A Public Policy Center study shows the need for integrating dental care into the coordinated, population-based health home care model, which has arisen out of the Affordable Care Act’s (ACA) emphasis on delivery system changes. A health home, as defined by the ACA, offers coordinated care to individuals with multiple chronic health conditions, including mental health and substance use disorders.
The ACA initially focused on access to health care and an expansion of public and private insurance options, but gradually shifted to delivery system changes and the need for more coordinated care. Likewise in dentistry, the focus has shifted to integrating dental care into the overall health care delivery system.
While the patient-centered medical home has been evolving over 50 years, the dental home model has been slower to develop and is unfamiliar to most primary care dentists. Most existing models focus on access to care for young children, have no standard definition, nor a model for measuring outcomes.
Advantages of integrating dental care and medical care include improved effectiveness in preventing disease, improved management of chronic disease, expanded entry points into the dental care system, and a greater likelihood of cost savings. For example, fewer patients would use emergency departments for preventable dental conditions.
However, there do exist some barriers limiting the integration of dental care into overall health care. They include: traditional separation of medical and dental services, limitations of provider training/skills, separate insurance systems, limited dental providers who accept publicly insured or other underserved groups, limited public awareness about the importance of dental health, and limited evidence on the effectiveness of medical-dental integration.
The broader difficulty in integrating the two systems is the extremes under which each operates. The majority of dental providers are in solo practice, unaffiliated with a hospital, whereas more physicians work for a practice partly owned by a hospital or are employed directly by a hospital. Secondly, insurance and financing systems differ broadly for the two, presenting a hurdle to successful integration. Finally, Medicare does not include coverage for dental care, though Medicare patients are in an age group that would benefit greatly from improved financial access to dental care.
The report describes ongoing initiatives to encourage the development of dental health homes as sources of coordinated care, and how the current health environment is favorable for developing this model. To read the report, click here.