DentaQuest Remains Voice for Oral Health Equity in Disparities Leadership Program

For the second straight year, DentaQuest is participating in the Massachusetts General Hospital’s Disparities Leadership Program. Last year, DentaQuest became the first oral health organization to be accepted into the program. Over the next 12 months, we will build upon our previous efforts to promote oral health equity for Medicaid and CHIP populations.

The Robert Wood Johnson Foundation recently released a paper that defines health equity as “the ethical and human rights principle that motivates us to eliminate health disparities,” both a process and an outcome.

Now in in its 11th year, the program gathers a variety of health care leaders to develop strategies that address disparities in health care. We are particularly excited to remain part of this team, which is designed to cultivate leaders who can align equity efforts with the transition to value-based health care.

DentaQuest is one of five health plans in this year’s class and once again the only oral health organization. Our project will focus on how to leverage data and our national footprint to identify and alleviate oral health disparities, while also promoting equity as a key objective for our own organization.


Why is it important that oral health leaders are involved?

Despite progress towards a more equitable health care system, oral health disparities persist.

• Untreated dental disease is disproportionately prevalent among racial and ethnic minorities
•  42 percent of African American adults and 36 percent of Hispanic adults have untreated dental disease, compared to 22 percent of Caucasians
• Among adults with incomes below the federal poverty line, 42 percent have tooth decay—that’s three times more than adults with incomes above 400 percent of the federal poverty line.
• Rural areas experience higher rates of dental disease and tooth loss with lower preventive utilization rates.
• Barriers such as cost and fear of discrimination mean just 10 percent of the surveyed LGBT population say they have regular dental visits.

With much progress still to be made, the four branches of the DentaQuest enterprise—benefits administration, philanthropy, science, and care delivery—will work in tandem to reduce inequities in the communities we serves across the country. This work not only enables us to get closer to achieving oral health for all, but also will drive our work with others.

Ultimately, our participation in this program steps up our ability to address health equity collaboratively with our partners – from states and clients to providers and patients.

Penny Wise, Pound Foolish?

This week, two news stories caught my eye. One, in the Washington Post, was about a vote taken in the U.S. House of Representatives to repeal mandatory funding for school-based health center construction. The other, in the Worcester, MA Telegram & Gazette, recalled the days when children in Worcester received their dental care within the public school system. That ended in the late 1970s when most school dental clinics were closed. And since then, the rate of dental disease in the city’s children has been on the rise. It also doesn’t help that the city of Worcester does not fluoridate its water supply.

Across the United States, school-based health centers are becoming an important vehicle for health care delivery for all children, but especially for poor, uninsured or underinsured children. Providing health services where children spend the greatest part of their day makes sense. It eliminates the biggest impediments to getting care – such as the parent/caregiver getting time off from work, finding a provider who accepts the family’s insurance plan, and securing appropriate transportation. School-based health centers help families too, especially when the providers introduce children, siblings and the extended family to community health resources that all can use.

School-based clinics are a first line of disease prevention and eradication. When children and their caregivers know what to do to take care of teeth, and when they are able to see a dentist when something is wrong, cavities are nearly completely preventable. And when neither of the above takes place, children can end up with serious decay and infections that require emergency room care and extreme interventions. (Read about Early Childhood Caries in this blog here and here.)

Today Worcester, MA is working to establish a pathway for young at-risk children and their families to a lifetime of good oral health. Through a pilot program, 730 Head Start children and their families are learning about oral health as part of classroom activities and parent meetings. They are introduced to the dentist as a friendly, supportive adult. Parents/caregivers get a colorful “Baby Tooth Timeline” -- a growth chart which tracks age, height and weight and provides useful dental health information for the child’s first five years. The chart explains when to expect first teeth, what to do to prevent decay, and when to schedule dentist visits.

The next step is to be sure the children have connections in the community to get care when they need it. Statistically, low-income children suffer from dental disease at much greater rates than the general population. Many Head Start children are covered by Medicaid; but not all dentists accept Medicaid patients.

And, not all school-based health centers provide dental services. We think they should. As the Worcester example shows, prevention works. It would be nice if the U.S .House of Representatives would reconsider their recent vote, and instead, approve the wise investment in school-based health centers.

Dr. Mark Doherty is Executive Director of the DentaQuest institute, a not-for-profit organization focused on improving efficiency, effectiveness and quality in dental care.

Keeping America’s Oral Health Safety Net Strong

Ask any American what they think about healthcare reform and, for better or worse, you’ll probably find very strong opinions about the role of government and spending.

However, backstage, away from the public debate about the new law, a quiet revolution is underway to help the 59 million Americans who go without medical care and the 100 million who have not had dental care this year, get the care they desperately need.

It’s not the individual mandate or the state health exchanges. It’s the most significant investment in primary care you’ve probably never heard of—an $11 billion commitment to community health centers and $15 billion to prevention programs. It may sound like small potatoes compared to the estimated total cost of healthcare reform--$940 billion over 10 years--but the impact will be significant, especially for those who need it the most.

These funds, reopened for debate by Congress, would double the capacity of community health centers (CHCs) from serving 20 million people a year to 40 million. As the only access point for care besides the emergency room, CHCs provide critical prenatal care, behavioral health services, primary and specialty care for 1 out of 7 uninsured individuals. By 2015, with new capacity, CHCs will serve 1 out 3 uninsured.

Healthcare reform requires that CHCs offer oral health services. This means as many as 17 million children will get to see a dentist, some for the first time ever. Currently, these children are significantly underserved because they can’t access to care to prevent tooth decay and, once they have decay, to get timely treatment.

There’s a reason why former U.S. Surgeon General David Satcher declared childhood tooth decay a “silent epidemic”. 6.5 million children have untreated dental disease, the majority of whom are from low-income households. Half of these children are estimated to go to school with mouth pain—as children who cannot eat properly or pay attention in class and do well in school.

For infants 3 years old and younger, this can mean a mouth full of diseased baby teeth that can only be treated through surgical intervention. This is followed by a life time of being at greater risk for tooth decay, because the corrosive bacteria that cause tooth decay have colonized their mouths in greater proportion.

Tooth decay not only disrupts development and educational attainment, it can also turn deadly. The 2007 death of a 14-year-old Maryland boy is a tragic reminder of how one ‘simple’ toothache can develop into an unchecked infection that can quickly spread to the brain. His death could have been prevented with a timely dental care, but, at the time, oral health services were difficult to find for families on Medicaid.

From our work as president of a foundation focused solely on oral health and as a lifelong practicing dentist in both a private practice and a community health center, we see evidence every day of how oral health disparities in underserved communities are every bit as cruel as violence, inadequate housing, or poorly performing schools.

Fortunately, dental disease is nearly 100% preventable with education, regular check-ups for prevention, and treatment. That is why we’re committing DentaQuest Foundation resources to supporting and strengthening the community care safety net for oral health. We want to make sure that greater numbers of health centers will be prepared to provide effective, high-quality oral health services to children and families. The DentaQuest Institute and its Safety Net Solutions program are joining us to make sure that happens.

It may take decades before the impact of this investment in community health centers is fully appreciated. That’s okay. Today we are thinking about the millions of children who will have greater opportunity in life because of accessible health care.

Blog post by Ralph Fuccillo and Dr. Mark Doherty.

Ralph Fuccillo is President of the DentaQuest Foundation.
Dr. Mark Doherty is Executive Director of the DentaQuest Institute. Its Safety Net Solutions Program is helping community health center dental programs become more efficient, effective and financially stable.

Some Good News at Massachusetts’ Medicaid Dental Program

This February, U.S. District Court Justice Rya W. Zobel ended 5-years of court oversight of the MassHealth (Medicaid) dental care program for low-income children.

This is a milestone to celebrate.

In 2005, as the conclusion to a class action lawsuit against the Commonwealth of Massachusetts, Judge Zobel ruled that Massachusetts children covered by the MassHealth dental program encountered “extraordinary difficulty” in obtaining timely dental care, and that the program violated federal Medicaid law. At the time, barely a third of eligible children Massachusetts were being treated by a dentist.

The judge ordered Massachusetts to bring the MassHealth children’s dental program into compliance with federal law and appointed a neutral Monitor, Dr. Catherine Hayes, to make sure the necessary changes were made.

Since then, Massachusetts has made significant improvements to its Medicaid dental program.

1. The state established a full time Medicaid Dental Director. Previously, there was a part-time leader/advocate for oral health.

2. The state hired a 3rd party dental management administrator (DentaQuest) to efficiently manage the processing of claims and to provide provider relations.

3. The Massachusetts legislature increased the fees paid to dentists treating Medicaid patients to a point far more comparable with the cost of providing care. Previously, dentists were reluctant to treat Medicaid patients. In 2009, the Massachusetts Dental Society set a goal to have 65 percent of its membership, including specialists, participate in the MassHealth program by the year 2013. New dentists are joining MassHealth every day.

These changes are making a difference. In 2010, 50% of the children in the program saw a dentist compared to 33% before 2005. So after reviewing the current data, Judge Zobel declared the MassHealth dental program free to function without a guardian.

In Massachusetts, there are other good news events for children’s oral health. School-based programs are now in place across the state, some state-funded and some funded by private philanthropy-- they provide dental examinations including placing dental sealants (thin plastic coatings on molars) and fluoride treatments on children’s teeth to protect against cavities. And, MassHealth is now paying pediatricians and nurse practitioners when they apply fluoride treatments and advise parents and caregivers on how they can help prevent cavities in children.

That’s not to say that there still aren’t oral health challenges in Massachusetts. Benefits are closely tied to the economy and the state’s budget. In 2010, dental benefits for adults in the MassHealth program were cut back. Adult benefits are vulnerable because states are not required to provide them, even though doing so makes good sense. Parents’ dental coverage is a good predictor of whether or not their children will obtain dental services.

Despite economic challenges, more Massachusetts children are getting good preventive dental care, and that’s great news.

Massachusetts has an oral health plan

The plan, presented at the Massachusetts State House by the Better Oral Health for Massachusetts Coalition on April 12, is the result of over a year and a half of work by a dental care providers, program sponsors, lawmakers, state officials, insurers, health advocates, policy leaders, and consumers, in communities from Cape Cod to the Berkshires.

The goal of the state Oral Health Plan is to improve the system of oral health services in the state through a strategy that includes increasing access to preventive services, broadening the public’s understanding of oral health, developing the oral health workforce, and strengthening disease surveillance. The plan emphasizes cost-effective strategies and public-private partnerships at the local, regional and statewide levels.

The Better Oral Health for Massachusetts Coalition was formed in 2008 in response to data provided in 2008 report by the Catalyst Institute’s report, The Oral Health of Massachusetts. This report found gaps in access to preventive oral health services across Massachusetts. For example, 48% of children under the age of 9 suffer from tooth decay and 1 in 10 children from low-income and minority families reported mouth pain while at school. Untreated tooth decay can inhibit a child’s ability to learn, speak, and eat, and result in lower educational attainment and poorer overall health.

I had the pleasure to serve as master of ceremonies at the launch of the plan. Speakers representing state government and the health care community spoke about the importance of oral health and its connection to overall health.

The DentaQuest Foundation has been the primary supporter of the Better Oral Health for Massachusetts Coalition through in-kind and financial contributions. View the plan at www.massoralhealth.org or, at www.dentaquestfoundation.org/resources/reports.php.

Guest post by Ralph Fuccillo, President, DentaQuest Foundation