The Quest for the Holy Grail: Integrating (or Aligning) Dental and Medical
By Mike Adelberg, NADP Executive Director
August 25, 2023
It seems like everyone in the dental benefits industry, in one way or another, acknowledges the value of “putting the mouth into the body.” Despite the difficulties with doing so, we are continuing to take steps on a long quest toward integrating, or aligning, dental and medical care.
At the 50,000-foot level, we all understand the potential benefits of dental-medical alignment. Principal among them is the potential to improve health outcomes while lowering costs. Particularly with the lower income and senior populations that are least likely to utilize dental services, missed appointments lead to avoidable and expensive oral health services delivered in more expensive settings, such as the hospital Emergency Department. Medicare alone spends more than $500 million a year on dental services provided in hospital EDs.
A number of moves are underway to enhance the convenience of obtaining dental services. There are a growing number of multi-purpose clinics that co-locate primary care physicians and general practice dentists. This allows patients to see both providers in one trip and creates real-time referrals between the two providers. Walmart, among other national retailers, is experimenting with offering dentist services in some of its stores. Here, the dental clinic is co-located with both physician and pharmacy services.
It is well understood that good oral health improves outcomes for people with several chronic diseases including diabetes, certain cancers, stroke, dementia, high blood pressure, and respiratory conditions. In comparison to dental, the medical care necessary to treat these conditions is vastly more expensive. Therefore, relatively modest investments in preventive oral health have the potential to improve patient outcomes and provide net savings across the health care system.
A study focusing on people with diabetes who received periodontic services documented costs savings of 12% for patients with commercial insurance and 14% for Medicaid patients. (See Journal of the American Dental Association, Periodontal Treatment Associated With Decreased Diabetes Mellitus–Related Treatment Costs (2023). There are other studies that suggest savings are possible in other populations.
Dental plans are evolving their coverage in recognition of the need to further incent people with chronic diseases to seek dental care. They are encouraging employers and other clients to consider enhanced dental coverage for certain, generally preventive, services in an effort to reduce medical costs and improve outcomes for employees and their families. Extra cleanings, for example, are now often available to people with diabetes or heart disease, as well as pregnant women. And more dental plans are providing rewards to members who fully utilize their covered preventive services (often reduced deductibles or increased annual maximums). This aligns dental plans and dental providers with the overall health needs of the individual.
Whatever the benefits, aligning dental and medical is difficult. For a variety of historical and operational reasons, dental and medical have different cultures and code sets. As noted in a prior blog, certified electronic record adoption in dental is behind medical; electronic medical record (EMR) and electronic dental record (EDR) systems generally do not talk to each other. The lack of diagnostic codes in dental makes it harder to identify patient conditions, collaborate on treatment plans, and reward high quality provider care and patient engagement. Member persistency and low profits in dental insurance make it harder to invest in alignment. Inertia and skepticism must be overcome with each new step attempted.
Truly integrating dental and medical is a giant undertaking. Aligning incentives in dental and medical is hard too, but it may be more attainable. The fuel for this transition is likely to be shared savings. When medical money is saved, a percentage of those savings will need to be shared with the dental plans and providers whose targeted activity enabled the savings. NADP is eager to convene stakeholders and support our members as we inch closer to the Holy Grail.