We Heart Oral Health

On this holiday in which we express our love with chalky heart candy and sugary chocolate, CHI’s new report Open Wide for Opportunity aims to do its own matchmaking. The connection is between oral health care and Colorado’s Medicaid program, Health First Colorado.

Last year’s launch of the Regional Accountable Entities (RAEs) — organizations hired to connect and coordinate the care of Medicaid members — represents a new opportunity to expand and improve oral health services for Health First Colorado members.

The need for oral health services is significant. Coloradans’ use of dental services has remained flat at around 66 percent since measurement began in 2009. About 23 percent of Colorado children did not have a dental visit in the past year. One in three Colorado adults (33%) report that their mouth and teeth are in fair or poor condition, compared with 30 percent nationally and 22 percent in Illinois, the best-performing state. And many gains in oral health care over the past decade or two have not been equally distributed across all racial and ethnic groups. 

Colorado has made strides toward increasing access to oral health care. Medicaid started offering a limited dental benefit for its adult members in 2014. Many safety net clinics across the state offer co-located oral health services. And the Department of Health Care Policy and Financing (HCPF) has added a financial incentive for RAEs and providers to increase the percentage of members receiving dental care.

Ernie Duff, CEO of Dental Aid, understands the opportunities. Dental Aid is a dental safety net practice providing care to over 7,000 Coloradans in its Boulder, Longmont, and Louisville clinics. Around 62 percent of Dental Aid’s patients are enrolled in Medicaid. Not long after he started as CEO, Ernie attended a meeting with the RAE in his area. He felt decidedly in the minority among those who focused on integration of behavioral and physical health care — a major aim of the RAEs. When the attendees were asked to prioritize the health needs of Medicaid members, oral health came in at number seven. “At least you’re in the top 10,” another attendee remarked to him.

Ernie sees this as encouraging. The RAE is engaging with Dental Aid in new ways. For example, he currently serves as a voting member on the RAE’s advisory committee, and he is in discussions with the RAE about oral health metrics. He is establishing partnerships with other oral health providers in his region. And he recognizes the potential for oral health to gain more equal footing with other types of care through integration of services. “Oral health has to achieve parity with physical health and behavioral health to make a holistic impact on members’ health,” he says.

CHI’s report highlights the unique position of Health First Colorado, the RAEs, and DentaQuest — Colorado’s dental administrative services provider — to lead and reframe how oral health services are delivered to Medicaid members. For example, leadership in this area means treating oral health as a chronic disease, evaluating the evidence behind commonly accepted practices, and delivering care based on a person’s risk for developing oral disease.

The report also includes CHI’s recommendations based on its research.

Key among the recommendations is establishing partnerships, integrating care, and developing new approaches to measuring progress. The recommendations reflect the mounting evidence that the prevention of oral disease and maintaining a healthy mouth promote overall physical health throughout the lifespan.

Ernie Duff at Dental Aid sees the potential for Colorado’s Medicaid program to be a leader in these efforts. “We are on the threshold of making this opportunity a reality. We shouldn’t wait. If we maintain focus and rigor, we will see impact,” he says.

The CHI team hopes the evidence and recommendations in this analysis will ignite and continue strategic conversations about addressing oral health needs in Colorado.

Have a happy Valentine’s Day. And don’t forget to brush.

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