might using measures be useful to you and your practice? o Do you participate in any value‐based care arrangements?  How are you incentivized by payers to engage in value‐based care? o What are some challenges or barriers that have prevented or limited your engagement? o Conversely, are there any resources or external factors that have helped your practice’s participation in value‐based oral health care?

Integrated and Team‐based Care  How would you describe the relationship between medical and dental health delivery? o Do you work directly with primary care or other health care providers as part of an integrated team?  What kind of health care providers do you collaborate with? Can you briefly describe the workflow?  What partnerships or collaborations would you suggest to increase team‐based care? (e.g., data‐sharing, payment models) o What are the challenges to medical‐dental integration?

o What recommendations do you have for how medical and dental professionals can work collaboratively to improve patient oral health?

Closing  As we discussed in our introduction, the US health care system is increasingly beginning to adopt value‐based oral health care through tactics such as medical‐dental integration, alternative payment models with oral health incentives, etc. How do you view this change with regards to how it will impact your practice and how you deliver care to your patients?  How will it affect population health overall/in your patient population? o How will this shift towards value‐based care impact health equity?  What might be potential unintended consequences on vulnerable populations (e.g., uneven allocation of resources, lack of focus on outcomes important to patients, increasing health disparities)?  What are your concerns about transitioning to value‐based oral health care?  What is needed for value‐based oral health care to be widely and successfully implemented?