A number of innovative efforts are underway to bridge the gap between Medicaid and public health agencies in order to address broad population health needs. Programs such as the Centers for Disease Control and Prevention’s 6৷18 Initiative, collaboration with public health under State Innovation Models, and the Center for Health Care Strategies’ (CHCS) new State Oral Health Leadership Institute (SOHLI) support cross-sector collaboration to improve health and control health care costs. These initiatives acknowledge the increased potential to effect change when evidence-based approaches to health improvement are aligned across systems. In the oral health arena, continuing uncertainty surrounding the path forward for the Affordable Care Act (ACA) and any changes to the Medicaid program underscore the need for collaborative efforts to sustain oral health care coverage and services for low-income and other vulnerable populations.
CHCS recently hosted the launch meeting for the first cohort of SOHLI, which provides leadership coaching and technical assistance to support collaboration between pairs of Medicaid dental program directors and state oral health program directors. The key issues that emerged from the discussions, particularly salient during this time of change, included:
1. Understanding potential oral health implications of changes to the ACA
At the forefront were concerns about possible changes in coverage; access to care; and the potential obstacles to care resulting from higher costs to consumers. Of particular concern to state oral health leaders would be: (a) conversion of Medicaid from an entitlement program to a per-capita cap approach, especially with a corresponding reduction in federal funding for Medicaid; (b) disruption to state Medicaid-expansion programs; and(c) an end to tax credits that pay for health insurance deductibles and co-payments.
2. Building the case for policies and programs
State oral health leaders are always interested in approaches that build the business, clinical, and social case for policies and programs supportive of oral health. This includes mining and using data effectively, as well as developing narratives that bring messages to life. For example, the 2007 death of 12-year-old Deamonte Driver — who had Medicaid coverage, but nevertheless died from complications due to a tooth abscess — provided a heartbreakingly compelling narrative around shortcomings in access to oral health care that continue today.
3. Addressing social determinants of oral health
Partnerships between oral health leaders in Medicaid and public agencies can create opportunities to take a more holistic approach to advancing care. This involves looking beyond the walls of a dental office to consider the role that factors in the community may play, such as access to healthy foods, cultural norms, and transportation availability.
4. Securing alternative sources of funding for state programs
Identifying alternative funding from foundations or public-private partnerships to maintain oral health programming could be important for oral health leaders to consider in light of any potential changes to public health funding.
5. Alternative payment models that incorporate oral health
The growing transition of health care systems from fee-for-service to value-based payment models will create more incentives to provide whole-person care. This presents an opportunity for oral health care to be reimbursed in non-traditional settings and through emerging alternative payment models.
6. Reducing abuse of opioids triggered by dental-related pain
As opioid-related deaths have risen across the nation, the overprescribing of opioids to treat pain has gained attention as a significant public health issue. Overprescribing of opioids often results from treatment for dental-related pain, either in the dentist’s office or, in some cases, the emergency department. Dentists are responsible for 12 percent of opioid prescriptions, and that percentage is even higher among adolescent patients. Oral health prescribing guidelines are of interest to states in their quest to address the impact of the opioid crisis.
Cross-sector collaboration among state oral health leaders can address these issues and improve care delivery to meet the oral health needs of vulnerable populations. In the current environment, programs such as SOHLI aim to help Medicaid and public health leaders find innovative new ways to work together to drive change in publicly financed care.