Mixing Dental, Medical Care would Cut Cost, Pain

Collaboration on all healthcare sought in pilot rollout


Boston, MA, USA – It can take patients in need of oral care weeks or months to make it into Emily Simon’s dental chair, a time period when they are often saving up money and determining when they can miss school or work to make their appointment.

“And through it all, they are in pain,” said Simon, who practices dentistry in safety-net clinics and teaches oral health policy and epidemiology at the Harvard School of Dental Medicine. “Preventable, ceaseless pain.”

Simon spoke to lawmakers, staff and advocates at the launch of a new effort to integrate oral health with medical care in Massachusetts.


Sen. Harriette Chandler speaks at the launch of the Oral Health Integration Project. (Katie Lannan/SHNS)

An initiative of Health Care for All’s Oral Health Advocacy Task Force, the project is based around the idea that incorporating oral health in accountable care organisations and more closely aligning medical and dental care can both save money and improve a patient’s overall wellbeing.

The initiative comes about a month after the release of a Health Policy Commission report that found access to oral healthcare varies widely in Massachusetts and examined the rates at which patients visit emergency rooms for preventable oral health conditions.

The report said one-tenth of the state’s population lives in areas federally designated as having shortages of dental providers and that MassHealth, which covers approximately a quarter of the population, paid for almost half of all visits to emergency rooms for preventable oral health conditions.

Simon said the average American spends $700 a year on dental care, and providing dental treatment to people with diabetes and heart disease as part their medical care can reduce their healthcare costs by more than $1,000 per year.

“Nationwide, our health system spends $1 billion a year palliating, not treating, the pain of people who desperately need a dentist. We are paying through the nose for the mouth,” she said. “Today, dentists are paid for doing more, not caring more. A dentist is rewarded if a patient has poor oral health – if patients require complex procedures like root canals, crowns or implants – yet all oral disease is preventable.”

The Oral Health Integration Project’s ultimate goal is to see oral health and dental services included as a requirement in new state standards for Medicaid and commercial accountable care organisations.

A payment restructuring effort is underway at MassHealth that would move the state Medicaid programme toward an accountable care organisation model instead of its current fee-for-service method. Accountable care organisations, or ACOs, feature networks of doctors working collaboratively to manage a patient’s care, including acute care, behavioural health, and other needs.

The state plans to pilot ACOs by the end of 2016 with a full rollout by October 2017. The MassHealth reform is expected to be completed by late 2018.

Speakers at the Oral Health Integration Project launch said a nationwide move towards ACOs provides an opportunity for greater collaboration among dentists and primary care providers.

Shannon Wells, oral health affairs manager for the Massachusetts League of Community Health Centres, said such integration can take many forms, depending on the size and structure of a practice and a patient’s needs and preferences.

At its simplest, Wells said, integration can involve dentists and physicians referring to each other and educating their patients on different health issues. She said an ideal model would have dentists asking medical questions, testing blood pressure and screening for diabetes, while physicians conduct oral health assessments and provide fluoride varnish.

The integration project also aims to reduce dental health disparities based on income, race, geographic location and other factors.

Sen. Harriette Chandler, the Senate chair of the Legislature’s Oral Health Caucus, touted a bill she sponsored as a means of increasing access to dental care for people who currently lack it.

A Public Health Committee redraft (S 2076) of bills filed by Chandler and Rep. William “Smitty” Pignatelli, which was referred to the Health Care Financing Committee in December, would establish a mid-level dental practitioner post in Massachusetts. After receiving the necessary education and certification, an “advanced dental hygiene practitioner” would be able to see patients in an office setting or in facilities like schools and nursing homes, Chandler said.

“Stay tuned, because we’re hopeful that we’re going to see some action on this before this term is over,” Chandler said. – Katie Lannan