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December 2022
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Medical-Dental Integration Models Can Improve Overall Health Care Outcomes in Vulnerable Populations, Delta Dental-Funded Study Shows
By Alison Bailin - Wednesday Oct 12, 2022
Delta Dental of Arizona, long-time advocate of increasing communication between dental and medical providers to reduce barriers to care, announces the release of a new report from the University of Colorado School of Dental Medicine, which shows that Medical-Dental Integration (MDI) improves positive health outcomes in vulnerable populations, such as at-risk children, pregnant women, seniors, and those in need of chronic disease management. The study, funded by the Delta Dental Institute, also supports the research-based exploration of care delivery models like MDI that improve health care outcomes and advance patient-centered care.

Dr. Tamanna Tiwari, assistant professor in the department of community dentistry and population health at the University of Colorado School of Dental Medicine on the Anschutz Medical Campus led the review of MDI models over the last decade.

“The review finds that in an MDI model, coordinated, streamlined communication and collaboration among the entire care team is critical for positive patient outcomes and provider engagement,” Dr. Tiwari said. “Identifying creative ways to adapt to specific situations may help increase access to oral health screenings, diagnosis, and referral of patients for chronic disease management. This has the potential to reduce the number of appointments and providers a patient must interact with, which increases the likelihood that patients will receive critical preventive care.”

According to Delta Dental of Arizona director of community benefit Barb Kozuh, Delta Dental currently supports and partners with several organizations across the state to increase MDI, including:
• El Rio Health Center’s Pediatric Dental Integration Program, which expands direct dental screenings, fluoride varnish and oral health education during children’s medical well visits by embedding dental hygiene teams in five El Rio Health clinic locations throughout Tucson. The program also refers patients to dental care as appropriate with intent to provide dental home for those who do not have established relationships.
• Flagstaff Medical Center Children’s Health Center, which provides support to patients with chronic and disabling conditions that can inhibit their ability to use a regular toothbrush. The program provides electric toothbrush kits, fluoride varnish, and evaluations, as well as support instructions and preventive health education for these children and their families.
• Mountain Park Health Center’s Preventive Dental Care for Pregnant Patients, which provides no-cost preventive dental exams, x-rays, cleanings and education to pregnant women as part of their prenatal care. Mountain Park utilizes OB case managers to develop detailed care plans to ensure that dental care is a routine part of prenatal care.
• North Country Healthcare's Medical-Dental Integration Program, which that embeds basic oral health screenings, fluoride varnish applications and dental education into existing pediatric and obstetric appointments to assist in reinforcing the medical-dental connection. The program also provides referral to dental care as appropriate with intent to provide dental home for those who do not have established relationships.
• United Community Health Center's Dental Care for Kids, which integrates oral health services and education to over 800 low-income, underserved children during their medical well visits at United Community Health Center’s pediatric clinics. The program provides dental screenings, fluoride varnish treatments, dental home referrals (as needed), oral health education and dental supplies.
• Phoenix Children’s Hospital’s Oral Health Educator program, which focuses on lowering the infection rates of patients with central lines. Katharine Martinez, RDH runs the program that educates physicians, nurses, staff, parents and patients on oral health care during and after diagnosis, how to manage oral health and symptoms during treatment.
• Banner University Medical Center’s Hospital Oral Care and Periodontal Disease Education (HOPE) program supports an oral health navigator to educate and support patients across hospital units and departments, implement twice-daily oral health protocols and collaborate with case managers and social workers to identify barriers to care for the highest-risk patients.

“Oral health is a critical component of whole person health,” said Joseph Dill, DDS, MBA, Head of Dental Science at the Delta Dental Institute. “Care delivery models that rely on collaboration and integration between primary and dental care teams, when implemented successfully, can create more inclusive approaches that help the health care system work better for everyone.”

Dr. Tiwari will present her report discoveries at the Interprofessional Collaborations to Improve Oral Health poster session on November 7, 2022, during the American Public Health Association’s Annual Meeting.

Key takeaways from the report include:
• Best practices for implementation
o Coordinated and streamlined communication, collaboration, and adaptability among the entire care team.
o Electronic health record (EHR) integration and interoperability.
o Using warm hand-offs and emerging technologies, such as telehealth and teledentistry, to coordinate care, manage complex patients, and close referral loops.
• Recommendations for the sustainability of integrated services
o Train medical professionals on oral health care, maximize the contribution of dental professionals, and increase diversity and cultural competency of care teams to achieve long-term viability.
o Achieve better health outcomes at lower costs by implementing MDI’s value-based care model, which aligns health care systems, patients, and providers.
o Maintain net revenue positivity through MDI models that sustain patient volume and payer distributions. by coordinating
• Snapshot of successful care models
o There is no single formula for the success of an MDI model; adapting to specific situations and finding creative ways to maximize success are crucial to continuing the evolution of integrated care.
o The co-location of services model can improve coordination of care, which improves access to oral care, dental referrals, and preventive procedures. This model does not require full integration to be successful.
o The fully integrated care model involves the use of electronic health records (EHRs) and collaboration of providers to improve services to patients, which creates diverse referral relationships with dentists and can use strategies like teledentistry to improve access to care.