Wednesday, March 25, 2015

Winning Strategies for Health Plans: Medical Dental Integration: One Plan’s Perspective Leading to Success

By Steven Pollock, Chief Operating Officer, DentaQuest

We are continuing to see new data that links preventative attention to oral health with improvements in overall health and well-being -- beyond the dental office.

Most notably, health plans have taken note of this connection through dental-medical integration programs. These plans target members with medical conditions linked to oral health issues, such as diabetes or heart disease, and have become an increasingly common component in commercial group benefit programs. Within Medicaid, Medicare and CHIP programs, dental-medical integration brings the best of both worlds to health plans and customers - an opportunity to improve care outcomes and decrease costs.

Recently, I led a webinar discussion during which Dr. Justin Cramer, chief medical officer of Missouri Care, shared his experiences with a dental-medical integration program targeted at Medicaid members. Missouri Care is part of the WellCare family of health plans which provides managed care services to health care programs supported by the government, with a focus on Medicaid and Medicare.

In 2011, Missouri Care approached DentaQuest to help gain control over the rising cost and ineffective care of ER utilization for dental visits. In response, we created DentaQuest’s ER Diversion program to educate and redirect members to a dental office setting during dental emergencies, rather than the ER.

By way of background, reports from the American Dental Association (ADA), Florida Public Health Institute, Rutgers University and the Pew Center revealed a growing number of young adults (18-34) from low-income communities who were using the hospital emergency department for non-traumatic dental care. Not only are ERs among the most expensive sources of care, but they also are poorly equipped to provide dental care and are often only able to provide temporary relief for the problem.

To tackle this issue, DentaQuest and Missouri Care executed a three-prong approach to:
  • Educate members on the importance of preventative care;
  • Decrease emergency dental care; and
  • Increase dental care in a dental office setting.

To accomplish these goals, DentaQuest reached out to Missouri Care members who had recently visited the ER for dental-related issues by phone and mail. Our team provided assistance in finding a dentist, helped them schedule an appointment and offered suggestions on what to do next time they had a dental emergency.

We tracked the effectiveness of the outreach in several ways -- claims data, individuals who went to dentist in office setting, and education. The chart below speaks to the success of the program from 2011 to 2014.

Missouri Care is just one example of how dental-medical integration is achieving the triple aim of improving quality of care, reducing costs and improving member health outcomes. Furthermore, studies have shown that medical costs related to chronic diseases go down significantly when we treat dental disease to improve overall health. Long gone are the days of solely treating the outcomes of dental disease - we now know that by increasing our focus on prevention and early intervention, we can lower the cost of medical and dental treatment in the long-run.

Thursday, March 19, 2015

Think Teeth: Kids’ dental health improving, but there is still work to be done

By Ralph Fuccillo, President, DentaQuest Foundation

A recent CDC report revealed promising news - early childhood caries in preschool-aged children is at its lowest rate in 25 years. Preventing oral disease at an early age leads to a lifetime of healthy smiles, and this achievement is one that should be celebrated.

However, tooth decay is the still most common chronic disease of early childhood — 5 times more common than asthma. Half of all kids experience tooth decay before age 12.  

At the DentaQuest Foundation, as a part of our Oral Health 2020 goals, we’re working with a growing network of partners to ensure that 75 percent of children reach age five without experiencing tooth decay. Although we have made great strides in reaching this goal, there is still much to be done.

We all want the best for our children, but oral health doesn’t always get the attention some other health issues do. That’s why it’s especially striking to look at the research that points out how tooth decay can have long term impact on children’s lives.  For example, children with poor oral health were nearly three times more likely to miss school, according to a study from the North Carolina Health Assessment and Monitoring Program. Children who reported recent toothaches were four times more likely to earn a lower grade-point average than peers reporting no dental pain. 

Luckily, the most common chronic childhood disease is also almost completely preventable. We have identified many cost-effective, simple ways to reduce tooth decay. The cost of applying a decay-preventing dental sealant to a child’s permanent tooth is much less than the cost of filling a cavity, and ongoing maintenance of that restoration. To provide another example, would you believe that every $1 spent on water fluoridation saves $38 in dental costs? By providing early, preventive care, we can improve overall health and save costs for the long-term.

In addition to making dental care more cost-effective overall, programs such as Children’s Health Insurance Program (CHIP) have made care more affordable for individuals. CHIP has been a critical source when it comes to providing dental coverage for children whose families earn too much to qualify for Medicaid but too little to purchase private insurance. CHIP and Medicaid are already an oral health safety net for millions of children, covering services such as teeth cleanings, check-ups, x-rays and fluoride treatments.

Although CHIP currently ensures care for eight million children across the county, affordability will become a concern in the near future unless Congress chooses to extend CHIP funding before it expires in September. However, creating affordable care is only half the battle. An estimated 3.7 million children are eligible but not enrolled in Medicaid or CHIP, resulting in even more children who could miss out on preventive care merely because they are unaware of the benefits available to them.

Our duty to the next generation and their families is two-fold: to provide education on preventive oral health care and the benefits available to them, and to ensure that their preventive care stays affordable and accessible. If we can do this, our goals of improving the oral health of all are well within reach. However, if we do not follow through on both of these promises, it’s likely that much of our progress will be lost.

We can work together to make changes. These free materials have been developed so you can help families make good oral health habits, and provide tips for pregnant women, parents and caregivers.  There are also resources, in both English and Spanish, to spread the word on social media.

Join us and others in this movement by visiting to learn more.  Share your stories and show your support for this movement by connecting with Oral Health 2020 on Twitter and Facebook. 

Thursday, February 19, 2015

Get a Head Start: Prioritizing Our Kids’ Dental Care

By Ralph Fuccillo, MA, President, DentaQuest Foundation

As Dr. Luther mentioned in his post last week, February is National Children's Dental Health Month. I’d like to highlight an oral health program for children that is seeing some exciting results, which could serve as a leading best practice when it comes to prioritizing our kids’ oral health. In this collaboration between Massachusetts and Pennsylvania, called Building Successful Collaborative State Oral Health Consortiums, we are addressing oral health disparities and promoting access to care for children.

Most infants and one year-olds in the U.S. have seen a physician, but a mere 2 percent have ever visited a dentist. Surprising to many, children who wait until age two or three to see a dentist actually experience more dental issues than those who visit a dentist on their first birthday, or when the first tooth comes in, as recommended by the American Dental Association. In an effort to change this trend, the DentaQuest Foundation and Head Start Association worked together to encourage early childhood oral health care.

Head Start offers a comprehensive preschool program to low-income children, and also provides families with relevant health information and ensures that children in the program receive regular physical and oral health check-ups.

Through a grant from the DentaQuest Foundation, the Massachusetts and Pennsylvania Head Start Associations created a three-pronged approach to encourage early childhood care for oral health, which includes:
  • Developing relationships with key stakeholders including state oral health and public health organizations;
  • Promoting oral health education; and
  • Increasing access to oral care. 

Now in the third and final year of our initiative, our Head Start partners have experienced promising successes to share in both states.

The Pennsylvania Head Start Association has done a great job of getting the word out about early childhood care. They developed effective oral health coalitions through multiple forums, which had more than 175 participants. Additionally, they've trained more than 250 individuals in the “Cavity Free Kids” curriculum, which helps children practice good oral health habits. Of these trained individuals, many are teachers, infant/toddler specialists, family advocates and more. Furthermore, to date, more than 335 Pennsylvania dentists have been educated on the importance of treating one year-old children.

The Massachusetts Head Start efforts successfully connected children to dentists, giving them a “dental home”. At the start of the initiative, only 19 percent of dentists said they treated children age one or younger. Massachusetts Head Start implemented a program called “Connect the Dots”, to help dentists and primary care doctors understand the importance of starting a dental home at an early age. At the end of the first two years of the initiative, the number of dentists in Massachusetts reporting the treatment of children at age one grew from 19 percent to almost 40 percent.

We're proud of our work with the Massachusetts and Pennsylvania Head Start Associations, but we still have more work to do if we want to meet our national goal of 75 percent of children to reach age five cavity-free. From a national perspective, Head Start programs offer a great opportunity to reach our youngest children at a critical time in their development. We are looking at the lessons learned from the work done in Massachusetts and Pennsylvania, and sharing these tactics with our community partners across the U.S. By training the next generation on best practices, we are mobilizing communities to be sure all children receive the dental care they need, when they need it.

For more information on Head Start, visit (National Head Start Association) and (the Office of Head Start’s Early Childhood Learning and Knowledge Center). 

Friday, February 13, 2015

It’s National Children’s Dental Health Month and Here are Six Steps to a Lifetime of Healthy Smiles

By: Dr. John Luther, Chief Dental Officer and Senior Vice President, Dental Management, DentaQuest

February is not just for Valentine’s Day and cold winter weather - it’s also National Children’s Dental Health Month!

While we often focus on the importance of kids’ oral health in our work (and on this blog) we wanted to take a moment to recognize the importance of this month, and of promoting steps that can help protect the next generation of teeth.

The need for better education and care is clear:
  • In the United States, 28% of preschoolers and 51% of 6-11 year olds have cavities.
  • American children lose 52 million school hours due to oral health problems each year.
  • Dental disease is the most common chronic disease in children in the U.S.- even more common than asthma. 

From the Peach State Health Plan, our partner in Georgia, here are some simple steps that will help you set your kids up to have a lifetime of healthy teeth:

  1. Go see the dentist! There is a misconception that you don’t need to worry about healthy habits until permanent teeth are in. In reality, it begins well before that – cavity-causing bacteria can impact a lifetime of dental health, beginning with the first baby tooth. It’s important to see a dentist at least twice a year, even when those teeth just begin to grow in.

  1. Got fluoride? Believe it or not, fluoride is a crucial part of having healthy teeth - every $1 invested in fluoride saves $38 in treating tooth decay. It’s vital to not only have fluoride in your water, but to also use toothpase with fluoride. Many families are always on the go, so if you give your kids a lot of bottled water, make sure it has fluoride included.

  1. Ask your kids’ dentist about sealants. Dentists can apply sealants to permanent molars when a child is 5-6 years old – before tooth decay even begins - providing a thin layer of protective plastic coating to teeth.

  1. Snack smart. Many snacks kids love – from cookies to potato chips – are high in sugar and starch, which weaken tooth enamel. While its best to limit snacking between meals, be sure to reach for a healthy snack like yogurt, fruit or veggies.

  1. Take two! Everyone should brush their teeth twice a day for two minutes each time. Since two minutes can be an eternity for kids, play their favorite tune while you help them brush their teeth.

  1. Break the thumb-sucking habit. While most kids outgrow thumb sucking, dental problems can occur when kids start to get their permanent teeth and still suck their thumbs. Ask your pediatrician or dentist about ways to help break the habit.

We hope that these steps will help you promote oral health with your kids during this special month and beyond!

And we’d like to say thank you to our partners in Georgia for these excellent pointers. To learn more about the Peach State Health Plan, and some of the innovative work the team there is doing with Emory University, visit:

Tuesday, January 20, 2015

Using Ancillary Benefits to Battle Margin Compression

In a recent post, we examined some of the key drivers of margin compression in this new era of health care reform:

  • Increased taxes
  • Minimum loss ratio
  • Increased competition
  • Greater price transparency
  • Standard benefit requirements

These factors, combined with the substantial costs associated with member churn, are driving a business truism within the health care industry: to effectively battle margin compression, health plans must strive to be present in multiple markets, and they should consider how ancillary benefits can be used to maintain and grow their business.

Of course, our industry is not the first to face game-changing legislation similar to the ACA. Following the attacks of September 11, 2001, airlines grappled both with stricter regulations that were costly to implement and shrinking demand as travelers responded to the tragedy.

Around the same time, websites like Expedia and Orbitz emerged as one of the primary sources to purchase airline tickets. These sites facilitated greater price comparison and increased price transparency, much like we are seeing today within the health care marketplace.  Clearly, this kind of comparative shopping can significantly impact consumer behavior and choice.

The airlines that most successfully navigated these challenges attracted consumers with competitive base pricing and used optional amenity costs - such as added leg room, luggage fees, and food upcharges- to bring in additional revenue. Following a similar model, health plans can use ancillary benefits that appeal to consumers who are interested in purchasing supplemental care, thus preserving a significant portion of their customer base and the associated revenue stream.

Expanding into multiple markets to offset the effects of member churn can be similarly powerful in the fight against margin compression. Offloading members is costly and the movement of members between Medicaid and health exchanges can threaten the overall stability of a health plan by compromising its ability to predict its financial risk. Health plans that have a presence in multiple markets can preempt the negative impact of member churn and better preserve and protect their bottom line.

As is often the case with landmark legislation that impacts such a fundamental part of our daily lives, the Affordable Care Act has brought vast improvements and interesting challenges to the healthcare industry. Health plans have a unique opportunity during this watershed time to explore how ancillary benefits and market expansion can grow and protect their business and membership base.  

Learn more. DentaQuest is hosting a webinar discussing how health plans can use ancillary benefits like dental to grow their market share and control medical costs. Please join me, along with Dr. John Luther, DentaQuest's Chief Dental Officer, and Dr. Justin Cramer, Chief Medical Officer of Missouri Care, who will speak about Missouri's first-hand experience with medical integration.

On the Frontlines of Medical-Dental Integration
Wednesday, January 28
1:30 p.m. CT

Register at

Friday, January 9, 2015

Join our Webinar: “On the Frontlines of Medical -Dental Integration”

By Steve Pollock, Chief Operating Officer, DentaQuest

There is increasing evidence demonstrating the relationship between oral and overall health, yet many in the industry don’t realize that in addition to improved health for members, medical and dental collaboration also allows for better care management and thus reduced costs. 

On Wednesday, January 28, 2015 at 1:30 PM CT, I am hosting a webinar to discuss how health plans can use ancillary benefits like dental to grow their market share and control medical costs. I will be joined by Dr. John Luther, Chief Dental Officer for DentaQuest, who will speak about the scientific evidence to illustrate the centrality of good dental health to overall health and Dr. Justin Cramer, Chief Medical Officer at MissouriCare, who will speak about MissouriCare’s first-hand experience with medical dental integration.

The webinar will explore the unique opportunities that exist for health plans seeking to grow their market share by integrating dental benefits into health plan offerings and the healthcare insurance industry’s changing market dynamics.   Through this first-hand account of the challenges and benefits of medical dental integration, attendees will learn strategies to successfully implement the concept.

I encourage you to join us to gain more insight into what I consider to be one of the most important areas of growth for our industry. You can also learn about the benefits of medical dental integration by following this blog series on Oral Health Matters, “Why This Matters to Me.”

Please click the following link to register at no charge:

Tuesday, December 23, 2014

A New Year’s Resolution to Smile About

As 2014 comes to an end and we start making our New Year’s resolutions, once again getting healthy seems to be at the top of everyone’s list. But being healthy isn’t just about working out and eating a nutritious diet; good oral health is imperative to one’s overall health.

The New Year is the perfect time to start practicing good oral habits that will last a lifetime. Prevention helps you maintain a healthy mouth, and the single most important thing that you can do to protect your teeth is to brush for two minutes, twice a day, every day. And don’t forget to floss too. It’s equally as important to add this to your child’s daily routine..

Here are some brushing tips for all ages:

Infants, 3 months to 1 year and children, 1 year to 2 years: Gently wipe the baby’s teeth with a clean damp washcloth. For kids under age 2, use a soft toothbrush and a little water with a very small dabble of fluoridated toothpaste. Once teeth are cleaned at bedtime, they should drink only plain water.

Children, 2 years to 6 years: Help your children brush their teeth; hold the toothbrush with them and guide them. Demonstrate how to clean every tooth surface and to gently brush their tongue to remove germs and freshen breath. Use a pea-sized dab of fluoride toothpaste and teach your child to spit out the toothpaste when they’re done. Today there are numerous fun apps that you can download that will make brushing their teeth fun! Check out this video to for more tips on teaching children how to brush their teeth.

Tweens and pre-tweens, 6 years to thirteen: Once your child knows how to brush, let them do so on their own with your supervision. The goal is to spend 2 minutes to ensure they brush every tooth evenly– the front, back, top, and sides. Teach your children how to floss between teeth and instill this as part of their morning and nighttime routine.

Teens and Adults: We are all busy with work, school, sports, and family. However research is showing that poor oral health can exacerbate chronic health problems that people might have once thought were unrelated – such as diabetes and heart disease. Maintaining good oral health can aid in the management of these diseases. Teens and adults should clean they teeth gently but thoroughly for a full 2 minutes before they head out for the day. Finish the day by brushing to remove any leftover food in your mouth and floss between your teeth.

And remember this: Simple, repetitive tasks will become habit in just 21 days. Start on January 1 and make it your goal to brush your teeth for 2 minutes, twice a day, every day. You will have fulfilled one of your resolutions before the second month of 2015! You can do this!

Finally, think about when you last saw an oral health professional. If you haven’t done so in the last six to 12 months, now is a good time to schedule your next visit!