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June 2019
Volume 40, Issue 6

Teeth in Medicare Movement Gains Momentum—Let’s Challenge the System!

Michael C. Alfano, DMD, PhD

Less than 5 years ago, only a few organizations were actively working toward an expanded dental benefit in Medicare. Among them were Oral Health America, the Dental Lifeline Network, the Center for Medicare Advocacy, and the Santa Fe Group.

Today, some 86 prestigious organizations across a broad spectrum of consumer organizations, medical associations, patient advocacy entities, and various dental groups have signed on to a progressive statement calling for the expansion of Medicare to include basic dental services for individuals with medical need. Moreover, in a rarity in these times, a bipartisan group of US Senate and House members have called on the Centers for Medicare & Medicaid Services to use its regulatory power to expand dental care in Medicare for individuals with medical need.

How can consensus build so quickly? Per-haps it is the momentum of multiple driving forces. These include the assessment by the highly regarded Avalere Health, which conservatively estimated that the Medicare program could save $12 billion per year if only 20% of seniors with noncommunicable diseases (NCDs) received basic dental care. Also, the Santa Fe Group salon in late 2016 presented a spectrum of data on the relationship of oral to general health to 175 healthcare professionals, insurance representatives, academic scholars, and public health advocates from more than 100 organizations. In addition, the private insurance sector has made subsidization of periodontal care a best practice, indeed an economic imperative, for insured populations with NCDs.

Furthermore, new research studies and political vectors supporting this change appear every month. For example, the 2019 Santa Fe Group salon titled, "Comprehensive Health Without Oral Health: A Medicare Paradox," includes new data on the net benefits of dental care in reducing total healthcare costs in a Medicaid population. Another study presented by the private sector at this meeting demonstrates that dental prophylaxis across an entire population-healthy individuals and those with NCDs-also reduces total health expenditures. Finally, advocates for a dental benefit in Medicare are identifying the best themes to engage consumers in their self-interest for improved total health to sharpen their administrative and legislative approaches for this cause.

One final fact is particularly noteworthy. Preventive oral care reduces total healthcare costs by decreasing the need for hospitalization. This isn't simply a reduced need to use the ER for dental care, but more importantly, a decrease in hospitalizations for primary systemic diseases. Imagine that! Dental care actually reduces the need for hospitalization.

Momentum is building quickly, and I respectfully suggest that it is time for you to join the effort.

About the Author

Michael C. Alfano, DMD, PhD
President, Santa Fe Group, New York, New York; Professor, Dean, and Executive Vice President Emeritus, New York University, New York, New York

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