Health Center Regulatory Issues, Health Center State Policy

Reimagining Oral Health Care in Health Centers Beyond the COVID-19 Pandemic

Don Weaver, MD, Senior Advisor for Clinical Workforce, NACHC, co-authored the following blog post.

The 2000 Surgeon General’s Report on Oral Health in America reminded the nation that “oral health is a critical component of health and must be included in the provision of health care and design of community programs.”  

photo courtesy: Nizil Shah

This critical report acknowledged wide disparities in access to oral health care.  In promoting a coordinated approach to improving oral health, the Health Resources and Services Administration’s (HRSA) Integration of Oral Health and Primary Care Practice made it clear that oral health, provided by primary care and dental teams working together, needed to address risk assessment, oral health evaluation, preventive interventions, communication and education, and interprofessional collaborative practice. In the 20 years since the landmark Surgeon General’s report, there has been steady progress in the number of people that health centers serve who have benefited from this comprehensive approach.

Specifically:

  • Systems have been implemented to ensure  primary care patients are referred to the dental clinic for evaluation and care.
  • Dental patients are being screened for hypertension and diabetes and referred to primary care for evaluation and follow-up.
  • Primary care and dental clinics are working together to address smoking cessation.
  • Access to dental care has been expanded through school-based dental clinics, mobile dental vans, and teledentistry.
  • Increasingly available data demonstrating the role oral health plays in improving outcomes and decreasing costs for individuals with chronic health conditions such as diabetes has expanded support for the inclusion of oral health care in value-based payment discussions.
  • People getting dental care in a dental clinic, rather than stop-gap care in emergency rooms have contributed to overall health care cost savings.

Each of these actions has a place in NACHC’s Value Transformation Framework, “a conceptual model to guide systems change by translating research and promising practices into manageable steps health centers can apply to improve care and outcomes.”

The COVID-19 pandemic put a temporary halt to much of the progress being made and, sadly, reminded us of the inequities in our health care system. The response became “all hands-on deck” to address the pandemic. Shortages of personal protective equipment and the aerosolized nature of many dental procedures led to recommendations and even mandates for dental clinics to limit care to emergencies. Health center dental clinics were – or became – the only source for emergency dental care. In addition to keeping people out of emergency rooms, dental care team members were available to redeploy (assisting in other areas to address the pandemic), adapt (rapidly expanding use of teledentistry) like Petaluma Health Center and create (exploring alternative ways to provide preventive and some restorative services). 

However, with the Value Transformation Framework as a guide, we can build on the progress made and lessons learned during the pandemic to reimagine the future of oral health care in health centers:

  • Patients will need to be stratified based on their oral health needs and informed about this new approach to care delivery.
  • Care teams will need to be retained, recruited, and trained to provide this new approach to service delivery.  To maximize efficiency, each team member needs to be working at the top of their training.
  • Facility /equipment modifications will need to be made so those procedures that produce aerosols can be provided safely for both the patient and provider.
  • Payors including adequate payment for comprehensive oral health services must continue. And, paying for telehealth needs to be compensated based on its value to improving health. The COVID-19 pandemic has provided examples.
  • Adequate workforce and programs that support the retention, recruitment, and expansion of dental care teams, such as the National Health Service Corps and state loan repayment programs, must be expanded. With sights set on optimal health for all, oral health is an essential component.

This project was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under cooperative agreement number U30CS16089, Technical Assistance to Community and Migrant Health Centers and Homeless for $6,375,000.00 with 0% of the total NCA project financed with non-federal sources. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS, or the U.S. Government.

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