By Neetu Singh, DMD, MPH, and Hugh Silk, MD, MPH
Oral Health has been recognized by the Institute of Medicine, the US Department of Health and Human Services, and others as having a profound effect on overall health, from heart disease to diabetes. Accountable care organizations (ACOs) across the country are now including oral health services in their value-based care delivery and payment models, or at least considering it. MassHealth ACOs are participating in this effort by including an oral health quality measure, presenting an opportunity for the state to generate a strategic plan for oral health integration (OHI).
Under the ACO model, reimbursement is based on the ACO’s performance on quality measures, so ACOs have a powerful incentive to integrate dental and medical care. The initial stages of OHI will unfold over the next several years, with a goal of identifying and evaluating promising strategies within the current MassHealth ACO program structure. Strategies that prove most effective will be pitched for integration into MassHealth ACOs in 2022, the year the state renegotiates its Medicaid contract with the federal government.
Initiatives being considered to achieve OHI in MassHealth ACOs include the following:
- Integrating health care data, such as medical and dental electronic health records (EHRs), to facilitate interdisciplinary provider communication and ensure continuity of care
- Establishing a formal bi-directional e-referral pathway between MassHealth ACOs and oral health providers
- Implementing evidence-based oral health metrics that will help incentivize the provision of oral health care, measure performance, and guide quality improvement
- Reimbursing oral health providers based on the quality of their care, not the quantity
- Utilizing community health workers and dental coordinators to support cooperation among physicians, dental providers, allied health professionals, and patients
- Using dental hygienists and other mid-level providers to create interdisciplinary services for patients
Admittedly, challenges remain, including implementation costs, evolving payment systems for oral health providers, and the difficult task of integrating dental and medical care systems that have long operated on separate tracks. However, given the overwhelming potential for long-term cost savings as well as improved patient outcomes, every effort will be made to achieve OHI in MassHealth ACOs. Stay tuned for more updates as this important health initiative evolves.
Neetu Singh, DMD, MPH; Hugh Silk, MD, MPH
Dr. Neetu Singh is an advisor to the MMS Committee on Oral Health, and Dr. Hugh Silk is chair of the MMS Committee on Oral Health. UMass Medical School's medical and nursing students on the Oral Health Population Health Clerkship assisted with this article.
