Wednesday, March 25, 2015

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.