- Behavioral healthcare providers, public health departments, and long-term care facilities have started to attract a lot of attention when it comes to developing integrated population health management programs, but dentists and other oral healthcare practitioners have often been left out of the loop.
A growing recognition that oral health and access to dental care are tightly tied to the development and management of other chronic diseases is turning cavities and cleanings into a significant part of the healthcare industry’s broader population health management programs.
For example, Tufts Health Freedom Plan and Northeast Delta Dental recently announced their bid to improve access to oral healthcare by offering reduced premiums to New Hampshire employers who purchase coverage from both entities.
The two payers will be working together to improve dental care access for high risk patients whose diabetes, heart disease, or other chronic conditions may worsen due to dental disease.
“We know that a person’s oral health is closely tied to their overall health, and we are hopeful this partnership will allow us to intercept oral disease and help those with underlying medical conditions achieve their personal best health,” said Tom Raffio, President and CEO of Northeast Delta Dental.
Dental healthcare access rates follow socioeconomic patterns similar to other types of care, says the Healthy People 2020 project. Patients with higher levels of education and higher incomes are more likely to have completed a dental checkup in the past twelve months.
Approximately half of patients with some college education completed a dental visit in 2013, but just 17.5 percent of patients who had not finished high school could report the same. Among patients with a high school level education, 29.8 percent had a visit on record during the time period.
Patients with private health insurance are more than 2.5 times more likely to have a relationship with a dentist. Just 19.2 percent of uninsured patients and 31.4 percent of publicly insured patients visited a dentist in 2013, compared to 50.6 percent of consumers with private coverage.
These rates of access vary significantly across racial, ethnic, and economic lines. Just 31.1 percent of Hispanic or Latino patients visited a dentist in 2013, while 48.4 percent of non-Hispanic white patients accessed dental care.
Only 27.6 percent of patients with incomes below the federal poverty line were able to see an oral health professional compared to 55.5 percent of those above the 400 percent poverty threshold.
Data from the CDC also illustrates stark disparities across socioeconomic groups. Non-Hispanic black, American Indian and Alaskan Native, and Hispanic adults are nearly three times more likely to experience untreated tooth decay than white patients.
Destructive periodontal disease is also three times more likely to be a health concern for patients with less than a high school education compared with those who have at least some college.
Untreated oral health conditions can have significant long-term impacts on patient outcomes, and the disparities in care access can lead to marked differences in survival rates for patients with certain cancers.
The five-year survival rate for throat cancer in black men is approximately half that in whites (36 percent versus 61 percent), says the CDC.
Reducing these disparities and improving access to care requires a concerted cross-industry effort to integrate oral care into population health management programs and care coordination strategies. Data-driven techniques to target high-risk patients, coupled with patient outreach and education, may be able to close the gaps between populations.
Risk assessment analytics form a key part of the Public Health Foundation’s framework to increase the affordability and availability of oral healthcare. As part of a project funded by HHS, the Foundation recommends that providers employ surveillance and analytics tools that can identify high-risk populations, flag community factors that may prevent access to care, and track oral healthcare delivery at the community level.
The use of these population health management tools, alongside improved patient education and further development of the public health sector, will help to expand the delivery of preventative care and close disparity gaps between socioeconomic groups.
The American Dental Association (ADA) also recognizes the need to bring dental care and population health management closer together while addressing the specific needs to traditionally underserved communities. Dental Public Health has been a recognized non-clinical specialty since 1950, and the professional society has developed a strong public health infrastructure to encourage positive self-care choices at the community level.
Governmental support and a presence within the educational system, especially for young schoolchildren, have helped dental care professionals to start bridging the gaps between the traditional clinical care ecosystem and the public health environment.
“The challenge for dental public health, and dentistry in general, is to create a shared vision of optimal oral health for widely diverse groups; inform and educate these groups as to their potential role in improving oral health and to be better stewards of their own oral health; assessing the oral health status of differing communities of interest; designing, implementing and coordinating activities and programs; and evaluating outcomes,” the ADA says.
The society notes that reimbursement issues, an aging workforce, a lack of diversity among dentists, and difficulties serving medically complex patients are presenting obstacles to continuing to reach high-risk populations, including minority and low-income communities.
“Successfully meeting the oral health demands of all Americans depends on the inclusion of a strong private sector, adequately reimbursed, with an appreciation of cultural competency and adequate geographic distribution to treat those people for whom a viable business model capable of supporting that practice exists,” says the ADA.
“Assuring optimal oral health for all Americans requires close collaboration between the public and private sectors of dentistry.”