Congress: Protect Access to Dental Health Care

As the Senate debates health care bill proposals to transform our care delivery and financing systems, we must ensure they protect access to dental coverage for all Americans.

Over the past few years, more and more Americans have been able to access affordable dental coverage. In fact, since 2000, the percentage of children without dental coverage has been cut in half.

Medicaid has played a critical role in this progress. Dental services are considered an essential part of the Early Periodic Screening, Diagnostic and Treatment (EPSDT) program, which ensures that children receive regular dental care. Adults have also benefited in recent years, with 5.4 million adults gaining coverage through Medicaid expansion.

Other public programs have also helped. Because pediatric dental benefits are considered an essential health benefit on the exchanges, more kids have coverage. Further, many adults have selected dental coverage through the marketplaces.

As more of us gain access to coverage, we see the rate of untreated decay declining among low-income children, and research shows that costly emergency department visits for dental-related issues have declined. These improvements are in large part attributable to the fact that more people have access to dental coverage.

Over the past several months – continuing this week and for likely the near future – Congress has explored various avenues for health care reform. The value of oral health care and dental coverage cannot be overlooked in these conversations.

Let’s not overlook that tooth decay remains the most chronic condition among children, which can affect school performance and attendance.

Additionally, optimal oral health is not simply a goal in itself, but is vital to creating healthier communities. Research has shown that tooth decay can result in an elevated risk for diabetes, heart disease, and stroke. What’s more, recent studies demonstrate that treatment of gum disease can lead to better overall health management—as evidenced by lower health care costs and fewer hospitalizations—among people with common health conditions like those mentioned above or even pregnancy.

Any health care reforms must ensure dental remains a priority.

By improving access to dental coverage for low-income families in the past few years, we as a nation have made tremendous strides to

• ensure children are well-positioned for a lifetime of optimal health;  

• decrease poor quality, high-cost emergency department visits for dental-associated issues; and

• improve the oral and overall health of vulnerable populations.

We hope Congress pursues solutions that protect these improvements.

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.

Let’s improve oral health with provider-focused, patient-centric Medicaid dental partnerships

States and managed care organizations face real challenges when it comes to running a successful Medicaid program and helping people get and stay healthy. Medicaid leaders find themselves faced with extremely difficult decisions about how best to prioritize critical needs of the population – often times there are no silver bullets. Yet, Medicaid dental partnerships are a great step forward.

In the past, the dental component of a Medicaid program has fallen victim to tough decisions, receiving fewer resources and lagging behind when it came to ensuring access to needed care. And people suffered.  

Recognizing this, states started to look at their Medicaid dental programs differently. They began seeking out industry experts like DentaQuest to help work directly with Medicaid agencies or to support managed care organizations to implement best practices. 

The result was that more people got access to the medically necessary oral health they needed.

   

Rapidly expanding regulatory requirements and Medicaid budget pressures, as well as the tidal wave of value-based payment and care models initiated by the Affordable Care Act, mean states once again find themselves at a crossroads when it comes to their Medicaid dental programs.  

Forward thinking states are moving past the notion that access to treatment is all it takes to improve the oral health of all. They recognize that an effective Medicaid dental program must achieve the Triple Aim: lower costs, improved population health, and better patient experiences.  

Tennessee is a perfect example of a dental partnership focused on the triple aim. 

In 2012, state Medicaid leaders recognized they were no longer meeting the oral needs of the people they served and set out to create a new Medicaid dental program model. They also recognized that they needed a new partner, not just a vendor, to help develop and implement a holistic approach to oral health.   

Today, DentaQuest partners with the state to administer the TennCare Medicaid dental program and through this partnership, more children have access to preventive care at a lower cost to taxpayers.  

Since partnering with TennCare in 2013, DentaQuest has saved the state $27.5 million by prioritizing preventive care, which helps to avoid extensive, costly future procedures. In the second year of the program, the number of children participating in the program increased by 8 percent to 810,000 enrollees. Through our dental home program, we’ve made sure that each and every one of the 810,000 children is connected to a dentist who is willing and able to provide care.  

TennCare has been able to handle the influx of patients thanks to a provider participation increase of 31 percent. DentaQuest has focused on easing the administrative burdens placed on providers and facilitating transparent communications.  

This successful model is built upon the idea that aligned incentives can improve outcomes.  

DentaQuest has a shared responsibility when it comes to improving outcomes and reducing costs. This challenge should not fall on providers and states alone. DentaQuest must meet outcome benchmarks—set by the state—related to access, network adequacy, outreach, and cost.  

DentaQuest met or exceeded benchmarks in all categories during the first two years and is poised to demonstrate success again in year three.   

The results of this model are encouraging: 

• Average distance to a provider is 3.7 miles, compared to a benchmark of 30 miles 
• Wait times for routine, urgent, and emergency care are significantly lower than the state’s thresholds 
• 100 percent of beneficiaries have patient-centered dental homes—providing accessible, comprehensive, and coordinated care to enrollees 

 

DentaQuest has been able to succeed in part by educating and engaging patients and families—even hosting over 80 community events last year.  

This type of patient-centric program should serve as a model for other state Medicaid programs and partners. Change and innovation should not mean complexity and burden. 

There is a better way forward and DentaQuest has a roadmap to get there.