Treat­ing den­tal care as health­care

Modern Healthcare - - BEST PRACTICES - By El­iz­a­beth Whit­man

In one case, a cancer pa­tient was los­ing weight be­cause his treat­ments were hurt­ing his oral health. Once his teeth were pulled and he was fit­ted for den­tures, he gained 10 pounds. In an­other, get­ting den­tures helped lift the self-im­age of a 20-year-old un­em­ployed woman, who sub­se­quently found a job.

Those sto­ries, shared by Greg Nycz, ex­ec­u­tive direc­tor of the Fam­ily Health Cen­ter of Marsh­field (Wis.), a col­lec­tion of com­mu­nity health cen­ters in the state, are tes­ta­ment to the idea that oral health and med­i­cal health are in­sep­a­ra­ble. For the most part, the U.S. health­care sys­tem treats them oth­er­wise, but some providers are go­ing against the grain and see­ing pro­found ben­e­fits for pa­tients.

The Fam­ily Health Cen­ter of Marsh­field, for in­stance, con­tracts with the Marsh­field Clinic Health Sys­tem to pro­vide den­tal and med­i­cal care. The process of ex­pand­ing den­tal care hasn’t been sim­ple, but since 2002, those clin­ics have seen 135,905 pa­tients, many of whom strug­gled for years to get care for their teeth and gums.

The Marsh­field Clinic, a large med­i­cal prac­tice that also op­er­ates hospi­tals, first weighed pro­vid­ing den­tal care af­ter the U.S. sur­geon gen­eral pub­lished a re­port in 2000 de­scrib­ing the lack of ac­cess to den­tal care as a “silent epi­demic” that pri­mar­ily af­flicts the poor. The re­port called for “an ef­fec­tive health in­fra­struc­ture that meets the oral health needs of all Amer­i­cans and in­te­grates oral health ef­fec­tively into over­all health.” Poor oral health has been linked to heart dis­ease, di­a­betes and a spate of other health prob­lems.

In early 2002, Nycz met with the Marsh­field Clinic’s lead­ers, and they agreed Marsh­field needed to pro­vide den­tal care. Their first den­tal clinic opened in Novem­ber that year in Lady­smith, a town of about 3,000 in north­west Wis­con­sin. The pa­tients who flocked there from all over the state con­firmed the broad trends re­searchers have found: Ru­ral ar­eas are more likely to have short­ages of den­tal providers, and the fre­quency of den­tal vis­its aligns closely with so­cio-eco­nomic sta­tus.

Marsh­field now has 10 den­tal cen­ters across Wis­con­sin. Some are lo­cated near clin­ics run by the Marsh­field sys­tem, while oth­ers are stand-alone.

Although it’s not un­usual for fed­er­ally qual­i­fied health cen­ters to colo­cate den­tal and med­i­cal ser­vices, Marsh­field’s clin­ics are dif­fer­ent from most be­cause they in­te­grate med­i­cal and den­tal elec­tronic health records. Colin Reusch, a se­nior pol­icy an­a­lyst with the Chil­dren’s Den­tal Health Project, a Wash­ing­ton, D.C., group that aims to im­prove chil­dren’s oral health, calls this “fairly un­com­mon.”

Hav­ing joint records “en­ables our physi­cians to pull data if they want to learn more about a pa­tient’s den­tal his­tory,” Nycz said. “It also al­lows our den­tists, who may be deal­ing with a pa­tient with com­plex med­i­cal con­di­tions, to be able to do a more in­tel­li­gent treat­ment plan.”

Marsh­field ben­e­fits from sev­eral fac­tors that have made com­bin­ing den­tal and med­i­cal care fea­si­ble.

In Wis­con­sin, Med­i­caid cov­ers den­tal ben­e­fits for adults. This means that Marsh­field can come close to break­ing even while treat­ing Med­i­caid ben­e­fi­cia­ries, rather than los­ing money. For unin­sured pa­tients in poverty, it charges $10 for den­tal ser­vices, be they pre­ven­tive, restora­tive or emer­gency. Mean­while, pa­tients deemed near-poor re­ceive discounts of 50% to 70%. Grant rev­enue and do­na­tions, along with in­come from the few com­mer­cially insured pa­tients that the clin­ics treat, help cover the rest of the costs.

An­other ad­van­tage is Marsh­field’s in-house EHR sys­tem and IT staff, which al­lowed the sys­tem to han­dle in­te­grat­ing the EHRs with the help of a grant from Delta Den­tal of Wis­con­sin.

Pa­tients are health­ier as a re­sult of in­te­grated den­tal and med­i­cal care, said Dr. Jane Grover, direc­tor of the Amer­i­can Den­tal As­so­ci­a­tion’s Coun­cil on Ac­cess, Preven­tion and In­ter­pro­fes­sional Re­la­tions. “Hav­ing pa­tients be able to fol­low a great diet, be able to eat com­fort­ably and chew, that’s es­sen­tial,” she said.

That may seem ob­vi­ous, but most of the health­care sys­tem has yet to catch up with Marsh­field. “I think the rest of the health­care and den­tal care de­liv­ery sys­tem would be wise to take some cues from them, es­pe­cially when it comes to the in­te­gra­tion of care,” Reusch said.

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