As the COVID-19 pandemic continues to exacerbate health inequities, the Primary Care Collaborative (PCC) said that it has issued a report about the deepening national crisis in oral healthcare access that presents ways to integrate oral health and primary care to make it easier for millions of Americans to get the care they need to lead healthy, productive lives.
The report, Innovations in Oral Health and Primary Care Integration, provides a comprehensive look at the social and economic costs of unmet oral health issues and showcases the innovative ways that healthcare clinicians, community, and public health leaders are working together across the country to enable oral health to be part of primary care, the PCC said.
Even before the pandemic, the PCC said, at least a third of Americans had no dental insurance. The PCC also noted new economic reports showing that while all US health spending continues to lag pre-pandemic levels, dental services saw the greatest decline in spending at more than 17% over the past year.
Millions of people across the country struggle with unmet oral health needs such as gum disease, broken teeth, and oral pain because they are uninsured or underinsured or because they live in areas where they cannot find a dentist to treat them, the PCC said. Oral health problems also can complicate chronic conditions like diabetes and heart disease, the PCC added.
Barriers to care can leave patients with serious conditions that can threaten their overall health, quality of life, and long-term economic health and well-being, the PCC said. For people of color, rural communities, people with disabilities, older adults, and other historically marginalized groups, the PCC said, these problems are compounded.
“The COVID pandemic has undoubtedly worsened the oral health crisis, but it also gives us an opportunity to transform our broken system,” said Darilyn Moyer, MD, chair of PCC’s board of directors and executive vice president and CEO of the American College of Physicians.
“This report shows that by training members of the primary care team to offer first-line oral care in primary care settings, and reimbursing them for doing so, we can make it easier for everyone to access the care they need to lead healthy, productive lives. It also helps make the job of primary care clinicians more fulfilling in the long run because they are better able to meet patients’ needs,” Moyer said.
The report curates extensive data on barriers to oral healthcare, the PCC said. For example:
- The uninsured rate for dental insurance is four times higher than that for medical insurance.
- Uninsured and publicly insured adults make up to 70% of all the 2.4 million emergency department visits for a dental problem, which are preventable in many cases.
- Traditional Medicare offers no dental coverage for the 37 million adults and people with disabilities it covers.
- Coverage for low-income adults on Medicaid depends on where they live, as 11 states provide no dental benefits, 35 states limit coverage, and 19 state require a copay.
- Even when dental coverage is provided for low-income children who receive insurance through Medicaid or the Children’s Health Insurance Program (CHIP), access is limited.
“Lack of access to oral healthcare is a national crisis, and primary care is poised to play a pivotal role in opening the door for millions of Americans to get the oral care they need and deserve,” said Ann Greiner, PCC’s president and CEO.
“It’s not only a moral imperative, it’s also an economic one. We need a new model of care, one that enables oral health to be part of primary care and that expands who can deliver oral care. This report represents the way forward,” Greiner said.
The study lays out key policy recommendations, such as expanding oral health coverage access by developing a Medicare dental benefit and expanding Medicaid adult benefits to all states. It also suggests aligning oral health and primary care with new payment models:
- Develop and pilot oral health quality measures across primary care and oral health.
- Move away from fee for service reimbursement, focusing instead on value-based models centered on care delivery and patients’ oral health outcomes.
- Incentivize the development and adoption of health records that work seamlessly together and include medical and dental health records.
Also, the report recommends growing the oral health workforce:
- Incorporate oral health learning into all health profession training programs.
- Ensure health profession trainees are taught about racial and social justice as a driver of health equity.
- Broaden scope of practice laws to allow all clinicians, including dental therapists, to deliver oral health services consistent with their full scope of practice.
The PCC convened an advisory group of experts in primary care and oral health to help inform the report, which was produced with financial support from the CareQuest Institute for Oral Health.