Advancing Dental-Medical Integration: Plans, Providers, and Patients
Jeremy Jonckheere and Mary Lee Conicella, DMD, FAGD
The concept that good oral health is a driver of overall health seems to have reached widespread acceptance. The question now is: Who will lead it forward?
Recent studies from Mayo Clinic, DentaQuest Foundation, and many others have further reinforced that preventative oral healthcare and the treatment of periodontal disease improves overall wellness and lowers the total cost of care. Patients benefiting the most are those with diabetes, cardiovascular disease, or other chronic conditions. Given the prevalence and growth of these high-risk conditions, and with nearly half of Americans suffering from periodontal disease, the industry has begun to act. This encompasses a wide range of parties, including insurance plans, educational institutions, technology groups, and healthcare providers.
Insurance plans have taken initial steps as their incentives align with employer groups' demands for cost savings and dental's growing importance supporting member retention and Medicare Advantage quality ratings. Examples of functional and successful integration programs that remove access-to-care barriers include Aetna's decades-long efforts and Arkansas BlueCross BlueShield's work with Life & Specialty Ventures. These programs blend direct member outreach with incremental copay benefits for qualifying members. Aetna Dental, in particular, has created a gold standard with its programs for members with high-risk comorbidities that: (1) apply to all dental plans; (2) apply to all members, regardless of medical plan coverage; and (3) do not require members to file paperwork, or pay first-reimburse later.
Despite these bright spots, most insurance plan programs remain optional, confusing, and misunderstood by patients and providers. To fill this void, other stakeholders are creating new programs and partnerships to break down the historical industry silos.
Clinical Education. Many of the next generations of providers will start their careers already immersed in the need for, and benefit of, dental-medical integration (DMI). There appears to be more alignment as universities foster closer ties between medical and dental schools with programs that range from shared classes to full curriculum coordination. Harvard University, New York University, and University of the Pacific have all made headlines with their programs, and others are building similar foundations with classroom initiatives and technology platforms that encourage a holistic view.
Information Systems.Integrated care requires integrated and transparent information. To that end, Epic, in partnership with Pacific Dental Services, has invested significantly in creating an electronic health record (EHR) platform designed to support integrated dental-medical efforts. This system gives clinicians a view into a patient's comprehensive health record, helping to facilitate decision-making, scheduling, and care coordination across primary care and specialties.
Provider Coordination. Often overlooked, oral health providers offer a critical access point for patients disengaged in their overall health. Recent work by Pacific Dental Services has shown one in three patients visiting the dentist does not have active primary care relationships. When combined with adoption of screening for basic health metrics such as blood pressure, A1C, or flu shot status, this presents a significant opportunity to educate and influence a patient's health journey. Insurance plans also benefit from these efforts since, when documented and shared, they can contribute directly to Medicare Advantage ratings.
In local markets, dental and medical providers are already working to close gaps. Building on successful openings of joint dental-medical practices in Nevada, Pacific Dental Services joined Commonwealth Primary Care ACO in Arizona to drive better-coordinated healthcare. This alignment includes not only traditional preventative and population management tools, but also a dental plan offering tailored to support patients with high-risk conditions such as diabetes or pregnancy.
All of these endeavors have one thing in common: They bring dental and medical providers together in a way that supports education, awareness, and access to personalized care. By seamlessly sharing information, clinicians can help patients make the right decision for their individual circumstance. As DMI progresses, insurance plans are well positioned to catch up and advance the industry, although solving these challenges requires further efforts and concrete action. Without these steps, and missing a critical industry voice, providers and industry stakeholders will continue to work with patients and employer groups to innovate alone.
Six Ways Insurance Plans Can Work With Providers to Promote DMI
1. Support and value diagnostic coding adoption and health data collection (such as blood pressure) at each visit.
2. Recognize and target systematic underdiagnosis of periodontal disease.
3. Establish positive value-based programs for preventative care and treatment of periodontal disease.
4. Include incremental or flexible benefits with low administrative hurdles for members at highest risk.
5. Embrace the evolving capabilities of EHRs to coordinate a patient's dental and medical data.
6. Adopt augmented intelligence (AI) to create fair and consistent diagnostic criteria for provider claims.
About the Authors
Vice President, Strategic Payor Partnerships, Pacific Dental Services, Irvine, California
Mary Lee Conicella, DMD, FAGD
Chief Dental Officer, CVS Health/Aetna, Pittsburgh, Pennsylvania