Elements of the Affordable Care Act (ACA) may provide an opportunity to improve dental health, which would be especially welcome news for underserved dental patients in rural areas.
The ACA’s inclusion of pediatric oral health among its essential benefits and its focus on shifting providers’ incentives away from volume and toward quality care provide an opportunity to bridge the longstanding gap between dental and medical care, write Beau Meyer, D.D.S., and Sue Tolleson-Rinehart, Ph.D., both of the University of North Carolina at Chapel Hill, in a post on the Health Affairs blog. They see a particular opportunity in the use of accountable care organizations (ACOs), which use care coordination to deliver higher-quality care while saving costs.
The authors point to Hennepin Health in Minnesota, which included dental services in its plans and generated a 10-percent reduction in its emergency department dental visits over its first year of operation. Establishing an ACO is complicated enough to temper the authors’ optimism somewhat, though they still see hope for establishment of a “genuine partnership” between dentistry and medicine.
Such a partnership would be timely, since lack of dental health services has reached a crisis state in many rural areas, according to a story from NPR, in part due to lack of dental insurance and reduced access to fluoridated water. “You’ve got a double whammy if you’re on Medicaid and you’re living in a rural area,” according to Jane Koppelman, research director for a dental campaign run by the Pew Charitable Trust, alluding to the fact that among the relatively small number of dentists practicing in rural areas, few will see Medicaid patients because they find the reimbursement rates too low.
Medicaid expansion under the ACA has begun to change the situation, but only on the margins, according to data from the National Academy for State Health Policy showing that four states offer no dental insurance for Medicaid patients, while 15 more offer nothing beyond emergency care.