Prioritizing Our Seniors: Why Offering Medicare Dental Coverage Matters

More than 46 million seniors lack dental coverage, according to a 2015 report on enrollment from the National Association of Dental Plans (NADP) and Delta Dental Plans Association (DDPA). And that number is only expected to rise with our burgeoning population of older adults.

In order to help more seniors get covered, U.S. federal policy must more effectively address the oral health needs of this population.

Recently, there have been several big news stories about the barriers 70 percent of seniors face to receive quality oral health care.

One major contributor is that dental care is not covered under Medicare. Boston College researchers found that the percentage of people with dental coverage declines by more than half in the 10 years after reaching retirement age -- from 62 percent at age 65 to 26 percent at 75. Why? According to CBS News, the study suggests the following...

The reason: When most workers retire, they lose the dental coverage provided by their employer or union. But doesn’t Medicare, which starts at age 65, step in and pick up the slack? Not on your canines, “a fact that a majority of baby boomers are unaware of…”

According to a recent survey of 2,000 registered U.S. voters conducted by DentaQuest via Morning Consult, this is not a partisan issue. In fact, 83 percent of Republicans and 86 percent of Democrats responded that dental coverage should be included in Medicare.

Without coverage, seniors face significant out-of-pocket costs to obtain appropriate oral health care, as they are more likely to need the most costly procedures, such as crowns, implants, or false teeth as they age. Seniors are also more likely to have chronic conditions that may complicate or exacerbate these oral health issues.

Because traditional Medicare does not provide dental coverage, Medicare Advantage plans are taking a lead in providing oral health coverage for seniors. In fact, DentaQuest partners with many of these plans because they recognize the importance of oral health to the overall health of older adults. However, these benefits are optional or supplemental and not all seniors can afford to pay out of pocket for this coverage.   

More affordable solutions are necessary to bridge this gap for our seniors.

With all of the discussion surrounding changes to the Affordable Care Act and Medicaid, policies to expand dental coverage have largely gone overlooked. However, DentaQuest has taken steps to begin addressing this gap.

A few weeks ago, the DentaQuest Foundation announced a $668,000 grant to Oral Health America to expand the Wisdom Tooth Project and increase advocacy for publicly funded dental coverage for seniors. This project focuses on five strategies including education for seniors and professionals and pilot demonstration projects to combat barriers to care. The DentaQuest Foundation has been pivotal in supporting Oral Health America’s efforts for older adult oral health since 2010.

As health care prepares to undergo substantial changes, industry stakeholders may support different proposals but our goal should remain the same. We echo AHIP’s comments that the industry must bond together “to ensure every American has access to affordable coverage and quality care so they can achieve their best health.”

Expanding access to health care, including oral health care, is a foundational pillar to achieve this goal.

We cannot leave our seniors behind.

Dental Coverage has Bipartisan Support among Voters

As the new Trump Administration and Republican Congress begin their work this month, they will have the opportunity to advance conservative priorities through major legislative changes. At the top of their list is repealing the Affordable Care Act (ACA), which will have implications for the dental health and overall health of many Americans.

ACA replacement proposals from President-elect Trump, Speaker Paul Ryan, and the nominee for Secretary of Health and Human Services Rep. Tom Price should signal major changes forthcoming to the health care industry.

The ACA’s Medicaid expansion, essential health benefits, and exchange provisions have increased access to dental care for both children and adults. While the future of these elements is uncertain, we at DentaQuest want to ensure that replacement proposals do not jeopardize this important access to oral health. We’ve made great strides in eliminating barriers to dental coverage for millions of Americans who gained access through the ACA.

As policymakers consider different replacement plans, the role of oral health must remain a priority. 

In a recent survey of 2,000 registered U.S. voters conducted by DentaQuest via Morning Consult, the inclusion of dental coverage in public programs received widespread support from voters of both parties.

The survey showed that:

• 83 percent of respondents think dental coverage should be a part of Medicare
• 83 percent of Republicans agree
• 86 percent of Democrats agree
• 81 percent of Independents agree
• 73 percent of respondents believe dental coverage should be a required benefit in Medicaid
• 64 percent of Republicans agree
• 82 percent of Democrats agree
• 71 percent of Independents agree

Dental coverage is not currently included in Medicare, nor is it a required benefit for adults in Medicaid. A full repeal of the ACA could compound oral health access issues by eliminating Medicaid expansion and the exchanges— two important sources of affordable dental coverage.

Research continues to show a connection between oral and overall health. Dental coverage is a critical first step to improve both oral and overall health outcomes, reduce persistent health disparities, and contain systemic costs.

As policymakers seek to improve our existing health care system, oral health must be a part of the solution. 

It is clear: Dental coverage has demonstrated itself to be a bipartisan priority for the American public. As we enter a 2017 legislative session with significant health care policy changes on the agenda, dental coverage must also remain a priority for Congress.


The full survey conducted by DentaQuest and Morning Consult will be released in 2017.

Why are dentistry and oral health care practices seemingly easy to question?

The topic of evidence in dentistry and oral health care has been in the news a lot recently, with articles like this column in the New York Times by a professor of pediatrics.

In his column, Aaron Carroll discusses the differences he sees between his own and his wife’s dental journeys, as well as what little rigorous research has been done to support certain generally recommended dental practices.

What is interesting is that articles like this one and the popular flossing article from the Associated Press, among others, imply that recommendations made by dentists are based solely on limited or weak evidence – or worse, based simply on what the dentist will get paid for by an insurance company.

They also leave readers feeling that plaque removal and cavity prevention/treatment are the only elements necessary to address for good oral health.

Ultimately, Carroll suggests in his column that while lack of evidence doesn’t mean oral health prevention efforts don’t work, we should invest in research to ensure that those things we do are evidence-based.

For those of us in the business of improving oral health, we couldn’t agree more with that conclusion. But let’s take a closer look at some of the points that may have gone overlooked by recent press coverage.

We know that evidence something works for populations doesn’t directly translate into solutions for a specific individual – that is in fact why Carroll and his wife have such dramatically different dental journeys.

Carroll notes he has had just one filling in his life and doesn’t religiously care for his mouth, while his wife has “more fillings than [he] can count” but is fastidious in her oral care routines.

This underscores two important points:

1. Every person is different. Individualizing care is critical to improved oral health.

While evidence-based research informs standards of care, it is the dental team that must develop the best care plan for any given person’s situation. That is why DentaQuest invests in the development and adoption of evidence-based care protocols that focus on prevention, early intervention and disease management.

Our investments in disease management and risk assessment help provide dental teams with the knowledge and tools they need to best serve their patients.

For instance, across a five-year period, the DentaQuest Oral HealthCenter demonstrated that risk assessment and intense preventive efforts (including sealants and fluoride varnish) directly resulted in a reduction in the need for invasive surgical procedures.

Sealants are one of the most cost-effective strategies for protecting teeth, as noted in another recent New York Times column. This is because they provide a physical barrier against cavities. They can even be applied to teeth that are just starting to show signs of new cavities, and stop them from getting bigger.

The best time to seal a tooth is immediately after it erupts in the mouth, and so the DentaQuest Oral Health Center strives to set aside extra time at visits for children ages 6 and 11 since the permanent molars are usually erupting at that time. It is also why the DentaQuest Foundation collaborates so closely with school-based health alliances working to improve access to oral health care – and sealants – among children in grade school.

Additionally, with a patient population of over 10,000, the DentaQuest Oral Health Center works in collaboration with the DentaQuest Institute to refine strategies that make patients healthier. And when these best practices are implemented, they actively improve peoples’ health.

2. Prevention and oral health improvement do not take place solely in the dental chair.

Preventive dental visits provide an important opportunity for people to check in on their oral health habits and get evaluations for early signs of not just dental disease, but also chronic diseases like diabetes and hypertension.

Most of us spend two hours a year in a dental office. And, if we are to reconsider the benefit of two annual preventive visits as Carroll suggests, some of us might end up spending even less time with a clinician. So what about the other 8,758 hours?

The differences in the oral health of Carroll and his wife are not because he brushes with an electric toothbrush every day or because she is doing something “wrong” in her routine. Oral health care is more than just brushing and flossing. In fact, it is about more than your teeth and gums.

To make an impact, we have to take a look at how we pay for oral health care, how our public policies enable it, and how our communities prioritize it, in addition to how we provide it.

Addressing just one of those will not improve oral health care on the larger scale or reduce health care costs, as Carroll aims to do with his recommendations. We know oral health care is indeed critical for overall health. This is why we at DentaQuest look far beyond the dental chair.

For example, as part of Oral Health 2020, the DentaQuest Foundation is investing in efforts to incorporate oral health into the primary education system. Oral health education, screenings, assisted referral, and delivery of preventive care through our schools provide equitable, reliable entry into long-term oral health care.

DentaQuest also champions efforts to include innovative financing models for dental in person-centered approaches to care enabled by the Affordable Care Act (ACA).

Over the last decade, we’ve seen significant movement to transform our health care system into one that improves quality, lowers costs, and makes people healthier. In fact, on the medical side the Triple Aim is starting to be supported by alternative payment and care delivery models that are person-centered and focus on prevention.

Why did that happen? Because experts and advocates knew there had to be a better way forward for a healthier America.

The same is true for oral health. We are beginning to see that it is possible to live in a world where optimal oral health is the expectation, not the exception. We must continue to invest the same transformative energy into improving the oral health of all because you cannot have optimal overall health without optimal oral health.

 

Dental Health Care Needs Quality Improvement Now

The message couldn’t be clearer: The time for the dental profession to jump on the health care quality improvement (QI) bandwagon is now.

In the past quarter-century, the United States has seen medical care improve and per capita health care costs go down thanks to QI standards adapted from other industries like manufacturing. But why has the dental profession been so slow to join the game? Our recent DentaQuest Institute editorial in the July/August 2016 issue of Pediatric Dentistry provides some clues.

In our editorial, we argue that, because of QI’s effectiveness—in medicine and other fields—it is 

“...imperative that dental professionals create the culture and systems necessary to apply QI principles and activities for the benefit for our patients, the public at large, and our profession.” 

That may be easier said than done, but our own Dr. Natalia Chalmers, who heads DentaQuest Institute’s Analytics and Publication team, and her colleagues lay out a number of programs that place a heavy emphasis on QI - from DentaQuest Institute’s EarlyChildhood Caries (ECC) program and the UCLA-First 5 LA Oral Health Program to new initiatives from the American Dental Association’s Dental Quality Alliance. 

The common thread with these programs: they all work.

• Through ECC Collaborative, an effort to reduce dental caries in young children, 32 federally-qualified health centers (FQHCs) significantly improved patient outcomes after implementing a disease-management approach to QI.
• The UCLA program helped 22 local FQHCs redesign workflows based on QI models, improving diagnostic, preventive and treatment services in participating dental clinics. With the “triple aim” of improving patient experiences, improving health status, and lowering costs, the ADA’s Dental Quality Alliance seeks to help dental practices establish processes “to reliably deliver evidence-based care to every patient.”

The authors note small steps may be all that’s needed to push the profession toward QI. For example, the Plan-Do-Study-Act cycle results in a trial-and-error approach until performance improvements are realized. This practice has helped improve quality performance in industries from high-tech to higher education. There’s no reason dentistry can’t do the same.

They also understand that integrating QI into a dental practice requires considerable planning, coordination and commitment. And it takes a team for QI to take root. Dental practitioners, office staff and even patients must be invested in the process for it to work.

That said, dentists need to begin thinking now about QI at the practice level. These efforts will have an enormous impact on the way dental care is delivered. And, as the DentaQuest editorial illustrates, that’s a win-win for everyone.     

           

Better Care for Today; a Better Healthcare System for Tomorrow

Guest blog post by Cindy Hannon, DentaQuest Institute Quality Improvement Manager

I just had an inspiring experience at the Institute for Healthcare Improvement’s (IHI) 23rd Annual Forum. Over 6,000 participants (yes 6,000!) converged on Orlando, Florida to focus on quality in healthcare. Over the last year, I have been working with DentaQuest Institute partners on three Quality Improvement projects in dental care – Dental Sealants for Adolescents, Early Childhood Caries (ECC), and Elimination of Dental Disease.

I wanted to attend this year’s IHI Forum because the DentaQuest Institute is gearing up for an exciting 2012 with a strong focus on quality and a prevention-focused, disease management model of care. There is a lot to be learned from the work of the Institute for Healthcare Improvement. Its successes are lessons in the kind of change management that facilitates improvements within a care system. Time and again, people that I met in sessions and around the conference said they were so happy to have people involved in dentistry at the quality table.

Maureen Bisognano, President and CEO of IHI started the two-day forum reminding us of our purpose -- we are capable of “making better care for today and a better healthcare system for tomorrow.”

With Quality Improvement, we are “acting for the individual but learning for the population.” Stories of patients and their families are important tools: “Stories,” Maureen reminded us “are first personal, then they become public, and then collective, and lastly, they become political.” There is a connecting thread: we help the individual and what we learn supports improvement for others. A compelling patient story helps grab attention today and builds the will for change. Our patient encounters help us understand the situation (patient, disease and environment) and devise better solutions. Data help us make the case to move change through the system. Quality improvement, at its core, is applying reliable new knowledge (science-based evidence) with a goal of better outcomes.

On the plane returning to Massachusetts, I sat in my seat tired but full of energy. Charlie Homer, MD, MPH, President of the National Initiative for Children’s Health Quality (NICHQ) and a national leader in improving the quality of healthcare for children, was on the same flight. Jane Taylor, EdD, an Improvement Advisor for IHI, was also on the flight. I was just a few rows behind them. It occurred to me –dentistry may be behind medicine in this quality improvement work, but we are all on the same flight, headed for the same destination… better health outcomes. And, I am thinking about the stories we will have to tell.