Blog Post

Why population health leaders should care about oral health

July 12, 2018

    Provider care teams are becoming increasingly more integrated—engaging nontraditional roles such as behavioral health specialists, pharmacists, and pain management experts to help execute patient care plans. But oral health care professionals largely remain isolated or completely missing from medical care. In fact, even though 96% of health care executives believe the integration of dental benefits in medical plans is imminent, few hospitals and health systems have established relationships with dentists or oral surgeons.

    This gap is an untapped opportunity to better manage the total cost of care for population health managers. Here are three reasons why:

    1. Patients without dental care have poorer health outcomes and are more likely to use the ED for treatment

    Patients without oral health care access are more susceptible to chronic illnesses and inappropriate acute utilization. For instance, people without dental benefits—when compared to those with dental benefits—are 67% more likely to have heart disease, 50% more likely to have osteoporosis, and 29% more likely to have diabetes. Without prevention or early treatment, these patients present in high-cost settings, such as the ED. In 2015 alone, ED visits for dental conditions cost $2 billion—and nearly 80% of those ED visits could have been treated in a dental office.

    2. Lack of communication with oral health providers can cause opioid misuse and abuse

    Dentists prescribe 12% of immediate-release opioids in the United States, and they are often the target of "doctor shopping" for opioids. However, medical providers typically do not have access to information about medications prescribed by dentists and vice versa. This communication gap limits the ability of prescribers of any type to make informed decisions about dosing and patient risk.

    Reining in opioid prescribing among oral health providers is most critical for patients who are children and adolescents. Opioid use before high school graduation is associated with a one-third greater risk of future opioid misuse, yet dentists are the most common prescriber of opioids for this population—often for wisdom tooth extraction.

    Health systems invested in reducing opioid misuse and abuse should include dentists and oral surgeons in initiatives focused on safe prescribing practices.

    3. Increasing access to dental care reduces health care costs and improves patient loyalty

    Studies demonstrate that access to dental care can result in significant cost savings. For example:

    • Medical costs among adult Medicaid beneficiaries with seven chronic conditions decreased by 31% to 67% when they received a preventive dental benefit (National Association of Dental Plans); and
    • Patients with Type 2 diabetes who were treated for periodontal disease experienced $2,840 savings in annual medical costs and a $1,477 decrease in drug costs, when compared with patients with Type 2 diabetes whose periodontal disease was not treated (Journal of Preventive Medicine).

    In addition, beyond reducing costs, oral health providers can engage patients disconnected from primary care. Approximately 9% of patients go to the dentist but not to a physician. Since dental school education largely overlaps with two years of medical school, there are several opportunities to train dentists to screen for chronic conditions and provide referrals to primary care providers (PCPs).

    What should your organization do differently?

    Despite this strong case for integration, medical and dental care largely remain separate. However, when providers do collaborate with oral health providers, it typically takes on one or more of these three strategies:

    1. Develop a closed-loop referral process: Oral and medical care providers form a collaborative practice agreement to establish guidelines for referral and acceptance of patients. Federally Qualified Health Centers and community health centers commonly deploy this model.

    2. Create a shared financing model: An ACO takes full financial risk of attributed patients, including dental care, as part of patients' health plan. Most ACOs accept a variation of a capitated payment in which dental services are carved out, with individual dentists receiving upside incentives without direct downside risk.

    3. Co-locate services and EHR-based referrals: For those sharing financial risk, medical providers and dental practices work in close proximity using referral protocols and a shared EHR to improve access, increase efficiency, and close care gaps.

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