Reflections on Health and Equality

By Ralph Fuccillo, Chief Mission Officer

Today, many of us at DentaQuest are taking a few minutes to remember and celebrate the life and work of Dr. Martin Luther King, Jr.  We honor Dr. King for challenging us on how we can be a more equal society.  He reminded us that, "Of all the forms of inequality, injustice in health is the most shocking and the most inhumane."

This January, we also remember the 50th anniversary of President Lyndon B.  Johnson’s declaration of a War on Poverty.  This week, politicians and national media have been commenting on whether this national campaign accomplished anything. Current data shows the poverty rate has only dropped to 15 percent from 19 percent over two generations.  46 million Americans live in households where their income is scarcely adequate to cover basic needs. And despite gains in worker productivity, wages are stagnant for middle and low income families.   While the dialogue continues, we know there is more that must be done to reduce disparities in health, especially when it comes to oral health.

In this spirit, I call up these words from Dr. King as an inspiration to work for improving our systems of care, community, policy and financing so health inequity becomes a thing of the past:   

“A true revolution of values will cause us to question the fairness and justice of many of our past and present policies. On the one hand, we are called to play the Good Samaritan on life’s roadside, but that will be only an initial act… True compassion is more than flinging a coin to a beggar. It comes to see that an edifice which produces beggars needs restructuring.

Our overall enterprise strategies are redefining oral health in ways that will meet the oral health needs of many more Americans.  DentaQuest is committed to improving the oral health of all.

Meeting Dental’s “Triple Aim”

By Cindy Hannon, Manager of Quality Improvement, DentaQuest Institute

The way that healthcare is delivered to patients is undergoing significant change and dental is no different. The Institute for Healthcare Improvement termed our new healthcare goals the Triple Aim: improving the patient experience of care, improving the health of populations, and reducing the cost of care.  At the DentaQuest Institute, we believe this is the future of care and are proud to have created a model that is helping to meet the Triple Aim with our Early Childhood Carries (ECC) Collaborative.

Early Childhood Carries is an aggressive form of dental disease in very young children (1-5 years old). Often times, when the disease is not treated early, children end up in hospital operating rooms for oral surgery, which can involve anesthesia, root canals and stainless steel crowns. This is a very scary, painful experience for young children; it places an unnecessary strain on hospitals, especially given that dental disease is nearly 100 percent preventable.

We recognized that this method of care was just treating the symptoms and not the cause.  Nor was it preventing the disease from recurring again; many children returned in a year with the same symptoms in other teeth. So, partnering with dentists and their care teams at Boston Children’s Hospital (BCH) and St. Joseph Hospital for Specialty Care in Rhode Island (St. Joe’s), the DentaQuest Institute created the ECC Collaborative in 2008. We focused on teaching dental care providers and dental clinics how to work with children and parents to prevent dental disease rather than just treat it. Our goal has been, and is, to spread best practices about preventive education and disease management to think differently about the way we treat young and vulnerable patients before and after surgery. This disease management protocol is, we believe, providing a more engaged caregiver experience and this is helping improve patient and family outcomes, ie. better oral health. This Collaborative is building evidence to meet the Triple Aim.

During the first phase of the program:

• Children participating in the ECC Collaborative reported a 50 percent decrease in pain.

• The number of children who did not develop additional disease after the initial treatment improved by 69 percent.

• Operating room utilization was reduced by 55 percent.

The ECC Collaborative has expanded considerably since 2008. In 2011, five community health centers and hospital-based dental clinics across the country joined BCH and St. Joe’s for Phase II. The teams collected data about disease risk, pain from untreated decay, and new cases of disease.  Each site focused on individual system changes, engaging and educating staff in the importance of scheduling recall visits within the recommended timeframe, educating care givers to think about possible behavior changes and helping them set self-management goals for their child. Once again, we saw that disease management and prevention improved outcomes, reduced disease, controlled cost and kept the children’s mouths healthier.

You can learn more about the ECC Collaborative, what current participants are doing and how to get involved. Watch our video.

DentaQuest CEO Fay Donohue Discusses the Pediatric Dental Mandate

Photo Credit: Kevork Djansezian/Getty Images/NPR

Although the Affordable Care Act includes pediatric dental care in its “essential health benefits” package, the implementation is confusing, leaving families in most states unsure of their options and more importantly, impeding children from receiving much needed oral healthcare.

DentaQuest president and CEO Fay Donohue discussed the issue with NPR’s Julie Rovner today, highlighting the problems some Americans face when searching for dental insurance for their children, and why it is important for all children to receive coverage.

Below is an excerpt from Julie Rovner’s article or you can listen to the full story here:

“‘In some states, for example — a Maryland or a Massachusetts — you can go onto the exchange and shop just for dental," Donohue says, "and are able to pick a dental plan for yourself that makes sense and is an easy experience."

In other states, she says, "it is extremely difficult, and in others, pretty impossible."

That's not just a problem for the bottom line of dental firms, Donahue says. Unmet oral health needs — particularly those of children — are a serious health problem. It's estimated that 1 in 10 children from low-income families is in pain from untreated dental problems.

"How can you go to school and learn anything when you're in pain?" Donahue asks. "If you care about education, you've got to care about oral health."

That difficulty in finding plans extends to adults, too. Under the health law, any adult who doesn't have dental coverage should, theoretically, be able to just go to the exchange and buy a plan.

But Donohue says that's not always happening, either. "In some [states], you can," she says. "In some, you can only buy dental if you've already purchased a medical. And in some, they're not there at all."

DentaQuest is committed to improving the oral health of all, and we are committed to working with our partners to ensure that the intent of the ACA to provide dental coverage for all children is met. 

A Resolution to Smile About

As 2013 comes to a close and we start making our New Year’s resolutions for 2014, getting healthy seems to be at the top of everyone’s list.

But being healthy isn’t just about working out and eating a nutritious diet; good oral health is imperative to overall health according to the US Surgeon General.

The New Year is the perfect time to start practicing good oral habits that will last a lifetime: Brush 2 minutes, 2 times a day, every day.

Prevention helps you maintain good oral health and the single most important thing that you can do to protect your teeth is to brush for two minutes, twice a day, every day. And floss too.

It’s equally as important to make sure this a daily routine for your children as well.

Here are some brushing tips for all ages:

Babies to 2 years: Gently wipe the baby’s teeth with a clean damp washcloth. For kids under age 2, use a soft toothbrush and a little water; no toothpaste is necessary. Once teeth are cleaned at bedtime, babies should drink only plain water (no juice, milk or soda).

Children, 2 years to 6 years: Help your children brush their teeth. Hold the toothbrush with them and show them how to clean every tooth surface and to gently brush their tongue to remove germs and freshen breath. Use a pea-sized dab of fluoride toothpaste and teach your child to spit out the toothpaste when they’re done Check out this video to for more tips on teaching children how to brush their teeth.

Children, 6 years to thirteen: Once children know how to brush, let them do so on their own, but supervise to make sure all teeth get cleaned. The goal is to spend 2 minutes to be sure they brush every tooth – the front, back, chewing surfaces and sides. Teach your children how to floss between teeth and make this part of their nighttime routine.

Teens and Adults: We are all busy with work, school, sports, family – but that is no excuse for not brushing. Clean your teeth gently but thoroughly for a full 2 minutes before you head off for the day (work or school) and finish the day by brushing to remove leftover food in your mouth and floss between your teeth. Your goal is to remove food that will decay, creating acids that will attack the tooth’s enamel, and also to remove plaque. Plaque is the sticky film of germs that forms on teeth and gums after eating. If it’s  not removed by brushing twice a day and flossing once a day, plaque can lead to cavities.

And remember this: Simple, repetitive tasks will become habit in just 21 days. Start on January 1 and make it your goal to brush 2 minutes, twice a day, every day. You can do this!

Finally, think about when you last saw an oral health professional. If you haven’t done so in the last six to 12 months, now is a good time to schedule your next visit. Dental disease (cavities and gum disease) is preventable.  

DentaQuest will be tweeting encouragement and reminders all month long. Follow us at @dentaquest.

Happy Holidays from DentaQuest

DentaQuest would like to wish you a happy and safe holiday season!

It has been a great year and we want to thank all of our colleagues and partners for their work to improve the oral health of all in 2013.  We thought it would be fun to take a look back at some of our most popular blog posts this year.

1. Let’s start with our post on dental office safety, which outlined key questions you should ask your dentist to ensure that you are being treated in a safe (and sanitary) environment each time you visit.

2. Probably the biggest news in health care this year was the rollout of the Affordable Care Act, or Obamacare. Check out why we believe it is so important that pediatric dental was included as 1 of the 10 essential health benefit. All children should have access to dental care as part of maintaining good oral health, so we are committed to working with the dental community and policymakers to ensure that all children have this benefit.

3. Third, we met Dr. John Luther, our new Senior Vice President of Dental Management and Chief Dental Officer at DentaQuest. Our readers loved meeting the new member of our team through his blog post.

4. We also learned about the danger of parents putting their child’s pacifier in their own mouth to clean it, which can transfer harmful bacteria into their child’s mouth and ultimately cause cavities. Early tooth decay can quickly put kids at a lifelong disadvantage.

5. And last, our favorite blog post of the year featured our new infographic, which displays key facts about oral health in America. Did you know that dental disease is five times more common in children than asthma?

We hope you enjoyed following our blog this year and we look forward to bringing you even more informative and engaging posts in 2014. 

Let’s Keep the Spotlight on Pediatric Dental

By: Fay Donohue

Photo Credit: NY Moms World Blog

Most of the media coverage around the Affordable Care Act (ACA) recently has focused on the problems with Healthcare.gov and marketplace websites, so I was happy to read an article in the New York Times this week about pediatric dental benefits. I’ve written before about pediatric dental; Catherine Saint Louis’ New York Times article highlights both why it is so important that all children have access to dental benefits and what steps we need to take to make that a reality.

In the United States, children miss 52 million school hours per year because of dental problems. Dental disease is the most common chronic disease of childhood - five times more common than asthma. The ACA provides an unprecedented opportunity to improve children’s access to dental care. However, the way it is being implemented is creating challenges that may prevent it from achieving that goal. Currently, families purchasing insurance outside of the new marketplaces will be required to purchase pediatric dental benefits. The rules for purchases through the marketplaces do not require you to include dental insurance in your “shopping cart” when you “check out.”

This discrepancy means that if people choose not to buy dental insurance, millions of children may continue to go without necessary dental benefits. This was clearly not the intent of the law. We believe essential benefits should be essential in all circumstances.

The New York Times article also talks about the different ways you can purchase dental benefits through the marketplaces – either through an option that includes or “embeds” your dental benefits in your health insurance plan or as a separate plan from your medical benefits. Ninety-eight percent of Americans with employer-sponsored dental coverage today get their benefits from a standalone plan.

Before the ACA, if your employer didn’t offer dental coverage, it was difficult to shop around for a dental plan on your own. Now, the marketplaces provide a one-stop shop – technical glitches aside – for people to compare plans and purchase dental coverage.

One key point that was not made in the New York Times article is that people are buying dental plans through the marketplaces. In fact, early reports out of some states show that their first marketplace enrollments on 10/1/13 were for dental plans and in at least one state more people are purchasing dental plans than medical!

We think people need choices and that may mean standalone or embedded dental benefits. However, dental benefits embedded in medical plans could expose buyers to a less than generous dental benefit and greater upfront costs for basic services like cleanings, sealants, fluoride, and filings -- especially if it is the only option on the marketplace. It is also important that there be the option of plans that offer adult dental as well as pediatric dental benefits. Selection of plans and benefits is dependent on a person’s unique needs. That’s why there need to be knowledgeable ACA navigators to assist new buyers.

Additionally, there are tax benefits available to families who cannot afford to purchase health insurance. If you qualify for a subsidy, it will first be applied to the cost of the premium for your health plan. Then, if there is money left over, it will be applied to the premium for your dental plan. This formula could leave millions of families unable to afford dental insurance because there will be few, if any, dollars available to cover pediatric dental. The federal government can make a simple adjustment to this formula to ensure that low-income families have the financial assistance they need to purchase high-quality dental coverage. Unfortunately, other important priorities have taken the focus away from pediatric dental health. As the New York Times article states, “kids’ dental shouldn’t be the stepchild of plans the exchanges are offering.”

At DentaQuest, we are committed to working with our colleagues, the federal government, members of Congress, and advocacy organizations to develop short-term and long-term solutions to ensure that all children have access to high-quality, affordable dental care.

Prevention Summit Targets Eradicating Childhood Caries

By Ralph Fuccillo, DentaQuest Chief Mission Officer, President DentaQuest Foundation

 

As I’ve said many times, the common diseases of the mouth – cavities and gum disease—are nearly completely preventable with education, information and access to care.

I was very pleased to have the opportunity to participate in the American Dental Association’s (ADA) Prevention Summit. As a leading national professional dental association, the ADA commands attention. The ADA brought together participants from academia/research, private practice dentistry, philanthropy, dental teams, health promotion, industry, non-dental health care providers, patient advocates, policymakers, insurers and ADA dental societies. I sat with colleagues in philanthropy. Dr. John Luther, DentaQuest’s Chief Dental Officer, joined others involved in financing care. Dr.  Michael Monopoli, Director of Policy and Programs for the DentaQuest Foundation joined the policy table. Dr. Rob Compton, Executive Director of the DentaQuest Institute led a session on How Financing Incentivizes and Reinforces Practice.

Elaine Kuttner of Cambridge Concord Associates led the group through an interactive summit agenda and initiated thoughtful table discussions. Many of us have come to know and respect Elaine for her careful work in guiding common ground conversations at the U.S. National Oral Health Alliance Colloquia. I was also very pleased to see that the DentaQuest Foundation’s Systems Change Approach was one of the prevention frameworks presented for discussion.  After two days, the Summit concluded with all agreeing to some ambitious goals:

1. Eradicate childhood caries
2. Emphasize health equity
3. Apply the chronic disease framework to dental disease
4. Build community-facing care systems
5. Redesign prevention

I was particularly inspired by the keynote presentation of Dr. Hayagreeva Rao, PhD, the Atholl McBean Professor of Organizational Behavior and Human Resources at Stanford University. Professor Rao studies the social and cultural causes of change and the role of social movements as motors of change.  Dr. Rao encouraged participants to consider the motivational dynamics of other movements and how an oral health movement might be shaped.

We are at a crucial movement in oral health. The ACA has inserted prevention and oral health into the national dialogue. People who had not previously had the ability to purchase dental insurance for themselves or their families now can through the exchanges. And the emerging national network of oral health supporters and advocates, many of whom are Foundation grantees and partners, is ready and willing to carry the message of oral health to families, consumers, care givers, policymakers, and legislators.

Following the Summit, there have been many meaningful exchanges among participants regarding the potential and sometimes the frustration in funding ways to make prevention a more central focus of oral health.

For more information on DentaQuest Foundation and DentaQuest Institute, visit DentaQuest.com.