In the current debate over the future of the Affordable Care Act (ACA), research evidence on the impact of the law and the effects of health insurance coverage in general is critical. Studies of health insurance expansion over the past decade have demonstrated that coverage expansions can produce significant reductions in mortality-particularly among minorities, those living in poorer areas, and those with chronic conditions potentially treatable with timely medical care. More recent studies of the ACA in particular demonstrate that the law has produced historically large reductions in the uninsured rate, with resulting improvements in access to care, perceived quality of care, and self-reported health. Yet much of the general public and many policy makers remain unaware of this evidence. Researchers and clinicians in academic medicine have a role to play in ensuring that critically important health policy decisions are made using rigorous evidence to best protect the interests of our patients.
Research brief written by the ADA Health Policy Institute in partnership with The Dartmouth Institute for Health Policy & Clinical Practice. March 2016.
Most accountable care organizations (ACOs) are not responsible for dental care as part of their ACO contract. Nine percent of the largest commercial contracts and 25 percent of Medicaid contracts hold providers responsible for the cost and quality of dental services.
The top reason ACOs report for excluding dental care is a lack of integrated health information technology. The perceived potential for cost savings associated with dental care is the top motivation among ACOs that include or plan to include dental care.
Despite research suggesting that integration of dental care may benefit patients, financing and delivery of dental care remains disconnected from other health services, even among ACOs working to improve overall population health. Integration of dental care may present an opportunity for improved accountability for total health, yet to date, there is little incentive for ACOs to facilitate access to these services.
Research Brief written by the ADA Health Policy Institute (HPI), a thought leader and trusted source for policy knowledge on critical issues affecting the U.S. dental care system.
In a tertiary health care setting, physicians reported they were dissatisfied with the referral system to dentists, the coverage of dental care services for patients, and their ability to distinguish a worrisome oral lesion from a variant of normal.
More than half of worrisome lesions were referred to physician specialists instead of dentists specifically due to the lack of a referral system.
Efforts to improve the referral system to dentists, facilitate the creation of an electronic referral system, and promote dental education for physicians could increase both physician and dentist satisfaction and the quality and efficiency of care for patients.
Since the founding of dental schools as institutions distinct from medical schools, dentistry—its practice, service delivery, and insurance coverage, for example—and dental care have been kept separate from medical care in the United States. This separation is most detrimental to undeserved groups at highest risk for poor oral health. As awareness grows of the important links between oral and general health, physicians and dentists are collaborating to develop innovative service delivery and payment models that can reintegrate oral health care into medical care. Interprofessional education of medical and dental students can help produce clinicians who work together to the benefit of their patients.
This white paper was commissioned by the National Interprofessional Initiative on Oral Health with support from the DentaQuest Foundation, the REACH Healthcare Foundation, and the Washington Dental Service Foundation.
Strengthening the primary care delivery system, investing in prevention, and reducing unnecessary costs are national healthcare priorities. As the leaders of organizations committed to advancing oral health, we see a clear opportunity to improve health, reduce waste, and maximize the value of our limited healthcare workforce by incorporating oral health in routine medical care.
We commissioned an initiative to develop, test, and disseminate an actionable pathway for delivering preventive oral health care in the primary care setting, and improving the structure of referrals from primary care to dentistry. We assembled a Technical Expert Panel to guide this effort, which included primary care and dental care providers, medical and dental associations, payers and policymakers, a patient and family partnership expert, and oral health and public health educators and advocates.
Based on input from this panel, and a careful review of previous efforts to integrate once fragmented services into primary care, the authors developed an organizing framework, which we present in this white paper.
The Oral Health Delivery Framework has been endorsed by a broad array of organizations, and is consistent with how primary care teams manage preventive, acute, and chronic care needs for a wide range of clinical conditions across the lifespan. As such, we believe that implementation of the Framework is an achievable goal.
It has been 15 years since the U.S. Surgeon General identified oral disease as a priority health concern and documented pervasive and systemic barriers to dental care. Despite calls for all healthcare professionals to pay attention to oral disease, too little progress has been made in reconfiguring the healthcare delivery system to better meet our nation’s oral health needs. Only by partnering together can we reduce the burden of oral disease. We hope that the information presented in this white paper will inspire primary care teams and dental health professionals—and the stakeholders that support them—to end the artificial separation of oral and systemic health.
The U.S. Department of Health and Human Services (HHS) is committed to advancing the oral health and general well-being of all populations across the lifespan. The HHS Oral Health Strategic Framework 2014–2017 outlines a strategic alignment of HHS operating and staff divisions’resources, programs, and leadership commitments to improve oral health care and delivery.
The Framework is written for oral health, behavioral health, and primary care health professionals and program administrators within and outside of the federal government and other external stakeholder groups interested in oral health. It serves as an essential resource to (1) optimize the implementation of activities planned and those underway, (2) strengthen existing cross-agency collaboration, and (3) identify new avenues for private-public partnerships by creating maximum synergy with other current federal and non-federal oral health initiatives.
Lack of access to oral health care contributes to profound and enduring oral health disparities in the United States. Millions of Americans lack access to basic oral health care. In 2008, 4.6 million children – one out of every 16 children in the United States did not receive needed dental care because their families could not afford it. Children are only one of the many vulnerable and underserved populations that face persistent, systemic barriers to accessing oral health care.
The United States health care system is able to provide acute care but continues to struggle to address the need for ongoing care, especially for vulnerable populations such as the elderly, disabled, mentally ill, and special needs populations. Safety net organizations that provide health services to uninsured, low-income, and vulnerable persons continue to look for ways to coordinate services among providers to improve access to quality care.
The 2011 Institute of Medicine (IOM) reports, Advancing Oral Health in America and Improving Access for Oral Health for the Vulnerable and Underserved, recommended that the Health Resources and Services Administration (HRSA) address the need for improved access to oral health care through the development of oral health core competencies for health care professionals. In response, HRSA developed the Integration of Oral Health and Primary Care Practice (IOHPCP) initiative with three inter-related components. The first component was the creation of a HRSA prepared draft set of oral health core clinical competencies appropriate for primary care clinicians. The second component was the presentation of a systems approach to delineate the interdependent elements that would influence the implementation and adoption of the core competencies into primary care practice. Finally, the third was the characterization and outline of the basis for implementation strategies and translation into primary care practice in safety net settings.
Though it is highly preventable, tooth decay is a common chronic disease both in the United States and worldwide. Evidence shows that decay and other oral diseases may be associated with adverse pregnancy outcomes, respiratory disease, cardiovascular disease, and diabetes. However, individuals and many health care professionals remain unaware of the risk factors and preventive approaches for many oral diseases. They do not fully appreciate how oral health affects overall health and well-being.
In Advancing Oral Health in America, the Institute of Medicine (IOM) highlights the vital role that the Department of Health and Human Services (HHS) can play in improving oral health and oral health care in the United States. The IOM recommends that HHS design an oral health initiative which has clearly articulated goals, is coordinated effectively, adequately funded and has high-level accountability. In addition, the IOM stresses three key areas needed for successfully maintaining oral health as a priority issue: strong leadership, sustained interest, and the involvement of multiple stakeholders from both the public and private sectors.
Advancing Oral Health in America provides practical recommendations that the Department of Health and Human Services can use to improve oral health care in America. The report will serve as a vital resource for federal health agencies, health care professionals, policy makers, researchers, and public and private health organizations.