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Massachusetts health care — wonky, with a healthy dose of reality

Oral Health Integration: Case studies from across the care delivery spectrum

Oral Health Integration: Case studies from across the care delivery spectrum

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