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.

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 www.dentaquestfoundation.org to learn more.  Share your stories and show your support for this movement by connecting with Oral Health 2020 on Twitter and Facebook.