“I believe that everyone in this country deserves the benefit of a totally integrated heath care system with access to timely, convenient, comprehensive, and culturally sensitive care.”
– Kenneth Wright, DMD, MPH, Chair of the HSDM Initiative to Integrate Oral Health and Medicine
Ken brings an extensive background in medical-dental integration. He joined Kaiser Permanente in 2011 after retiring from an impressive 30-year career in in the Navy where he held multiple leadership roles. As deputy director for the chief of Naval Operations, Ken was responsible for delivering a balanced medical and dental program for the Navy and Marine Corps.
At Kaiser Permanente, Ken oversees the Dental Care Program for the Northwest Region’s twenty-one dental offices that serve 270,000 members. Kaiser Permanente Northwest’s business model integrates dental care into its system. Benefits to patients include access to convenient, coordinated services and an electronic health record that combines medical and dental history.
Synergies between the Initiative’s mission and Ken’s career
Ken embodies the Initiative’s ideology and shares its commitment to advancing medical-dental integration (MDI). As an HSDM alumnus, Ken learned early on about the benefits of connecting oral health to overall health and has put this into practice throughout his career. In his work at Kaiser, Ken follows the Institute for Healthcare Improvement Triple Aim Framework to optimize health system performance and simultaneously improve patient experience and health outcomes while reducing costs.
Working towards similar objectives, the Initiative supports projects and research that test new models of teaching and delivering integrated care. The aim is to educate practitioners to deliver integrated care, develop and disseminate best practices, and provide the evidence-base required to advocate for systems change.
As Chair, Ken hopes to accelerate the Initiative’s trajectory. He envisions the Initiative becoming a resource for health care organizations and government agencies seeking to leverage MDI principles and the Triple Aim Framework in developing integrated workflows, processes, and revenue systems.
Medical-Dental Integration (MDI)—a holistic approach to healthcare
Dr. Bruce Donoff, Dean of the Harvard School of Dental Medicine, and Jane Barrow, the Initiative’s Executive Director and Associate Dean for Global and Community Health, recently visited Kaiser Permanente’s Cedar Hills Dental and Medical Office to learn about the collaborative care model they are piloting. The clinic, which opened in January 2017, focuses on treating the whole person by creating greater connections between the physical, behavioral and oral health delivery systems.
At Cedar Hills, medical and dental practitioners work together to deliver dental and routine medical care under one roof. The staff includes general and pediatric dentists, dental assistants, a family practice physician, a physician assistant, and nurse practitioners. The clinic has developed integrated workflows that they continue to refine.
Such high levels of collaboration are possible due to a combined electronic medical and dental record. Having access to this “total health record” allows dentists and physicians to view a patient’s complete medical and dental history.
The dental office as an entry point into the health system
According to Ken, this model has resulted in expanded roles for dental and primary care providers, greater convenience and improved outcomes for patients, and reduced costs and medical volume for insurers.
“Before dental patients arrive for appointments, we check if they are due for medical procedures (immunizations, lab tests or blood pressure checks) that can be addressed during their visit. We recently had a dental exam patient who also needed blood tests for an upcoming procedure. We consulted with her physician to prearrange testing services. While she was in the dental chair, a nurse practitioner reviewed her medical records, drew blood, and administered a vaccine. We were even able to administer flu shots to her kids. The model really supports busy working families.”
Recently the Northwest dental and medical offices teamed up to close gaps in care for a population of diabetic patients who were overdue for their sugar level screenings. After running a query of health records, 1200 patients were flagged to have upcoming dental exams and also need screenings. The dental office worked with the medical lab to arrange for patients to be screened in the dental office or in close proximity.
“We just got the results a couple of days ago. Our first analysis shows that we closed about 63% of the care gaps for those patients. That’s twice the rate that medical had been closing them,” adds Ken.
Ken attributes this success to the holistic and empathetic approach provided by their dental staff. Dentists are trained to care about a patient’s overall health and to collaborate with medical staff to provide convenient and timely care.
Lessons learned
Of course change brings challenges. Change management is critical to the success of a new process roll out. Dentists and physicians practicing together must develop a common dialogue. In some cases scope of practice needs to be redefined. For example, some states allow dental offices to administer flu shots while others do not. And while a combined health record provides great benefit, it can be difficult to implement.
Working towards the Triple Aim, Kaiser has set internal goals to increase member satisfaction, improve long-term outcomes, increase affordability, and decrease costs through better disease management, preventative care, and by making patients “partners” in the total care experience.