MORE Care Initiative Attacks Rural Oral Health Disparities

When it comes to the medical field, there is often a significant disparity in the care received by individuals residing in rural areas compared to those in more urban settings. Unfortunately, it's no different where dentistry is concerned.

When it comes to the medical field, there is often a significant disparity in the care received by individuals residing in rural areas compared to those in more urban settings. Unfortunately, it’s no different where dentistry is concerned.

But MORE (Medical Oral Expanded) Care, an initiative developed by DentaQuest, a leading dental benefits administrator, is looking to change that. It’s new South Carolina initiative has set a goal of providing greater access to preventive oral health services.

“The rural healthcare system is a fragmented one,” says Dr. Sean Boynes, director of interprofessional practice for DentaQuest. “There are a lot of different pieces, but not necessarily fairly devised in a way that allows for communication between all of the partners who can be involved in a patient’s healthcare. And so what we wanted to do with MORE Care is to address the health needs, but also start looking at how oral care can impact systemic wellbeing.”

Taking Triple Aim

Boynes explains that MORE Care grew out of the Institute for Healthcare Innovation’s triple aim proposals, which recommend improving the patient care experience; improving the health of populations; and reducing the per capita cost of healthcare.

“We wanted to look at that as to how we can improve oral health’s role in the rural areas, as well as be able to focus the medical/dental partnerships that could come to fruition from that,” Boynes explains.

The South Carolina initiative is still in the pilot stages, with Phase 1 focusing on how communities in rural areas can start bonding with or responding to one another. In other words, breaking down some of the barriers that have been in place, allowing for smoother communication for each of the providers, as well as for the patients in navigating through the healthcare system—with oral health being a large component of that.

An Inter-professional Approach

If you look up inter-professional dentistry, the definition refers to care being provided by multiple types of dentists—surgeons, periodontists, orthodontists and the like. But inter-professional practice, the term coined by DentaQuest to better define and understand the MORE Care concept, goes beyond that.

“If you picture [inter-professional practice] as an umbrella, underneath this umbrella would be integrated care and coordinated care,” Boynes says. “Integrated care is basically an interdisciplinary approach to healthcare. And it incorporates specific procedures of other disciplines on a daily practice and allows for an enhancement of inter-practice relationships. And the idea here is it would improve outcomes.”

Coordinated care, on the other hand, which Boynes says is particularly starting to blossom, is using a continual care pathway approach that allows the patient better navigation and understanding of their needs. As an example, if a patient sees his or her dentist, the dentist might ask, “When was the last time you saw a medical provider?” If the patient doesn’t have one, then the dentist would help find one.

“That seems to be where we’re heading,” Boynes says. “At the end of the day, the idea is that these components improve the system by either reducing costs, which should make care more affordable; or improving patient outcomes, which should reduce the cost of disease and the burden to the patient.”

Dentists Benefit

The benefit here for dentists, Boynes explains, is they will be able to produce better outcomes for their patients. Rather than providing care for a tooth or an area of the patient’s mouth, they’ll be treating the patient as a whole.

And there’s also a bottom-line benefit.

Boynes says that in some states, like Oregon for example, dentists are taking part in accountable care organizations, or coordinated care organizations, which is allowing them to benefit from the shared savings program coming out of the Affordable Care Act.

“It’s hard to say how this will all work out,” Boynes acknowledges. “But we hope that there would be a way for dentists to start being more involved in the outcomes-based payment structure that’s on the medical side.”

The MORE Care initiative began in South Carolina in August 2015, and Boynes says DentaQuest expects to add two to four more states in 2016, with a large multi-state platform rolling out in 2017.

Meanwhile, he wholeheartedly endorses dentists reaching out in their communities not only to other dentists, but to primary care physicians and specialists as well.

“The more professional care we have, the better it’s going to be,” Boynes says. “And if there are certain states that are more advanced than other states, then when we come in with the collaborative, they will be so much more further along in being able to innovate. And at the end of the day when we have to eventually leave and go focus on something else, they’re going to continue to be champions and continue to blossom in the practices that they’ve changed.”