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Oral health hasn't historically played a major role in discussions of so-called "Patient-Centered Medical Homes." That could soon change.
The patient-centered medical home model of care has been center stage in healthcare for the better part of a decade.
Historically, as the PCMH model has developed, the first component to be integrated was primary care, helping patients navigate the complexity of gaining access to care. Behavioral health was next, due in large part to its close connection to general healthcare. And then came oral health.
Mike Monopoli, DMD, MPH, MS, vice president of foundation programs for DentaQuest, says that oral healthcare and dentistry have often been siloed from general healthcare, and tend to be about 10 to 20 years behind the trend.
“But I think there is a more conscious effort now towards looking at oral health and the developing capacity for oral health to be integrated into healthcare,” Monopoli says. “And I think a lot of the impetus comes from a sense that with integrated care, with patient-centered models, you have better patient outcomes. You have a better patient experience.”
Technology, Systems, and People
What has delayed the integration of oral health into the PCMH-type model? Monopoli says that while co-location is a factor, the bigger issue is that systems of care are separate. Separate electronic records and separate billing mechanisms mean that even if clinical entities are co-located, they often function as separate entities that might as well be across the street or across town.
“Co-location somewhat makes it easier, but it doesn’t either help a whole lot or inhibit a whole lot when the technological issues and the system integration issues are there,” Monopoli explains.
People are also a factor. Monopoli acknowledges that change is always difficult. It can bring opportunities, but it also brings with it a sense of uncertainty. To that latter point, oral health integration into patient-centered healthcare has been met with hesitancy across the board.
“Dentists are a bit wary because they have been a bit separated,” Monopoli says. “But I think as it becomes clearer what needs to happen, and it becomes clearer that all of this is happening, whether anyone likes it or not, to be at the table and be a participant in the change is much better than having the change happen to you.”
Working Toward a Goal
Monopoli says that DentaQuest’s goal, rather than focus specifically on PCMH, is to make sure that whatever patient-centered models are developed, that they define the best model for patient-centeredness. He explains that while the organization is participating in some PCMH activity, its goal is broader.
“We want to make sure that oral health is there from the beginning,” he says. “To be either the driver or be in the passenger seat, at least, but definitely not out in front of the bulldozer.”
To that end, the DentaQuest Foundation has been working with organizations such as the REACH Healthcare Foundation and the Washington Dental Service Foundation to examine patient-centered care, integration of care, and how health disciplines can interact with each other in a productive way.
Within that initiative DentaQuest has been working with a large group of physicians to develop an online curriculum for the broadest range of healthcare providers to look at oral health; to be trained in aspects of oral health across the lifespan. The training modules start at childhood and extend to a geriatric module, giving information for all of the provider disciplines about how to address oral health.
“We want physicians and other medical providers, behavioral providers, to address oral health, but we also want dentists to be able to address issues of general health,” Monopoli says. “And to make sure that referrals and navigation for patients across both are equal and well developed.”
Monopoli believes that by engaging in patient-centered oral health integration efforts, dental practices can both directly and indirectly financial benefits through more developed referral mechanisms. For example, if dentists identify underlying health issues and can refer them to medical providers, that makes their patients healthier and more apt to complete care. Additionally, when health providers see patients and refer them back to dentists it results in the establishment of robust relationships.
“I think that as health payers start to look at value-based payments and look for improved outcomes as the way to incentivize payment among providers, I think it’s going to be more and more important for dentists to have a sense of their role in promoting improved outcomes that are beyond not having untreated dental decay,” Monopoli says. “For oral health people to be at the table to be able to define what those outcomes are and what it could look like makes financial sense.”