IMPROVING ACCESS TO DENTAL CARE
“Oral health is a critical component of overall health, yet many Ohioans face barriers to accessing dental care, particularly in rural areas.” – “Partners In Progress, Pursuing Medical/Dental Integration in Ohio” CareQuest Institute and Oral Health Ohio Impact Report, 2025 (https://www.carequest.org/system/files/CareQuest_Partners-in-Progress_7.2.25_v2.pdf).
One of the many opportunities I have as an ODA member and especially as a member of the Executive Committee is to participate in projects that expand on the relationships we have with other oral health advocacy organizations. One of those is, intuitively, the ADA. As I have discussed in a previous article (https://www.oda.org/news/musings-about-medicaid/) Ohio, along with five other states, has been participating in a pilot study to elucidate effective means of increasing Medicaid provider engagement. I, along with several other ODA leaders, were able to happily report that Medicaid provider engagement and participation has increased since the 93% fee increase went into effect last year. Completion of this project is slated for September 2025.
The other, not directly tied to the ADA or ODA, is known as MORE Care OHIO (Medical Oral Expanded Care – Ohio). MORE Care is a two-year collaborative program joining the CareQuest Institute and Oral Health Ohio to study the institution and efficacy of medical/dental integration, along with the concept of value-based care and an alternative payment model, in order to enhance quality of care in the pediatric population of several Ohio counties. I had the privilege of being asked to participate as a dental provider.
Now, that was a lot of words so let’s unpack a little, starting with:
Medical/Dental Integration – while many definitions could be applied here, for the purposes of MORE Care let’s use this – “Medical and dental providers communicating patient information, through electronic or other HIPAA-compliant means, allowing all providers to provide the most conscientious treatment for that patient.”
We tend to use the word “silo” a lot when we describe the dissonance between medicine and dentistry. A means to de-silo ourselves is to formulate a bridge with regard to sharing the patient’s complete medical record. This is currently in place in settings such as hospitals with in-house dental clinics and combination medical/dental FQHCs. A more complete discussion regarding the commitment in time, money and other resources to implement a medical/dental EMR is beyond the scope of this article, however, it needs to remain on our radar.
Value-Based Care (VBC) – This is a term that can evoke a variety of responses from dentists. In Ohio, some view it as a synonym for “pay-for-performance” (kinda close) or more ominously, “Episodes of Care.” The tribulation (torment?) there being the concept of “positive and negative incentives” which were a plague for many of us several years ago. With regard to MORE Care though, VBC has a much more wholesome connotation: “Incentivizing preventive care.”
The incentive, as you may be asking silently, was receiving a monetary payment for meeting certain performance measures emphasizing prevention. Those would include caries risk assessment, setting and monitoring patient/parent self-management goals and fluoride application. This constituted the …
Alternative Payment Model. And, as stated in the impact report, “The participants faced no financial risk in the APM and could not lose money if they did not reach their performance measure benchmarks.”
No negative incentive.
This pilot spanned a two-year period from October 2022 to October 2024 with a convening and review of the final report held last month in Columbus. The report and ensuing discussion reiterated several themes that are well known:
- Prevention is more cost-effective than restorative and surgical intervention.
- Communication between dental and medical providers greatly enhances the provision of comprehensive care for the patient as a whole.
- Stakeholders, policy makers and especially payers need to be educated as to points 1 and 2.
I was grateful to have been asked to participate as it afforded multiple opportunities to network with oral health providers and advocates from around Ohio and beyond, all seeking the same answers to the question: “How do we increase access to care, especially to underserved populations, in light of social and financial determinants, workforce challenges, and the political climate?”
While we all continue the efforts to adequately address this ubiquity I will close with some thoughts posed by Marla Morse, executive director of Oral Health Ohio: “When we (Oral Health Ohio, ODA and others) speak to legislators we oftentimes hear back that, while information from advocacy groups is beneficial, who they really want to hear from are non-oral health providers (including primary care, school nurses and superintendents, nursing homes staff, etc.) and the patients themselves.”
Therein lies our perpetual challenge. It’s time to communicate outside the silo.
