Let’s Focus on Quality, not Quantity

By Mark Doherty, DMD, Executive Director, DentaQuest Institute

It’s hard to miss the fact that our health care system is in the middle of a lot of change. I read about “pay for performance,” “accountable care organizations” and “value-based care” all the time. Oral health is not usually part of the discussion but that won’t be for long. The growing cost of care, the variation in treatments and care outcomes and the significant disparities faced by disadvantaged groups are important issues for dental care delivery too.

So I am very excited by the strong interest and motivation among my peers to find opportunities to focus on quality rather than quantity in America’s oral health care delivery system. I just returned from a meeting in Washington, D.C. with leaders in oral health and health care from across the care delivery spectrum (ADA, ADEA, CDHP, ADHA, CDC, HRSA, IHI, CMS, dental educators, providers, hospitals, health policy experts, insurers and more) where quality improvement and accountability were the central topics. Folks left the meeting ready to take part in this Quality Journey.

The impetus for the meeting was a new report (just released), edited by Paul Glassman DDS, MA, MBA, professor of dental practice and director of the Pacific Center for Special Care at the University of the Pacific Arthur A. Dugoni School of Dentistry. The report, Oral Health Quality Improvement in the Era of Accountability, is a call for a new dialogue on how to improve quality and increase access to affordable dental care.

Until now, the limited evidence of best practice for most dental procedures has led to widespread variation in clinical decisions among dentists; [Read the blog post, To Fill or Not to Fill by my colleague Dr. Doyle Williams to understand the variability in treatment approaches.] And today, there are few incentives to implement quality improvement programs.

But we need to. Dental expenses are now one of the highest out-of-pocket health costs for consumers. And 37 percent of African American children and 41 percent of Hispanic children have untreated tooth decay, compared to 25 percent of white children. The disparity is unacceptable.

Take a close look at the ideas in this report. We need to look at the opportunities to do better.

At the DentaQuest Institute, we’re emphasizing prevention and disease management in our quality improvement initiatives. The good news is that this approach works. When we apply a disease management model to the care of a chronic disease like Early Childhood Caries (ECC), we are seeing longer-term improvements in the patient’s oral health.

The DentaQuest Institute will post the presentations from the meeting in Washington on our website.

This is an exciting time for those of us who are passionate about better oral health for all.

New Year, New Design

From the Oral Health Matters team

You may have noticed some changes here at Oral Health Matters. We decided to improve the blog, much like our commitment to improving oral health.

We redesigned the blog so it’s easier for you to read. You’ll notice there is more white space in the new design, and the photos of our contributors have been moved to a new column on the left to help keep them in view. Tools for sharing and searching the blog are more prominently displayed at the top of the right hand column, making it simple to share posts and search by topic.

We will continue to share our thoughts, ideas, stories and news in oral health innovations with you in 2012.

We invite you all to tweet at us to let us know what you think! If you’re not already following us on Twitter, come check us out: @dentaquest

Best,
Doyle, Fay, Steve, Ralph, & Mark

A [Dental] Wake Up Call for Baby Boomers

Guest Post by Dr. Michael Monopoli, DentaQuest Foundation Director of Policy and Programs

The baby boom generation has consistently enjoyed better health and better oral health than any previous generation. Thanks to community water fluoridation, fluoride toothpastes and having dental insurance as part of employer-sponsored health plans, this generation is the first where a majority will keep and maintain their natural teeth over their entire lifetime.

This is wonderful news, and the facts support it. CDC data shows that over the past decade, the number of adults missing all their natural teeth has declined from 31 percent to 25 percent for those aged 60 years and older. And more good news: Seventy percent of adults at or above the poverty level said they visited a dentist in the past 12 months (CDC Fact Sheet). This is a generation that cares about and values its good oral health.

But there’s a serious dental wake-up call on the horizon for this first wave of boomer retirees. Even with largely good oral health, today’s retiring adults are realizing they will have to plan to pay largely out of pocket for dental care to maintain their oral health beyond their working years.

Many have all of their teeth and received routine dental care through their lives. They are now struggling with the realization that Medicare generally doesn’t cover routine dental procedures, such as cleanings or fillings. Medicaid, the jointly-funded Federal-State health insurance program for low-income people, funds dental care for low income and disabled elderly in a few states, but reimbursements are low. Most dental plans that cover the necessary services to maintain good oral health are based on employment and these dental benefits are lost with retirement. Retirees now have to figure out how they can continue the level of dental care they enjoyed through their working lives, and will need to balance these expenses along with other important needs like food, housing, and the rest.

And to add insult to injury, over the past decade, the value of retirement funds and IRAs has been shrinking with the ups and downs of the economy. Some retirees are facing the fact that their retirement funds may no longer support the lifestyle they were used to or hoped for – including good preventive health services.

It’s not a comfortable feeling to have to decide what dental care you are willing to pay for in order to have good oral health -- especially when we know good oral health is an integral part of overall health.

This is one of the issues that was discussed by the new U.S. National Oral Health Alliance, leaders from dentistry, medicine, dental education and the dental industry, health advocates, policy makers and philanthropy at their first leadership colloquium in 2011. Without access to oral health care and prevention, our nation’s most vulnerable families are at high risk. Many middle class elders will begin to face dental issues that our nation’s most vulnerable families have faced for many years. Hopefully, this larger group will change the conversation.

Best Wishes for Optimal Oral Health!

Grantees of the Oral Health 2014 Initiative, the DentaQuest Foundation's multi-year campaign to strengthen and accelerate state and community action on behalf of better oral health, met as a group for the first time on November 9 and 10 in Washington, DC. Grantees, advisors and DentaQuest Foundation staff gathered for an Oral Health 2014 group photo.