A Healthy Blog

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

OHIP urges MassHealth to integrate Oral Health into ACOs

OHIP urges MassHealth to integrate Oral Health into ACOs

July 20, 2016

The Oral Health Advocacy Taskforce (OHAT) has a new initiative: integrating oral health into the rest of the health care system. OHAT’s new Oral Health Integration Project (OHIP) kicked off this past May and has hit the ground running. Over the past couple of months, OHIP members and stakeholders have put their heads together to think about what oral health that is fully integrated with the rest of the health care system could look like.

There is currently a significant opportunity to elevate oral health in health care here in Massachusetts. As explained in previous blog posts, MassHealth is proposing substantial changes to its program with the renewal of its 1115 Demonstration Waiver, to be approved by the federal government. At stake is 1.8 billion dollars over five years to support MassHealth’s transition to Accountable Care Organizations (ACOs). ACOs are a new way to pay for and deliver care that works by bringing together providers to coordinate high quality health care – care that we believe should include oral health.

MassHealth’s released Waiver Proposal touches upon oral health in a few important ways, and briefly outlines the inclusion of oral health metrics in the ACO quality measure slate as well as contractual expectations for ACOs around oral health. OHIP is pleased to see that oral health is included in MassHealth’s future plans for restructuring and is urging MassHealth to expand its efforts in this area.

OHIP submitted formal comments to MassHealth pushing for more robust ACO standards that would facilitate increased integration of oral health. A summary is listed below:

  • ACOs need to have accountability for oral health and dental services, and dental services should be phased into ACO total cost of care
  • Dental providers should be allowed to join ACOs and take part in risk-sharing arrangements starting in the first year of ACO roll-out
  • ACO payment methodologies for dental and oral health services should incentivize high-value, evidence-based, preventative care
  • Delivery System Reform Incentive Payments (DSRIP) funds should be used to transition the delivery system to adequately address oral health
  • Oral health quality metrics can help tie oral health into overall health in ACOs and should be strengthened
  • Oral health should be integrated into all aspects of care coordination
  • Roll-out of dental services inclusion in ACOs should first consider piloting
  • ACO governance, quality, and clinical committees should have representation from oral health clinicians
  • There should be adequate consumer protections built-in throughout the ACO structure

Take a look at OHIP’s full set of comments here.

Kelly Vitzthum