Slide 1: Health Care For All
15 YEARS OF ORAL HEALTH POLICY & ADVOCACY
Health Care For All (HCFA) is a Massachusetts nonprofit advocacy organization working to create a health care system that provides comprehensive, affordable, accessible, and culturally competent care to everyone, especially the most vulnerable among us. We achieve this as leaders in public policy, advocacy, education and service to consumers in Massachusetts.
Slide 2: Reducing Health Disparities by Integrating Oral Health into One Care 2.0
Neetu Singh, DMD, MPH
Oral Health Program Director
Health Care For All 
nsingh@hcfama.org
Slide 3: Why is it important to integrate OH? 
•	Poor oral health and dental disease impact overall health:
o	Poor general health
o	Pain
o	Systemic infections
o	Hospitalization
o	Worsening of other medical conditions
o	Poor self-esteem
o	Poor nutrition
o	Sleep disruption
o	Employment
Slide 4: Rise in Emergency Department Usage
Young adults had the highest rates of ED visits for preventable oral health conditions:
Note: Left side depicts graph labeled, Young adults had the highest rates of ED visits for preventable oral health conditions.
•	Adults under age 65 accounted for 90% of ED visits for preventable dental conditions. Rates were highest for young adults aged 19 to 34.
•	ED Utilization rate in MA is 14%, higher than the national average.
•	42% of these visits may have been preventable
o	Most common reasons for preventable visits:
1.	Inflammation of dental nerve
2.	Inflammation of the gums caused by plaque
Slide 5: Cost Savings
Note: Right hand side of slide depicts graph labeled: The rate of ED visits for preventable oral health conditions was higher among individuals with MassHealth. 
•	There could be many reasons for higher rates of preventable oral health ED visits among MassHealth enrollees, but likely contributing factors include: clinical risks factors, a low number of dentists accepting MassHealth patients and patients’ costs.
•	MassHealth paid for half of all oral health-related ED visits in 2014
•	36,060 preventable oral health ED visits
•	Cost our health care system between $14.8 - $36 Million
Slide 6: What’s happening in Massachusetts?
•	MassHealth ACO program – Includes OH quality measure
•	DSRIC – Oral health integration policy recommendations submitted for consideration 
•	HPC – Considering inclusion of OHI in certification standards for ACOs and PCMHs
•	One Care – Comprehensive dental coverage
•	BCBS - Expanded dental benefits to members diagnosed with specific medical conditions 
•	Massachusetts Medical Society (MMS) adopted policy “to support OHI into ACOs in MA”
•	DPH Office of Oral Health Advisory Committee – OHI is a priority
•	Ongoing dialogue with EOHHS 
Slide 7: What’s happening in Massachusetts? (cont’d)
•	MassHealth Delivery System Restructuring
•	Goal: Transition from a fee-for-service (FFS), siloed care model into integrated, accountable care models
•	Method: Innovative 5- Year 1115 Medicaid Waiver (2017-2022)
•	Reasons: 
o	Unsustainable growth – almost 40% (>$15B) of the Commonwealth’s budget
o	Current FFS model for providers results in fragmented, siloed care
o	The fundamental structure of the MassHealth program has not changed in 20 years
•	LEGISLATION:
o	MassHealth adult dental program (S.1212/H.1917) 
o	Dental therapy (S.1215/H.1916) 
o	Telemedicine (S.612/H.991)
o	Medicare Dental Benefit Act of 2019 (S.22) - federal
Slide 8: Spectrum of Oral Health Integration
Note: A linear depiction from left to right and reads from low to high:
•	Formal Referral Process.
•	EHR/Telehealth Integration
•	Shared Clinical and Financial Accountability
•	Co-location of Medical and Dental Providers
•	Full Integration
Slide 9: Spectrum of Oral Health Integration (level example 1)
Level- Formal Referral Process and corresponding examples:
•	Closed-loop, bidirectional referral process between medical & dental providers (ideally through shared EHR)
•	Adequate dental provider network
•	Provider & patient education
Level- EHR/Telehealth Integration and corresponding examples:
•	Shared HER
•	Shared intake/risk assessment form
•	Adding OH questions to baseline medical history intake form
•	Reconciliation of medication (i.e. Opioid prescriptions)
o	Antibiotic & pain medication stewardship
Slide 10: Spectrum of Oral Health Integration (level example 2)
Level- Shared Clinical and Financial Accountability
•	Include OH quality metrics that tie OH & overall health
•	Promote OH services that can be done in primary care settings including fluoride varnish application & patient education
•	Allowing dental providers to take part in risk-sharing arrangements that align financing with better outcomes
•	Incremental phasing-in of dental services into One Care TCOC
Level- Co-location
•	Dental & medical clinics on-site in same facility
•	Innovative health care teams: NP in dental clinic or RDH in medical clinic 
Level-Full Integration
•	All of the above
•	Dentist is a member of the patient care team 
•	Clinical & financial alignment between medical & dental providers
•	Oral health care included in all aspects of care coordination & care plans

Slide 11: Recommendations for One Care 2.0
1.	Formal bi-directional, closed-loop referral process between medical & dental providers
2.	Inclusion of OH quality measures that tie oral & overall health
Slide 12: Thank you!
Neetu Singh, DMD, MPH
Oral Health Program Director
Health Care For All 
nsingh@hcfama.org
Slide 13: Appendix I: Additional Considerations
•	Provide OH education to allied health professionals i.e. case managers, CHWs, PAs to ensure comprehensive care coordination
•	Partnerships with community-based programs that provide OH services 
•	One Care governance, quality & clinical committees having representation from OH providers, particularly those who serve vulnerable populations
•	Alignment of payment periodicity with individual patient risk for oral disease (instead of with 3rd party payer frequency limits)
•	Use of diagnostic coding – increases accountability by establishing medical necessity for procedures billed; also enables better tracking of care quality & patient health outcomes
Slide 14: Appendix II: Key Principles of OHI
•	Oral health is a crucial part of overall health, and thus medical & dental services should be integrated to improve patient outcomes
•	Racial, ethnic and socio-economic disparities in oral health outcomes and access to needed services must be explicitly addressed in the process of integration
•	OHI is complex and will require a multi-pronged approach including:
o	payment and delivery reform 
o	provider education
o	investments in health information technology
o	other important strategies
•	OHI should meet the Triple Aim goals: 
o	improving the patient experience 
o	improving the health of populations
o	reducing per-capita health care spending
•	Our agenda is best promoted by broad-based coalition with representation of a full range of stakeholders including providers, payers, community organizations, consumers and advocates.