Medicare dental benefits are inevitable: A response

In his recent article on dental benefits, Dr. Marc Cooper envisions that dentistry will eventually be included in Medicare. He foresees this development being driven by evidence showing better healthcare outcomes at lower cost, a significant goal for payers, providers, and locations of care. He also predicts that dentistry will be challenged to address the increase in demand for services.

As part of his argument, Cooper acknowledged the growing evidence connecting the mouth to the body as an opportunity for dentistry's advanced role in healthcare and related to the potential increase in dental care demand. Cooper stated that dentistry must more actively respond to payers migrating to "value-based care" -- a healthcare delivery model in which providers, including hospitals and physicians, are paid based on patient health outcomes.

In value-based agreements, providers are rewarded for helping patients improve their health, reduce the effects and incidence of chronic disease, and live healthier lives in an evidence-based way. To migrate toward a more effective and efficient healthcare, payers have to answer an essential question: Where should healthcare's focus go -- health or care?

Health or care?

For the most part, we begin life essentially healthy. The problem is that we do not experience the symptoms of chronic health conditions until adult age when those problems become difficult to manage. Specifically, health is what we don't have, and we often present to healthcare providers when we're already in trouble -- too late in the game.

Dr. Fred S. Ferguson.

Instead of looking at health, our current system remains focused on care, which has not provided breakthroughs for payers to achieve their goals. Employers, insurers, and state governments must realize a balance of health and care is needed to improve population health.

It would be logical that healthcare engages consumers early as essential stakeholders, asking them to provide information about the quality of their health management with the goal of them becoming partners rather than patients. This is a significant opportunity to advance value-based care.

As consumers drive their health or potential for chronic illness, the next critical step for healthcare would be to clinically confirm good consumer health management and gain early clinical signs of poor health management.

This two-step process could provide the effective measures that healthcare needs to become anticipatory, proactive, and preventive. The benefit would be lower costs, better quality, and reduced impact of the social determinants of health -- especially for at-risk individuals and vulnerable communities.

Oral health in value-based care

The evidence is clear that the mouth shows the effects of consumer health management long before symptoms of chronic illness of the body present in adults. Tooth decay, chronic gingivitis, and dental bone loss can begin in early childhood. These oral-systemic connections could give dentistry a unique advantage in a value-based system.

Imagine a system in which consumers provide their oral health management feedback to dental practitioners. Then, dental practitioners would add feedback about the patient's oral examination. Because oral-systemic connections share health and risk factors, both types of feedback would enable measures for both "health status" and "early disease" as warnings for future costly chronic health problems.

Sharing this feedback across healthcare could advance chronic care management. Consumers would gain personalized health guidance -- a "Fitbit" to connect consumer and healthcare in partnership for all ages.

In addition, payers could incentivize consumers, dentists, and health providers for good health management. Dentistry would simultaneously realize an advanced value position in healthcare as payers realize the essential benefit of timely dental visits and that the resultant data can provide a crystal ball to a patient's future.

The predictable impact of the social determinants of health and the COVID-19 pandemic has confirmed that healthcare must get in front of chronic disease to address the challenges of cost, value, equality, equity, and justice. Dentistry has an opportunity to lead the way. Tracking oral health as part of long-term planning versus a short-term fixing strategy will facilitate effective and efficient healthcare for all.

Dr. Fred S. Ferguson is an attending pediatric dentist at One Brooklyn Health in New York City and a distinguished teaching professor - emeritus at the Stony Brook University School of Dental Medicine. During his 42-year career at Stony Brook, Ferguson developed oral health programs for children with HIV infection, as well as patients with special needs, chronic health problems, and craniofacial deformities, and maintained an active practice. He is also president, CEO, and founder of Health Migration Consulting and AboutSmilesWorld.

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