Poor oral health can lead to other health problems, including cardiovascular disease, and some chronic health conditions, like diabetes, are associated with poor oral health. This clear link between oral health and overall health has led state advocates and national partners to find innovative ways to integrate dental and medical care systems. Recently, Community Catalyst and Health Care for All collaborated on a webinar series to highlight the importance of oral health integration, provide on-the-ground examples of state efforts to create more integrated, efficient, and cost-effective models of care, and highlight the specific role that Accountable Care Organizations (ACOs) can play in integration.
What is oral health integration?
Oral health integration requires a shift in thinking about oral health and physical health as separate issues to recognizing that oral health is an integral part of overall health and wellness. It involves primary care and other medical providers taking responsibility for oral health and specific strategies for incorporating dental health care services into the broader health care system through a spectrum of activities. Strategies for oral health integration include:
- Integrated referral systems, where dentists screen for health needs and refer to a physician (and vice versa)
- Co-located services, where a dental hygienist, dentist, or dental therapist works in a primary care office or clinic or a nurse practitioner or physician’s assistant works in a dental office
- Shared electronic health records (EHR) systems among dental and medical providers
- Redesigning medical and dental education curricula to include comprehensive education for all providers around overall health that includes oral health
- Shared financing mechanisms like ACOs
Integration improves care, reduces costs, and can play a role in addressing disparities
Oral health integration creates a system that views and treats patients as whole people – where the health of the mouth and teeth is connected to the rest of the body. Integration can have a critical role in improving health and wellbeing, as oral health is critical for overall health. Because getting routine dental care is associated with lower overall medical costs, integration is also a path to cost-effectiveness. Integration is particularly important within state Medicaid programs because the low-income populations who are eligible have higher rates of oral disease and are less likely to get needed dental care. Black and Latino adults are also less likely to visit a dentist and experience higher rates of oral health problems. Because black and Latino adults are overrepresented in Medicaid, strategies for oral health integration in Medicaid have the ability to reduce oral health disparities by income and race.
ACOs are consumer-friendly and cost-effective
ACOs are networks of providers that can include physicians, dentists, and other professionals, that work together to coordinate care and tailor it for a specific population. ACOs hold providers accountable for the quality of care they provide by paying them for outcomes or value rather than on a fee-for-service basis. Though not all ACOs include dental care (25 percent of Medicaid ACOs across the country cover dental services), doing so creates an integrated system of wellness for patients and saves money. ACOs enable providers to share information, resources, and financial risk and reward for patient care. By providing coordinated, whole-person care, ACOs that incorporate dental services avoid the high costs associated with the need for intensive dental services and health complications that occur when people don’t get routine and preventative dental care.
ACOs are an innovation that in the process of disrupting the current system of care delivery offers opportunities for making changes to improve patient care and efficiency. This is why Massachusetts and other states have focused advocacy efforts on including oral health integration into their state’s ACOs.
Massachusetts Medicaid ACOs are a community-driven pathway to oral health integration
In 2012, Massachusetts passed legislation requiring its Medicaid program (called Masshealth) to adopt ACOs to coordinate care for Medicaid beneficiaries in the state. Massachusetts-based advocacy organization, Health Care For All (HCFA) led a state-wide oral health coalition that worked with Masshealth to ensure that oral health was incorporated into the ACO model of care. This coalition included dozens of community-based partners who agree that ACOs are an innovative way to improve delivery of dental care services and oral health integration. Due at least in part to the coalition’s work, oral health evaluation measures were included in the MassHealth ACO pilot program. MassHealth will fully transition to an ACO model in 2018 and HCFA and oral health advocates around the state are hopeful that oral health will play and increasingly key part of this system.