Integration of Dental Care with Primary Care: the Next Force of Change

Lack of access to oral health care contributes to profound and enduring oral health disparities in the United States. Millions of Americans lack access to basic oral health care. In 2008, 4.6 million children - one out of every 16 children in the United States - did not receive needed dental care because their families could not afford it. Children are only one of the many vulnerable and underserved populations that face persistent, systemic barriers to accessing oral health care (1). We are always living into a future. What makes the difference is the kind of future we are living into. When the future is past determined, then one does not see what changes are on the horizon. One sees what they already know. With the advent of electronic patient records, AI, Big Data, analytics, gap analysis, cloud computing, the demand to hold the cost of healthcare down, limited access, and relationship of oral to systemic health, the future is becoming obvious; the integration of dentistry into primary care. Kaiser recognizes this future. Guardian Insurance recognizes this future. The government recognizes this future. The United States health care system is able to provide acute care but continues to struggle to address the need for ongoing care, especially for vulnerable populations such as the elderly, disabled, mentally ill, and special needs populations. Safety net organizations that provide health services to uninsured, low-income, and vulnerable persons continue to look for ways to coordinate services among providers to improve access to quality care (2). Surprisingly, dentistry does not seem to be doing much to get ahead of this future and participate in the primary care - dental integration. For its entire history, the dental profession has largely operated outside of the mainstream healthcare delivery system. But pressures are building and it is becoming recognized that integrating dental care into primary care would benefit the health care system in many ways, from health outcomes to cost, from no access to acceptable access. A recent study performed by Optum, the nation’s leading health services company, on behalf of United Healthcare, investigated the impact of various dental treatments on medical and pharmacy costs for individuals with chronic medical conditions (3). By reading Optum’s study, it is apparent the future of dentistry will be in some way an integrated model with primary care. Solo practice will have great difficulty integrating into primary care. Their design and function are as isolated islands and the mindset of most solo practitioners is individualistic. Group practice on the other hand, will be able to work with medical (hospitals, health care insurers, employers) to figure out the best models for this integration. Another force against solo practice, and for group practice. References: (1) and (2) Integration of Oral Health and Primary Care Practice U.S. Department of Health and Human Services Health Resources. https://www.hrsa.gov/publichealth/clinical/oralhealth/primarycare/integrationoforalhealth.pdfServices Administration February 2014 (3) https://www.uhc.com/content/dam/uhcdotcom/en/Employers/PDF/B2H_Study.pdf