Closing 2017 - Ringing in 2018!

This December, we post some closing thoughts from people across the organization - together, we share pride and gratitude for the strides we as a company have made to benefit communities nationwide. Let 2018 bring greater progress toward a future where everyone has access to oral health, without exception.

I’ve never been more excited about the future of our enterprise. With strategic change and the work of the entire team we are able to drive both social and economic value to help us meet our mission-  to improve the oral health of all. -- Steve Pollock, President & CEO

It is a great time to be part of DentaQuest – our future does look bright! -- John C.

Educating and serving the communities we live… feels great to be part of the Team! -- Fatima

I am very thankful to have a wonderful Boss and Leadership team overall. I am thankful for my family and friends. I am thankful for my continued good health.May you all be safe during this Holiday Season. -- Diana S.

Great job to everyone in this organization that works so hard to ensure we offer the best customer experience possible. A special shout out to the customer service team that is on the front lines with our members and providers every day. - Angela K.

Looking very forward to 2018 and continuing to grow and evolve our organization!! -- Bill P.

Looking forward to an exciting New Year in 2018 with DentaQuest and our new (and existing) Leaders!! Happy Holidays Everyone!!! -- Susan H.


Look for a new blog location in 2018! Oral Health Matters, which remains a key part of our ongoing oral health conversation, is moving ... stay tuned and stay safe. From all of us at DentaQuest

A Quality Improvement Director Goes to the Forum...

This week, staff from DentaQuest’s Institute attended the 2017 Institute for Healthcare Improvement (IHI) Forum. During this multi-day conference, healthcare professionals from around the globe meet in Orlando to talk healthcare improvement. While oral healthcare is not a prominent discussion topic, DentaQuest has been attending since 2011. 

At Monday's pre-conference Scientific Symposium, Dr. Natalia Chalmers and Quality Improvement Project Manager Carrie Peltier presented a poster on our Dental Caries Management (DCM) Collaborative results (pictured left). Over 200 posters were submitted for consideration; the Institute’s poster was one of 70 - and the only one on oral health - chosen. Dr. Chalmers commented that the buzz about the importance of good oral health being vital to overall health was inspiring. Many wanted to learn more about the DentaQuest approach.

The general session featured a series of keynotes and 200+ workshops topics covering improvement science, joy in work, leadership, population health, person-centered care, safety, moving from volume to value to name a few. 

This year’s Forum opened from the lens of patient experience. The keynotes challenged care teams to create a bidirectional transfer of knowledge between patient and care team; this is, in fact, an act of caring. Care teams must work to create this space. It truly matters. Keynote Tiffany Christensen commented: we must ask generous questions to know and learn what matters to our patients. Our job is to make sure there is equity. These sentiments very much resonate with the Institute.

Later in the afternoon, we heard from Bryan Stevenson, a social justice advocate. Mr. Stevenson powerfully reminded us that it is our duty to create healthier communities. We must get closer to the poor and to communities that have been marginalized, neglected, and isolated. There is power in proximity. We also need to change the narrative that defines the difference of race. We must stay hopeful, as our hope has to fuel our practice. And lastly, we need to do the things that are uncomfortable. We have to make the choice to do the difficult thing.

General Stanley McChrystal shared his Team of Teams vision. He spoke about organizational change; being at an inflexion point and ready. He talked about ‘shared consciousness,’ meaning to connect on something with purpose and time and focus. “Together we need to project 'this place' where we want to go and make it to fruition.” This requires leadership that composes self-awareness, discipline, decision making, effective communication, connection, constant learning and functional excellence.

Lastly, as is IHI tradition, we heard from Dr. Don Berwick, president emeritus and senior fellow at IHI. Dr. Berwick’s spot-on remarks and reflections on the American healthcare system ring true year after year, and this year was no different. He shared a moving personal story of needing - and using - the healthcare system for his own family. He charged organizations to “snuggle,” meaning outline a clear and common purpose, be all together, or none at all and provide a safe vessel – failures are instructive; it’s OK to try, there can be shared honor, and we must have affection and mutuality. As this culture is what saved his brother.

Healthcare is complex; like the organizations who provide care and coverage. Inter-organizational competition is not the answer; coordination is. And DentaQuest is no different. Leaving this year’s Forum, I couldn’t help but board my plane back to Boston with some puffed feathers … DentaQuest has these pieces. We are prime to be the ‘Leading Voice.’ Improvement work is a social thing. It asks us to reflect, to adjust, to learn from, and to collaborate. It demands that we ask is what we are doing better or more of the same? We want better; we want to improve the oral health for all. That means understanding the system, at the macro, meso and micro levels. All together, or none at all. We must always ask “what do we want to learn over time?” and chart that course.

Cheers to another amazing Forum. Kaiser Permanente sent over 400 staff this year. Won’t you consider joining us next December in Orlando? This stuff matters!

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Cindy Hannon, MSW

Quality Improvement Director 

DentaQuest Institute  

"When you believe in this stuff, it is easy to write!"

Oral Health 2020 is helping unify and empower community voices

Hear from so many passionate individuals who are part of the DentaQuest Foundation's Oral Health 2020 National Network, which is working to address oral health equity, policy, and ultimately improved oral health for all.

Learn more about the movement: http://dentaquestfoundation.org/oh2020

Q&A: Dental Hygienist Opens Up for National Dental Hygiene Month

As October comes to an end, so does the national observance recognizing the need and importance of dental hygiene. For this Q&A, one of our own registered dental hygienists (RDHs) opens up about how she came to this career path and why it is invaluable to the oral health care system.

Let's dig in with Laura Skaret, RDH, BSDH | Project Manager, Safety Net Solutions | DentaQuest Institute

Q: Why did you decide to become an RDH?

A: My mom is a dental hygienist, and I got my first job at her office as a dental receptionist and then later was trained on the job to work as a dental assistant. I loved my experience as an assistant and found the work we did fascinating – including the devastating results of dental disease. I saw the cycle of dental disease first hand:  teeth would need small restorations, then larger restorations, then root canals, then crowns, and even sometimes implants. I knew I wanted to focus my career on helping patients prevent and properly manage dental disease rather than repairing the damage after it occurs.

We had a pamphlet in the office that said that enamel was far more valuable than gold (referring to a gold crown).  I found that to be such a thought-provoking and accurate concept.  It’s also similar to the old familiar adage, “an ounce of prevention is worth a pound of cure.”  That couldn’t be more true in the dental field.

Q: Why are hygienists important in the care team? 

A: Dental hygienists are patient advocates. When explaining the dental disease process to patients, I always tell them that my job is essentially to keep them out of the dentist’s chair, but I can only do so much without their buy-in.  Due to the nature of plaque biofilm, the daily care that patients do for their own mouths is far more important than the work that we do in one hour with them at the dental office. Patients go to the dental office maybe two to four times per year, however 365 days a year they are responsible for managing their own oral health.  This means our most important role is to educate and motivate our patients to improve their daily oral health habits. 

Q: What has been your greatest accomplishment or most proud moment in relation to working as an RDH?

A: I’ve realized that it’s not only what you do, but the way that you do it that can make an impact.  I always try to be very kind and compassionate to the questions and concerns of my patients. I’ve had several patients who were terrified of coming to the dental office when I first met them. Years of neglecting their mouths and avoiding the dentist would bring them to our office in a lot of pain and in need of quite a bit of dental work. In addition to using a gentle technique and local and topical anesthetics, I try to help them feel more comfortable by talking them through everything I’m doing or telling them stories to get their mind off of the situation. Sometimes it’s helpful to listen to their story to find out why they have a fear, affirm their past concern, and then assure them that won’t happen today. 

When those patients then continue to come in regularly, you know you’ve not only made a difference for their oral cavity, but for their life as well.  I had one patient who needed lengthy measures to address advanced decay and periodontal (gum) disease.  After we completed her first three visits of needed periodontal therapy, she actually sent a card to my office to thank me for helping her overcome her fear of the dentist.  With a more manageable level of fear, she was able to get the care she needed to restore her smile, which gave her back her confidence.

Q: How does your professional background impact/influence/help you in your DentaQuest Institute (DQI) role?

A: My primary role at DQI is as a project manager for Safety Net Solutions (SNS), a DentaQuest Institute program. Safety Net Solutions helps safety net dental clinics adopt targeted business management best practices.  Our focus is to ensure that these dental offices can maintain financial viability to stay open and provide access to care for the underserved. We also help ensure that they understand their capacity and can maximize access to care by optimizing their productivity.  

My previous experience of working in all areas of the dental office (receptionist, chairside with the dentist, and then also as a hygienist) means I have very comprehensive knowledge of how dental offices work, from scheduling appointments, to managing supplies and inventory, to managing the patient’s care experience, to dealing with dental equipment and instrument shortages. Basically, I can understand and relate to almost any concerns our SNS clients have.

Q: Why do you continue private practice once a week? 

A: Although you can technically keep your annual dental hygiene license “active” by simply paying the license fee each year, I want to keep it active with actual patient care, as well. Also I continue to practice because I love the work!  I love working with patients and helping them improve their oral health. I also believe this helps me stay relevant and engaged with my SNS clients and their common concerns. 

Q: What is one message you hope to impart to anyone interested in becoming an RDH?

A: Hygienists are super important members of the care team! As policy changes and we move forward with accountable care organizations and pay for performance insurance reimbursement models, I think the role dental hygienists play in preventing and managing disease will be brought even more into the forefront. When finances are attached to healthy patient outcomes, dental care teams will attach an even higher value to dental hygienists. 

Also, there is a massive shortage of dental professionals – and dentists in particular – nationwide. Maximizing the use of preventive modalities such as sealants, fluoride varnish, and silver diamine fluoride will help address access gaps where dentists are hard to come by, like rural areas.  Of course, we will never stop needing the education and skills of a dentist, but if we can reduce the demand for the skills of a dentist by reducing the dental disease burden, we can help minimize the gap in access to oral health care.  

Interested in learning more about prevention-focused dental care? Check out the DentaQuest Institute's Online Learning Center and let us know what you think! 

Lunch Box oral health education program expands to kids with vision impairment

You may know that our mission is to improve the oral health of all, and starting with young children and health literacy is a great step forward.

Before this school year started, we supported efforts by The Children's Oral Health Institute to grow their national Lessons In A Lunch Box: Healthy Teeth Essentials & Facts About Snacks® program. This expansion enables the program to reach children who have impaired or loss of vision. Everyone needs to care for their mouths in order to have healthy futures, and Lunch Box is ensuring all kids have this chance.

In February, special lunchboxes - now with braille - will be delivered to participating schools along with a volunteer presentation to run the program.

So what is this educational program about healthy teeth and why does it matter? 

The Children's Oral Health Institute, a nonprofit based in Maryland, outlines it clearly:

• Lessons In A Lunch Box: Healthy Teeth Essentials & Facts About Snacks is an educational oral health literacy program developed around a lunch box designed exclusively to teach elementary school children. The lunch box includes a color coordinated carrot case with a rinse cup top designed to store a toothbrush, toothpaste, and dental floss.
• The program is created to help children to begin learning early, throughout grade school, about taking care of their teeth, making good diet choices and careers in dentistry.
• The Children’s Oral Health Institute believes the program and the exclusive lesson guides, including the Code Red: The Oral Health Crisis In Your Classroom booklet, will encourage teachers to incorporate oral health education as a part of classroom instruction.
• The program model is presented is to elementary schools with support from organized dentistry, local dental school faculty, their students and community volunteers. It is important that dentist examine and provide treatment for underserved children.
• Exposing dental students to programs like Lessons In A Lunch Box may help to improve the access to the oral health care challenges we face throughout the country.
• Further, the profession of dental medicine is facing a workforce shortage. According to the 2000 Surgeon General’s Report, by 2020 there will be one dentist for every 100,000 Americans. The program places emphasis on encouraging children to begin considering the dental profession as a career option. 
• The ideal times during the school year to introduce the Lessons In A Lunch Box program are:
• October, National Dental Hygiene Month. This is a good time of the school year to present the program because it allows the teacher approximately 8 school months to refer to the visual and practical lessons offered by lunch box.
• February, National Children’s Dental Health Month (NCDHM). This is another great time because much of the dental community looks forward to participating in initiatives that highlight and support the annual observance of NCDHM when dental and medical professionals focus on efforts to improve the oral health of children.
• Give Kids A Smile® (GKAS) Day. Usually celebrated throughout the country in late January or early February, GKAS is the annual centerpiece NCDHM.
• The cafeteria has proven to be the best location in the school to present the program. Students can comfortably have their lunch box open in front of them while listening to the presenter explain all of the fun and exciting educational features of the delightful container. They learn about the following:
• flossing, brushing and fluoride
• healthy dietary choices and good eating habits
• careers in dentistry

Did you learn anything new here? By partnering and supporting this expansion, we learned a lot about the vision impaired community and successful ways to help all children develop important oral health habits.

Hispanic Heritage Month: Highlighting two organizations committed to oral health

As part of our commitment to meeting the different oral health needs for different populations, DentaQuest learns about cultural heritage through observances like Hispanic Heritage Month, which runs through Oct. 15. It is a month-long tribute to Hispanic Americans who have so richly contributed to our society, and to the cultures, languages, and traditions passed down by their ancestors. DentaQuest is committed to improving health equity and advancing solutions that meet the needs of the many different people our plans and services touch, in part by supporting the efforts of local organizations.

While the contributions of our Oral Health 2020 network partners are as diverse as the communities and the perspectives they represent, and impactful in so many important ways, we’d like to take a moment to acknowledge two of our grantees who are working in this way to improve the public’s perception of oral health, and bringing the voice of Hispanic and Latino* communities to the table.

We know that the only way to develop targeted solutions and ultimately achieve better oral health for all is to engage those people who are most impacted. One of the goals of Oral Health 2020 is to improve the public’s perception of the value of oral health. We want everyone, not just dentists and hygienists, to recognize and understand the importance of the health of the mouth to the health of the rest of the body. With this important understanding, we will continue to mobilize communities across the country to rally together to advocate for better oral health.

In California, Vision y Compromiso is committed to improving community well-being by supporting promotores (liaisons between their communities and health and social service providers) and community health workers. Across 24 counties from Southern California to the Greater Bay Area, Vision y Compromiso’s network of promotores and community health workers is serving as a bridge for both native-born and immigrant people, and leveraging their shared language, ethnicity, culture, and experiences to reduce barriers to care and education. 

For example, together with Asian Americans Advancing Justice, Vision y Compromiso is spreading a campaign to educate individuals and families in the state on the health coverage available to anyone in the state, regardless of income or immigration status.  In just under two weeks, Vision y Compromiso will be bringing together these important stakeholders at their annual conference in Ontario, CA.

Also working on the West Coast is Latino Coalition for a Healthy California (LCHC). LCHC is one of the leading voices for Latino health in California, with a focus on initiating and advancing policies that help build healthy communities. With their ongoing work to address disparities in oral health, LCHC is focusing efforts on ensuring that affordable dental care is accessible to all Californians. 

Like Vision y Compromiso, LCHS is also working with promotores, training them to be both advocates and messengers for oral health and its social influences in Latino communities. LCHC is committed to elevating the voices of those in their communities to be heard by decision- and policymakers, in order to improve oral health at a systemic level. A recent initiative champions efforts that reduce access to sugar-sweetened beverages, which not only impact oral health, but also contribute to the disproportionately high incidence of diabetes in both adults and children in Latino communities.

We are so proud to support these and so many other amazing organizations that are working to improve the oral health of all. Please visit their websites to learn more:

Vision y Compromiso  

Latino Coalition for a Healthy California

*While “Hispanic” and “Latino” are often used and understood interchangeably, “Hispanic” focuses on Spanish-speaking origin, while “Latino” refers to people of Latin American origin.

Children's Health Insurance Program (CHIP) is vital for kids' wellbeing

September is a big month for kids – not only are they starting or heading back to school, but this year they also are taking center stage in Washington as Congress heads back from its own summer recess. Funding for the Children’s Health Insurance Program (CHIP) will expire at the end of September, meaning Congress must act swiftly to ensure continued, comprehensive medical and dental coverage for our nation’s children.

Nationwide, CHIP covers approximately 9 million uninsured kids (and in some cases, pregnant mothers) in families with incomes that are modest but too high to qualify for Medicaid. 

States administer the CHIP program in different ways. Your state may have a separate CHIP program, combine the CHIP and Medicaid programs, or include CHIP within Medicaid expansion initiatives. Although administered by states in a variety of ways, the federal government provides matching federal funds to all states and that funding is vital to the program’s continued success.

Historically, CHIP reauthorization and funding have enjoyed bipartisan support, with members of Congress working together to guarantee health care coverage for vulnerable children. However, with the hotly-contested debates over Affordable Care Act repeal and replace legislation, securing the future of the CHIP program may prove significantly more challenging this time around…

Congress must tackle a significant number of important issues in short order this September. 

Addressing the debt ceiling to avoid a government shutdown, authorizing Hurricane Harvey relief, and handling a Trump administration proposal to privatize air traffic control are all at the top of the list. But Congress cannot lose sight the importance of CHIP. 

Without a long-term solution, states will be left with uncertainty over the future of their health care programs for kids. If CHIP funding is not renewed, or not renewed by the end of the month, states will be forced to make difficult decisions regarding the enrollment of the children in their programs. Without this funding, some children will be left without any form of medical or dental coverage.

We have seen over time that coverage leads to care and access to appropriate dental care is vital for children. In particular, tooth decay, the most common chronic disease among children, is degenerative without treatment and prevention, and research shows poor oral health impacts school performance and attendance.

But CHIP’s importance extends beyond oral health. 

For example, recent research indicates 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, such as type 2 diabetes. Ultimately, Congress must understand the gravity of their decision – coverage for children positions them well for a lifetime of optimal health and success. Don’t let politics put this at risk. Instead, let’s collaborate across party lines to quickly develop a sustainable plan that provides effective coverage for children and mothers in CHIP.

September 2017 marks the start of school and the start of what could make or break our children’s futures. This month is about ensuring our next generation is well-positioned to achieve optimal health throughout their lifetimes. As an organization committed to improving the oral health of all, DentaQuest strongly urges Congress to work together on CHIP funding and reauthorization in time to protect these vulnerable populations.

Make sure your voice is heard! 

Look up your Representative or Senator and ask them to renew CHIP funding and support long-term, sustainable solutions to protect our children’s health care.

Friday Federal Roundup: CBO, CHIP, and More

As a partner to states and the largest Medicaid / CHIP dental benefits administrator in the country, we at DentaQuest must stay updated on the latest health care policy trends - in large part because anything in the health space affects the oral health space.

Recent federal health reform proposals could have significant implications for Medicaid programs, exchange populations, and oral health coverage for low-income families. We keep our employees apprised of the latest happenings in Washington D.C. with weekly federal newsletters, and thought this week was particularly relevant for more than our staff.

Here’s this week’s newsletter.

CBO Releases Report on Subsidies 

According to a report released earlier this week by the non-partisan Congressional Budget Office (CBO), insurance premiums for ACA plans would rise 20 percent next year and in some areas of the country, people would not have any insurance options if the Trump administration scraps key ACA subsidies. Trump has repeatedly threatened to pull the ACA subsidies, particularly since Congress failed to pass repeal and replacement legislation before the summer recess. CBO’s analysis also found that eliminating the payments would increase the federal deficit by $194 billion over a decade because of higher spending on premiums subsidies. Trump must decide by early next week whether or not to make next month’s payment.

Congress Turns Attention to CHIP

Funding for the Children’s Health Insurance Program (CHIP) expires September 30th. With Congress out on recess, this leaves few legislative working days to ensure that nearly 9 million children maintain their medical and dental coverage. While CHIP reauthorization has historically been a bipartisan issue through the years, the hotly-contested debates over ACA repeal and replacement have left state officials anxiously awaiting assurances from Capitol Hill that 2017 will be no different. We will continue to monitor federal discussions on the future of CHIP and advocate where possible for the vital inclusion of dental coverage in reauthorization efforts.

Trump Administration Encouraging Medicaid Redesign Efforts, State Innovation

As Congress takes a pause on repeal and replacement efforts while they are on recess, states are looking to the Trump administration in the interim for more regulatory flexibility. CMS is expected to soon approve a Medicaid waiver from Kentucky which among other things would require most Medicaid-eligible adults to work as a condition of receiving coverage. Arizona, Arkansas, Indiana, and Maine are considering similar work requirements. HHS Secretary Tom Price and CMS Director Seema Verma have both expressed that they are in favor of such Medicaid redesign proposals.

Last month Alaska became the first state to get increased flexibility from the administration to prop up its individual marketplace with a reinsurance program. Minnesota, New Hampshire, Oklahoma, and Oregon are some other states that have already filed or are considering similar waiver proposals to submit to CMS.

HHS Proposes to End Obama-era Payment Programs

HHS Secretary Price has announced plans to eliminate two Obama-era Medicare bundled payment programs and scale back on a third. This proposal would cancel initiatives that make hospitals more accountable for the cost of certain joint replacement surgeries and cardiac care, and shrink an existing program covering hip and knee surgeries. This is considered a victory for providers who oppose requirements to participate in new payment models. We will continue to monitor whether or not HHS will take further action to roll back requirements in order to slow down the transition to value-based reimbursement structures.

‘Action for Dental Health’ in Congress

While we all paid close attention to health care in the Senate last week, the House Energy and Commerce Committee made a critical, yet mostly overlooked step to advance oral health for at-risk populations.

On July 27^th, the Committee unanimously passed HR 2422, or the Action for Dental Health Act of 2017. This bill calls for Congress to authorize additional oral health promotion and disease prevention programs to help at-risk populations struggling to obtain appropriate oral health care.

The bill points out that more than 181 million Americans will not see a dentist, but almost half of people ages 30 and older have some form of gum disease and nearly a quarter of children under age 5 already have cavities. 

As we at DentaQuest well know, caries is the most prevalent chronicdisease among children and can be prevented. What’s more, we see time and again that Americans of all ages are in desperate need of access to oral health care - Missions of Mercy like the one in Wise County, Va., is a great example. Both the Washington Post and The New York Times covered the July event, for which thousands of people come from miles away and lineup for hours and even days just to get access to dental and other services.

If this new legislation passes through Congress, the Centers for Disease Control and Prevention will award grants and collaborate with states, counties, public officials, or other stakeholders to implement a variety of initiatives.

These activities could include oral health programs that:

·         more broadly use portable/mobile dental equipment;

·         facilitate the establishment of dental homes;

·         eliminate geographic, language, cultural, or other barriers to care;

·         reduce the use of emergency departments for dental conditions; and

·         provide dental care to nursing home residents.

It is exciting to see bipartisan support for dental care initiatives that have tremendous impacts on the oral and overall health of patients. This type of work will drastically improve the health of Americans. And it has the ability to address the estimated $2.6 billion in free care that dentists currently deliver, as well as the nearly $2.1 billion spent on dental cases in hospital emergency departments – 80 percent of which could be treated in a dental office for roughly $4 million total, according to the bill.

Bipartisanship like this must continue and we urge legislators to make oral health a critical component of any health reform legislation that passes through this Congress. 

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.

DentaQuest Foundation grassroots grantees ready to leap for oral health

I recently heard the perfect analogy for our oral health advocacy during the DentaQuest Foundation’s Grassroots Engagement Strategy annual meeting. It’s a saying gardeners have about the growth process of perennials: “The first year they sleep, the second year they creep, then the third year they leap!”  This year is the year for the grassroots organizations and their partners to leap!

DentaQuest Foundation’s Grassroots Engagement Strategy started in March 2015 as an initiative to engage those most directly impacted by oral health inequities. Focused in six key states - Arizona, California, Florida, Michigan, Pennsylvania, and Virginia - the Grassroots Engagement Strategy leverages an existing network of key oral health advocates and stakeholders operating at the state level. The DentaQuest Foundation has funded 20 community-based organizations within these states to provide oral health outreach and take action on social justice and oral health equity, all with the goal of improving public perception of the value of oral health in their communities.

These 20 grantees represent deep and diverse experience working directly with community members and contribute essential perspectives of community advocacy and action. They are providing community-grounded voices within a broad group of stakeholders at the state, regional, and national levels, a perspective that is critical if we are to reach our mission of improving oral health for all.

The Grassroots Engagement Strategy has now entered its third year of development, and the purpose of the annual meeting this spring was for grantees to learn from one another about what has been accomplished in the last year, what is planned for the year ahead, and how to deepen the commitment to health equity.

On day one, each organization presented its community-driven plan that covered stakeholders, how they have incorporated the Oral Health 2020 goals into their communities, 2017 organizational priorities, their proudest moments, and their greatest challenges.

For example, one organization discussed advancing a legislative advocacy strategy around protecting oral health equity policies, while dealing with the major challenge that oral health is not a top priority for the community members facing other economic and social challenges.

On day two, many of the Oral Health 2020 national advocacy partners presented the resources and tools in development that will support the grassroots organizations in their work. Attendees also discussed how they can learn from one another and build their capacity to make change at the community level.

Additionally, there were presentations on different approaches to advocacy and lobbying, including how to provide empowerment opportunities for community members in advocacy and public policy.  Partners also discussed how they work collaboratively with other organizations to activate coalitions and networks that share common goals.

The underlying themes throughout the discussion:

• health equity 
• the link between oral health and other social determinants of health 
• the implications that these have 
• who  needs to be at the table  

Similar to previous years, the grassroots organizations returned home with a sense of rejuvenated momentum for oral health.   Words like “motivated,” “energized,” and “connected” were used by attendees format the close of the meeting.  With the political landscape changing, the role of grassroots organizations engaging in advocacy is even more critical at the local, state and national levels.

When community members are educated on the topic of oral health and have the passion and understanding of its impact, their voices are powerful.  

The Oral Health 2020 Network is excited to see the progress that will continue in these communities and beyond. The grassroots grantees are ready to “leap” into action for year three of the Grassroots Engagement Strategy!

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Guest post from DentaQuest Foundation's grants team member Liana DiRamio. Learn more about the grants and programs here: http://dentaquestfoundation.org/about/our-mission. 

DentaQuest Institute Releases New Report on Interprofessional Care in Rural Communities

New white paper delves into the role of interprofessional networks to coordinate person-centered care and improve oral health

DentaQuest Institute, in collaboration with the South Carolina Office of Rural Health, the Medical University of South Carolina, the Colorado Rural Health Center, and the Pennsylvania Office of Rural Health, just released a new white paper , MORE Care: Narrowing the Rural Interprofessional Oral Health Care Gap. The report highlights the importance of interprofessional oral health networks in achieving person-centered care and population health improvement. By producing coordinated care pathways between dental medicine and primary and behavioral health, interprofessional oral health networks have the potential to improve patient outcomes, increase patient and provider satisfaction, and reduce the cost of providing and receiving care.

The report is the result of two years of collective findings from the Medical Oral Expanded Care (MORE Care) Initiative involving twenty-one Rural Health Clinics and fifteen rural dental care partners located in Colorado, Pennsylvania, and South Carolina. MORE Care partners provide insight into the main factors affecting the initiation of interprofessional oral health practice observed during the early phases of MORE Care.

The white paper, and a soon-to-be-released implementation guide, offer insight into the needs of Rural Health Clinics and rural dental care teams as they undertook the creation of interprofessional oral health networks (IPOHNs). In addition to creating interprofessional oral health networks, the purpose of MORE Care is to serve as a vehicle for adopting system change in the rural communities.

For more information on how dental programs serving rural communities can leverage MORE Care, contact Rebekah Mathews, director of transformation at rebekah.mathews@improvingoralhealth.com.

Let's Talk Water Fluoridation this Children's Dental Health Month

In addition to Valentine’s and Presidents’ Days, February also marks National Children’s Dental Health Month, with a theme this year connected to fluoridation.

Dating back to February 1941, the month-long celebration brings together dental professionals, health care providers, educators, policymakers and more stakeholders to promote the benefits of good oral health for children through various activities and events.

This year’s campaign slogan is “Choose Tap Water for a Sparkling Smile,” focusing on the value of fluoridation.

Fluoride combines with enamel on the tooth’s surface to make it stronger, better able to resist decay, and prevent dental caries —the most common chronic disease for children.  

Over the years, research has supported the value of fluoridation:

• In 2013, the U.S. Task Force on Community Preventive Services found that on average fluoridated water increased the number of people in a community without dental caries by 25 percent. 

• A 2010 American Journal of Public Health article indicated that a child who consumes fluoridated water is less likely to have lost teeth from decay 40 to 50 years later in adulthood. 

Water fluoridation, since it requires passive action to show effect, offers a simple solution to contain total oral health expenditures, improve population health, and set children up to have better oral health as adults.

Water fluoridation benefits the entire community, regardless of status or background, which is critical to addressing ethnic, geographic, and socioeconomic barriers to effective oral healthcare—a widespread problem in the United States.

National Institutes of Health data indicates that 20 percent of White, non-Hispanic Americans have untreated tooth decay compared to 40 percent for Black, non-Hispanic Americans and 38 percent for Mexican Americans.

This data also showed that individuals below the federal poverty line (FPL) are almost three times more likely to have untreated decay compared to those making twice the FPL or above.

This makes dental disease a disease of disparities, which can be prevented, in part, by easy and free access to fluoride.

Fluoridated water is an evidence-based, cost-effective path to promote health equity and, as an oral health organization committed to improving the oral health of all, it is just another reason DentaQuest celebrates National Children’s Dental Health Month.

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.

Adult Medicaid Dental is Key to Overall Health, Requires Increased Access

Medicaid programs are well-positioned to prioritize optimal oral health in their states through adult dental benefits, but systematic changes are necessary to fully address barriers to dental care.

Although Medicaid programs are required to provide pediatric dental coverage for low-income children, extending those benefits to the adult population is optional. Currently 15 states offer extensive dental coverage for low-income adults on Medicaid, while 17 states only provide coverage for dental emergencies or provide no coverage at all.

Robust adult dental benefits can have tremendous impacts on state Medicaid populations:

·         Individuals with dental benefits are 42 percent more likely to have a dental checkup within the year than individuals who don’t have coverage. Additionally, when parents receive care, their children are more likely to go to the dentist as well.

·         Reducing or eliminating Medicaid adult dental benefits has led to significant increases in dental-related emergency department visit and associated costs in states like California.

·         Ensuring low-income adults have access to comprehensive dental coverage can improve employability, as adults lose millions of work hours each year due to dental disease.

·         Increasing access to dental coverage can help to reduce disparities as well because untreated dental disease disproportionately afflicts racial and ethnic minorities.

·         Treatment of gum disease can lead to better health management — as evidenced by lower health care costs and fewer hospitalizations — among people with common health conditions, such as type 2 diabetes, heart disease, and pregnancy. These links to improved overall health management are particularly critical for Medicaid beneficiaries.

The economic, oral health, and overall health outcomes above are tremendous arguments for states to invest in a Medicaid adult dental benefit, but access challenges will persist without systematic approaches to oral health.

In this month’s publication of Health Affairs, research conducted by the DentaQuest Institute and the American Dental Association shows that emergency department utilization for oral health conditions rose in Kentucky after Medicaid expansion, which included a dental benefit for adults.

In the emergency department, patients generally receive palliative and costly care. A combination of pain-management (usually opioids) and infection management for preventable conditions costs the U.S. health care system an estimated $1.6 billion annually.

Presumably, increasing coverage under Medicaid would have reduced emergency department utilization and associated costs. Why didn’t this happen for Kentucky?

Although Kentucky expanded dental coverage to adults in Medicaid, the state still faced many challenges:

• 23 percent of low-income individuals cited inconvenient locations or time as a reason to avoid going to a dentist.
•  Kentucky’s reimbursement for dental services was 44 percent of commercial rates.
•  Due to few dental providers in the state, Kentucky had 99 dental health provider shortage areas, and only 39 percent of Kentucky dentists participated in the Medicaid program.

Coverage is a critical first step to ensuring access to dental services for adults served by Medicaid, but it cannot be the only step. 

While information in Kentucky suggests that an increase in emergency department use following the addition of an adult Medicaid dental benefit is likely temporary, strategies to improve oral health in a state must go beyond coverage alone.

Key strategies that states must consider include:

• provider capacity and support, 
• reimbursement rates,
• dynamic oral health education, and 
• the integration of oral health screenings and/or referrals into primary care are. 

These factors are critical to ensure that patients receive the most appropriate care in a timely manner and in the most appropriate setting.

Fortunately, organizations like DentaQuest are creating multi-pronged approaches to these systemic oral health challenges.

At DentaQuest, we align philanthropy, science, coverage and care to improve the oral health of all. DentaQuest Foundation delivers millions of dollars in grant funding to hundreds of initiatives across the nation, fostering oral health innovation at the grassroots level. Ideas that prove most promising are leveraged by the DentaQuest Institute, which develops innovative clinical care and practice management solutions to help providers deliver optimal care.

Programs and initiatives that prove to be both effective and scalable by the DentaQuest Institute are then integrated in a broader fashion by DentaQuest Benefits Administration and the DentaQuest Care Group, fueling a comprehensive disease management approach toward health that is prevention-focused and outcome-driven. 

We are more than just a dental administrator. We are an incubator of innovation and a proving ground for pioneering initiatives in the oral health space that improve health.

These types of collaborative solutions that incorporate a wide array of stakeholders are imperative to successfully improve oral health in a state and to achieve the Triple Aim – reduce healthcare costs, improve the patient experience, and achieve better health outcomes. 

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.

 

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.