June 2017

June 15, 2017

Dental-medical integration is a response to decades of historic separation between two healthcare professions. The system has adapted to delivering care to people as two independent segments – one part mouth, one part everything else. But the thing is, our mouth doesn’t know it is distinct from our body and we’re the healthiest when we understand (and respect) the connection between our oral and overall health.

Thankfully, several efforts are now underway to help bridge the divide between medical and dental care delivery to create a healthcare system that prioritizes the patient experience. These efforts were highlighted at the Legislative Oral Health Caucus this past Tuesday where oral health advocates gathered to educate legislators about the HCFA-led Oral Health Integration Project (OHIP).  During the Caucus convening, case studies from the new HCFA policy brief were referenced to examples of oral health integration work currently underway in Massachusetts and beyond. Brief snapshots of each case study are provided below.

In Oregon, dental services are included as part of the standard Medicaid benefit package with locally-governed Accountable Care Organization (ACO)-like entities called Coordinated Care Organizations (CCOs) that are required to contract with all Dental Care Organizations (DCOs) to establish their dental provider networks. The 16 CCOs receive a global budget from Oregon’s Medicaid program to deliver medical, behavioral and oral health care for a defined population in a particular service area.

In Minnesota, Hennepin Health is a county-based Medicaid ACO made up of four different organizations, including a dental clinic, that share financial risk for over 30,000 patients. Patient care coordination and focusing on prevention are fundamental parts of the Hennepin Health care model.  For example, in well-child visits for children aged 0-3, a dental provider joins the physician to provide the first dental visit and also offers preventive parent education. The ACO also has an integrated electronic health record system to assist with care coordination.

Massachusetts also has innovative examples of oral health integration. The One Care program coordinates and integrates care for patients between the ages of 21-64 with complex needs and who are eligible for Medicare and MassHealth. Dental services are included in the One Care plan, and is cited as one of the primary reasons enrollees select the plan. At the Holyoke Health Center, medical and dental services are co-located at two comprehensive health center sites and pediatric dental residents work with primary care teams to provide oral health trainings. Lastly, the Early Childhood Caries Collaborative delivers risk-based, instead of insurance-based, oral health services to children to prevent and stop cavities that begin early in childhood.

Please click here for the full version of the policy brief titled “Case Studies in Oral Health Integration from across the care delivery spectrum: Lessons learned for Massachusetts.”

                                                                                                                                                                        Neetu Singh, DMD, MPH

June 12, 2017

Vox just published an article reporting that the U.S. Senate is getting close to enough votes to repeal the ACA, and pass a health care plan that would be devastating for Massachusetts and the rest of the country.

 

Behind closed doors, Senate Republicans have worked out a path toward Obamacare repeal. The plans under discussion would end Medicaid expansion, causing millions of low-income Americans to lose health coverage. They may allow health insurance plans to charge higher premiums to people with preexisting conditions, too.

 

In other words: The emerging bill looks a whole lot like the unpopular bill the House passed last month. It creates the same group of winners (high-income, healthier people) and the same group of losers (low-income, sicker people).

 

Read the rest of the article here.

 

This is the time to double down our efforts to stop this damaging bill from moving any further. In Massachusetts, 1.9 million people rely on MassHealth, our Medicaid program. Half of all people with disabilities, 40% of all children, two-thirds of people in low-income families, and over 60% of residents in nursing homes rely on MassHealth for their care.

 

Both MA Senators, Elizabeth Warren and Ed Markey, are on the right side of the issue, but you can reach out to your relatives and acquaintances in other states, asking them to call their Senators to show their opposition to this bill.

 

Here is how:

 

Join our Friends and Family campaign!

 

June 9, 2017

Anh Vu Sawyer, Executive Director of the Southeast Asian Coalition of Central Massachusetts and Health Care For All's supporter authored an op-ed that was published today on the Worcester Telegram and Gazette. In this piece, she shares her struggle to access dental care and her take on why oral health integration is crucial to improve access to preventive care especially for the immigrant community in the state.

As I See It: Flying to Asia to see a dentist?

As a director for the Southeast Asian Coalition of Central Massachusetts, I am quite concerned about the health care disparities my constituents have been struggling with due to their cultural and language barriers. However, a recent tooth ache that almost landed me in the ER gave me an insight into one simple step that may improve people’s overall health and make healthcare accessible and effective for many, especially the Limited English Proficient populations.

In January, right before my first vacation in four years, I ended up having to get an emergency medical appointment because of a high fever. I found out that this was due to the fact that a couple of years before, two of my teeth broke. Because there was no pain at that time, it wasn’t a big deal, so I didn’t do anything about it. But less than 24 hours before my trip to Europe, one of my broken teeth became infected and I was asked to cancel my trip. “No, my husband and I have to take this trip. Many events and appointments will be cancelled if we cancel.” That’s what I told the dentist who finally gave me very strong antibiotics so that the infection didn’t spread while on vacation. But he only did that with my solemn cross-my-heart promise that I would take care of the problem immediately once I was back in the U.S.

The antibiotic had unpleasant side effects and helped me to promptly keep my promise. I went to the dentist and was told I needed two root canals among other treatments and that would cost me around $5,000. I had dental insurance, but it would only cover 10 percent of the cost. I understood then that my dental insurance wasn’t really insurance; it worked more like a discount card. This preventable infection had been not only painful for my mouth, but also for my pocket, and almost ruined my sanity (I very much needed a vacation).

I was born and raised in Vietnam but I have been in this country for over 40 years. I am an educated and accomplished woman. I lead a wonderful community-based organization in Worcester that handles almost 10,000 visits a year and helps hundreds of refugees, immigrants and low-income residents to rebuild their lives and strengthen their communities. And I am a US citizen. What a gift! I might be Americanized in many ways. But not in every way. In my culture, at least where I grew up, oral health is not a priority and you don’t go to see a dental professional unless you really have to (i.e. life or death). For many years, because of my busy schedule, being frugal, and the lack of understanding the importance of healthy teeth, I didn’t visit a dentist. And for many years, I didn’t get a regular cleaning or a checkup - “It’s OK, because I brush and floss my teeth daily,” I reasoned with myself. I had to learn my mistake the hard way.

Many of us in the immigrant community experience language, cultural and financial barriers accessing this type of preventive care. Many of my fellow immigrants forego oral health care altogether. Some go as far as traveling to their home countries to get any dental procedure because it is cheaper to travel overseas and see a dentist than crossing the street to the dental office in their neighborhood. In one of our surveys, quite a few folks mentioned the money they saved from not seeing an American dentist covered the round trip airfares that they happily used to visit families. This doesn’t make any sense.

Read the whole article here

June 1, 2017

Andrew Dreyfus, the President and CEO of Blue Cross Blue Shield of Massachusetts, just published an op-ed in The Hill, a key source of news for Capitol Hill and people following federal legislation. Dreyfus argues strongly that the Senate should reject the provision in the House-passed ACA repeal bill that penalizes people with pre-existing conditions. While economics is an important consideration, he roots his arguments in the core American values of fairness and equality. This adds a new, and important dimension to the debate in Washington:

Our nation is already struggling with enough division — economic, racial, geographic, and political. It would be both tragic and unnecessary to create a new divide between those who are seriously ill and those who are healthy. Rather than trying to fix the pre-existing condition provisions in the House bill, the Senate should take them off the table, permanently. ...

Since 2010, the ACA has guaranteed that individuals with pre-existing conditions are eligible for the same coverage as everyone else, at the same cost. My state, Massachusetts, is one of seven that had pre-existing condition protections in place even before the ACA became law. It’s arguably one of the ACA’s most popular provisions, and it has maintained broad, bipartisan support. Unfortunately, a last-minute addition to the House-passed American Health Care Act (AHCA) reopens the issue by giving states the option of once again allowing insurers to charge higher premiums for individuals with pre-existing medical conditions. The CBO found that, in states choosing this option, “less healthy people would face extremely high premiums.” The Senate should settle the matter by rejecting this provision as unnecessary and divisive.  ...

A return to charging higher premiums for people with pre-existing conditions would also reinforce the mistaken notion that serious illness stems largely from personal choice. Most illness and disability is due not to choice but to bad luck and bad circumstances — the accidents of birth and life, including genes, economic and social factors, workplace conditions, and exposure to infection and toxins. 

Dreyfus also critiques other parts of the proposal, including the deep cuts to Medicaid (our MassHealth program), and the reductions in assistance for people buying coverage through health insurance marketplaces like our Health Connector.

But he concludes that our national comittment to impartiality and equal opportunity should guide our policy:

The net effect of these provisions would be to make health insurance unaffordable for many of the older and poorer Americans who are currently insured under the ACA. Bipartisan solutions to these problems should be within reach and may emerge in the Senate. But before we tackle these problems, we should agree that, whether we are healthy or sick, we are all created equal, and our health insurance system should reflect this American principle.  

We appreciate's his forthright voice in support of fair health policy, that provides not just the healthy and well-off, but to everyone in need.

                                                                                                                                                             Brian Rosman