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Health care reform brings new opportunities Marko Vujicic JADA 2014;145(4):381-382 10.14219/jada.2014.16 The following resources related to this article are available online at jada.ada.org (this information is current as of June 29, 2014): Updated information and services including high-resolution figures, can be found in the online version of this article at: http://jada.ada.org/content/145/4/381
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HEALTH POLICY PERSPECTIVES
Health care reform brings new opportunities Marko Vujicic, PhD
he U.S. health care system is on the cusp of transformational change. Whatever one’s political leaning, there is no denying that health care spending in the United States is far higher than in any other developed country, with little measurable benefit in terms of health outcomes, access to care, affordability or patient satisfaction.1 The Affordable Care Act (ACA) attempts to address this, not through a small “tweak,” but by fundamentally changing how health care is delivered and paid for. Health care reform has numerous implications for dental care providers.2 Looking at the long-term horizon, however, there are three that are important to highlight. First, health care reform is not going away. More precisely, the major underlying changes the ACA aims to bring forth will move forward, in some form or another, regardless of the political environment.3 This is due, in large part, to the fiscal sustainability issue. Economic problems cannot be outrun. Second, the focus of implementation of the ACA thus far has been on expanding coverage to the uninsured. This has been happening—to varying degrees across states—via new health insurance marketplaces
and expanded Medicaid enrollment. In terms of dental care, up to 8.7 million more children, and far fewer adults, are expected to gain dental benefits by 2018 as a result of the ACA.4 Expanding coverage is a critical step in the reform, but it is the “more-of-the-same” phase: getting more people access to the existing models of care delivery and financing. Third, the real transformational change—the one with the most significant implications for health care providers—will come in the next phase of implementation. This is when the focus will shift to designing and implementing new care delivery models and provider payment mechanisms that emphasize the value rather than the volume of health care services.5 A lot of changes are required in order to nudge the health care system in this new direction, and one of the most important is increased collaboration among various types of health care professionals. It is exactly in this area that the dental profession could be seeing some major new opportunities. In fact, tomorrow’s health care environment will provide a chance to reexamine the role of dentists within the health care system.6 The figure shows the percentage
of the population, in different age groups, who have a physician visit but not a dental visit in the course of a year. Across all ages, 35 percent of the population, or about 108 million people per year, fall into this category. What is striking is the much higher rate of physician-but-notdentist visits among young children. According to the data, 60 percent of children aged 1 through 4 years see a physician (presumably a pediatrician) in the course of a year but do not see a dentist. The figure also shows the flip side: the percentage of the population who have a dental visit but not a physician visit. Across all ages, 9 percent of the population, or about 27 million people per year, fall into this category. These data compellingly illustrate two major opportunities for the dental profession. First, there clearly is opportunity to increase dental care use among the population through enhanced collaboration between medical and dental providers, particularly when it comes to young children. The fact that more and more children will gain dental benefits as a result of the ACA7 further emphasizes that the most immediate opportunities are among the pediatric population. Second, and more profound, the figure draws out the opportunity for
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Have a Physician but No Dentist Visit 1-4
Have a Dentist but No Physician Visit 35-49
AGE GROUP (YEARS) Figure. Visits to dentists and physicians in the course of one year among U.S. patients. Analysis by the American Dental Association Health Policy Resources Center, based on data from 2011 (the most recent year for which data are available) from the Medical Expenditure Panel Survey of the Agency for Healthcare Research and Quality.
dentists to engage in a broader array of health care services that extend beyond the mouth. Almost one in 10 Americans visit their dentist but do not interact with the rest of the health care system. Given that in tomorrow’s health care environment, providers will be paid less and less based on volume and more and more based on results, organizations such as hospital groups, accountable care organizations and multidisciplinary primary care centers will have strong incentives to engage a variety of health care professionals to manage the population’s health. Dentists are a critical “touch point” that reaches segments of the community that other medical providers do not. As a result, there likely will be increased opportunities, for example, to engage dental practices in screening for and managing chronic diseases. Other health care professionals also are exploring opportunities for an expanded role.8 The idea of enhancing collaboration among health care professionals is not new. Nor is the idea of dentists’ playing a more active role in manag-
ing conditions beyond the mouth.9,10 What is new, however—and this is vital to understand—is that the health care system is changing to incentivize such collaboration. Health care reform is offering up the chance to reexamine and potentially redefine the role of the dentist within the health care system. A careful investigation of the risks and rewards, the costs and benefits of alternative paths will help chart a course through this watershed moment for the dental profession. n
Dr. Vujicic is the managing vice president, ADA Health Policy Resources Center, American Dental Association, 211 E. Chicago Ave., Chicago, Ill. 60611, e-mail [email protected]
Address correspondence to Dr. Vujicic. Disclosure. Dr. Vujicic did not report any disclosures. 1. Schoen C, Osborn R, Squires D, Doty MM. Access, affordability, and insurance complexity are often worse in the United States compared to ten other countries. Health Aff (Millwood) 2013;32(12):2205-2215. 2. American Dental Association Center for Practice Success. The Affordable Care Act and you. https://success.ada.org/en/practice/ operations/regulatory/the-affordable-care-actand-you. Accessed Feb. 21, 2014. 3. Blumenthal D. Reflecting on health reform:
the presidential health care curse—why do they bother? www.commonwealthfund.org/ Blog/2013/Nov/The-Presidential-Health-CareCurse.aspx. Accessed Feb. 21, 2014. 4. Vujicic M, Nasseh K. Reconnecting mouth and body: ACA fails to meet dental care needs but states can pick up slack. http://healthaffairs. org/blog/2013/08/26/reconnecting-mouth-andbody-aca-fails-to-meet-dental-care-needsbut-states-can-pick-up-slack/. Accessed Feb. 21, 2014. 5. Keller B. Obamacare: the rest of the story. www.nytimes.com/2013/10/14/ opinion/keller-obamacare-the-rest-of-thestory.html?pagewanted=all&_r=1&. Accessed Feb. 21, 2014. 6. American Dental Association. A profession in transition: key forces reshaping the dental landscape. www.ada.org/sections/ professionalResources/pdfs/Escan2013_ADA_ Full.pdf. Accessed Feb. 21, 2014. 7. Nasseh K, Vujicic M. Dental benefits continue to expand for children, remain stable for working-age adults. Health Policy Resources Center Brief 2013 October. www.ada.org/ sections/professionalResources/pdfs/HPRCBrief_1013_3.pdf. Accessed Feb. 21, 2014. 8. Gerson JD. Optometrists are key to successful management of diabetes patients. http:// optometrytimes.modernmedicine.com/ optometrytimes/news/modernmedicine/ modern-medicine-now/optometrists-are-keysuccessful-management-di. Accessed Feb. 21, 2014. 9. Greenberg BL, Glick M, Frantsve-Hawley J, Kantor ML. Dentists’ attitudes toward chairside screening for medical conditions. JADA 2010;141(1):52-62. 10. Greenberg BL, Kantor ML, Jiang SS, Glick M. Patients’ attitudes toward screening for medical conditions in a dental setting. J Public Health Dent 2012;72(1):28-35.
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