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This is Hat Dental podcast.
I'm thrilled to be joined today by Winter Jordan,
president and c e o of Care, quest Institute for Oral Health in c,
chief Health Equity Officer of Care, quest Institute for Oral Health,
Maisha Caz. Thank you both so much for being here today.
So starting with Maisha,
could you introduce yourself and tell us a bit about your background?
Sure. Um, so my name is Maisha Minter Jordan. I'm a physician by training.
I'm an internist. Um, and as you stated,
I'm the president and c e o of Care Quest Institute for Oral Health.
Prior to my taking on this role,
I led a community health center located in Roxbury, Massachusetts,
serving underserved and marginalized populations.
So I come to this work with the lens of, um, really being focused on equity,
being focused on how we think about healthcare from an integrated,
holistic framework, and also wanting to make sure that as we talk about health,
that we are inclusive of the patient's whole body, which includes oral health,
and that we understand the connectedness between oral health and so many chronic
diseases that impact both Americans and and globally. Uh,
and I'm excited to be able to join this conversation today because I think it's
a necessary one that providers and patients need to focus in
on and as well as policy makers, um,
as we look to improve healthcare outcomes and also reduce health healthcare
costs.
Fantastic. Thank you, Kaz.
Yeah, thank you. Uh, my name is Kaz Raffi.
I'm the Chief Health Equity Officer here at Care Quest Institute for Rural
Health. Uh, I am a dentist by training and, uh,
prior to this role, uh, where I, as a Chief Health Equity officer,
where I oversee our philanthropy as well as our health transformation side of
the house, where we have programmatic initiatives around value-based care
outcome, qualities of care, which are inclusive of that integration piece.
But prior to this role,
I was with the state of Oregon as a state dental director, and,
and I love to tie into what Maisha just mentioned, and that is the,
the policy piece and how medical, dental integration, uh,
can be facilitated and, and, and sort of catapulted, uh,
when the policies are right. And that's one of the things that I focus on,
on my past role.
Fantastic. Thank you. So my first question is,
what is the connection between oral health and overall health? Tess,
could you kick us off with that one?
Yeah, thank you. Um, well, they're literally and figuratively connected. I,
I think a lot of us that have been in this clinical space, we,
we've seen this firsthand, you know, through seeing our, our patients and,
and if you're examining someone's mouth, they, you know, we,
we start literally by a review of their medical history. And,
and while this is really an important question that you asked,
it really goes to show the challenge we're facing because we get this a lot.
So oral health is health. Um, more and more the research and,
and the data, a lot of it coming out of Care Quest Institute,
our own work through our analytics and data insight work has
shown this inextricable connection. Uh, but really this past decade has been,
has shed a big light onto the connections and linkage between oral health and
overall health through gum disease, tooth decay, oral cancer,
and other health connections that are really, um,
tie into broader health conditions outside of the mouth. Um,
we have evidence that dementia, pregnancy, preterm pregnancy, uh,
arthritis, uh, diabetes, um, are all connected.
And really an oral health is, is one of the ways that you can measure,
uh, the overall health of an individual. But, but I, I,
I challenge all of us, if you will, to,
to think of it as not this other separate piece if you'll, but,
but part of an overall physical health evaluation in the con
consideration.
Interesting. Thank you. Maisha, do you have any additional thoughts here?
Yes. Um, I mean,
as a physician and as one who led a community health center that had both a
dental clinic as well as primary care, primary clinic,
I saw this quite often in terms of the correlation between oral health and
chronic diseases.
We know that poor oral health has a direct link to heart disease, diabetes,
dementia, hypertension, asthma, um, as well as can impact the prenatal state.
And then we find that that also happens,
particularly in underserved and marginalized populations,
that poor oral health can lead to, um, poor morbidity,
maternal morbidity and mortality.
We also know that dental disease can also threaten a family's financial
stability. So when we think about other factors that influence health,
we know that, uh, poor oral health can also contribute to that.
So these socioeconomic factors,
so part of what we want to make sure at Care Quest Institute is that we are
supporting and incentivizing medical and dental providers to prioritize whole
person integrated care. And as Cas said,
for us to be thinking about health holistically inclusive of oral health,
inclusive of behavioral health. And, and I, I, this for me, um,
hearkens back to the days when behavioral health was siloed from overall
healthcare and how much further we've come. I see, um, many,
many parallels between oral health and primary care or overall health,
um, in that being as well.
Interesting. And Maisha, you just kind of brought this up.
Why is oral health so siloed from the rest of healthcare?
You know, it's really interesting as I have become more and more, um,
invested in understanding that very question, it really is historical.
The notion of dentistry as a,
as a field that's separate from medicine is a historical phenomenon that really
started when, um,
there were practitioners who seemed to be more of a tradesman, um, uh,
focused on pulling teeth. Um, right now we know that oral healthcare has,
has developed, um, over time to be a,
a significant impact and significant correlation to overall health.
And so we really want to move past that, those,
those historical phenomenon that led to it being siloed.
And we also know that healthcare in general has been somewhat past work,
as I mentioned, behavioral health earlier.
And it isn't a system that currently is designed or well designed to achieve the
best outcomes for patients.
And we know that integration is something that needs to happen across the board.
Um, and it's clear when you consider that 68 million Americans lack dental
coverage and Medicare and some Medicaid programs don't provide oral health
benefits to seniors or low income adults.
We know that the impact of QA continuing,
the siloing of the different aspects of one's healthcare are only harming
our patients and only harming Americans increasing costs and,
and really not improving patient outcomes.
Interesting. Kass, I'd love to hear that too as well.
Yeah, Maisha pointed out to probably the, the, the biggest indicator,
which is the historical fracture, if you will, in, in the training of,
of physicians versus dentists. But, uh,
really the reality is that what history is critical.
It shouldn't define how we approach oral healthcare currently. A again,
reemphasizing the policy piece. We know that the, it, it, when it comes to, uh,
our own healthcare policy in the us there's a disconnect of mouth between and
the body. Uh, so that perpetuates it.
Oral healthcare is also not really seen as something that's essential as an
essential healthcare service. And this is a fight that we're sort of, you know,
engaged in when it comes to, uh, Medicare, Medicaid, adult dental benefits.
It's, it's this argument that we constantly have to make. And so it's critical,
it's important. There is an economic burden, if you will,
on those minoritized and marginalized communities that's disproportionate as
compared to those who can in fact, uh,
engage private payers and private sources for their insurance benefits and their
coverage.
So now we have a fracturing and separation of education and training.
We also have the policy landscape that treats them separately.
We have the delivery that are, that are done in, in completely different, uh,
spaces for the most part. Uh, and you know,
this is a great conversation around talking about the value of medical,
dental integration. And, and lastly, probably most importantly, again,
as I mentioned, is who pays for this and how is that payment, um,
allocated? Um, and, and so those are all the constraints against this, uh,
our efforts wanting to, to create integration between medical and dental.
Thank you. And you sort of dived into this, um,
just now I'm curious as to, in a perfect world,
what does medical dental integration actually look like?
Well, to me at least, it doesn't have to have a a, a particular look.
It's not prescriptive as, you know,
it needs to account for context limitations such as,
you know, physical space, availability of providers, some of that reimbursement,
uh, landscape that I talked about. But in its absolute ideal form,
we used to call it the magic wand, if you will. It could be,
it could be fully co-located, uh, seamlessly in a,
like in a interconnected on an electronic health record platform that's suitable
for dental and medical and behavioral needs.
But probably most importantly to me,
it are clinicians and providers who understand the why for integration,
but are also incentivized properly to practice in that sort of setting. So the,
the, the, the, the physical layout, if you will,
the look of it is critical.
Practicing under the same roof creates those efficiencies,
but the clinicians and the providers need to understand the why and,
and really be engaged and immersed in it.
Thank you. Maisha, any thoughts here?
Yes. You know, I, I harken back to my experience in the community health center,
and one of the things that we did actively was in our dental clinic,
we ran a list of all of our patients with diabetes because we understood that
patients with diabetes have a higher risk of uncontrolled diabetes if they have
poor oral health.
So these are small things that have a significant impact.
And we also knew by getting those patients into care within the dental office,
we could also use that opportunity to educate and check in on their
diabetes status. Similarly, within our OB G Y N clinic,
we ran a centering pregnancy program,
and within that program we had pregnant mothers, um,
make appointments to go to our dental clinic.
We also had our dentists come into those prenatal group visits and talk
about the importance of oral healthcare. So it's this holistic approach.
When we think about the integration we want as patients to understand that all
of the providers that treat us, that touch us understand our body.
They understand which medications are being provided by other providers in the
interaction between those. They want,
we want our providers to be speaking with one another about our care and to have
us at the center. So for me, when I think about integration,
it's holding the patient at the center understanding that all of their, their,
the components of their body interact with one another,
and that we are providing a patient care plan that empowers the patient in
partnership with the patient,
but takes into account all aspects of their health.
Yeah,
that definitely sounds like there's a lot of benefits to the patients there.
When thinking about medical dental integration and,
and the whole body and its connection to oral health health,
I'm curious how does medical dental integration benefit the provider as well?
Maisha, could we start with you?
Sure.
So our research from Care Institute for Oral Health indicates that providers
actually want more medical integration,
that they just don't often have the tools or support that they need to implement
it. Um, for example,
while only one third of oral health providers say they currently screen patients
for diabetes,
more than half would be more willing to screen if they had better tools to
identify those at risk for diabetes.
CAS can certainly speak to some of the programs that we run nationally that,
that focus on integration and focus on training,
but I can tell you that providers, um, being one myself,
our goal is to make sure that we're providing the best care for our patients.
So if we have adequate training tools, resources, and support,
then that's what we will do.
And so by elevating the conversation to both the medical provider community as
well as the oral health community,
our goal at Care Quest Institute is to promote those conversations,
that discourse to understand how do we then continue to advocate for policy that
supports providers,
and then also how do we engage consumers so that they're asking the same of
their providers that they're asking for integrated in holistic healthcare, um,
as they come to understand the importance of oral health and its impact on the
body. ,
I'll turn it to you to talk about some of the programs that we're running
nationally.
Yeah, thank you so much. Um, so one of the things that I,
one of the programs that, that, uh, we, we happen to, to, uh,
initiate through our health transformation is medical oral expanding care.
This is really a breakthrough serious collaborative model.
We work within communities,
we establish an interprofessional oral health network, uh, and we really, uh,
our, our focus is, uh,
first on making sure that the medical practices have the develop,
have the skills, uh,
and are adopting the processes that are needed to integrate oral health services
within their existing workflows. So that's really intentional.
The medical practices then work to really implement this IT technology
solutions,
which allows for electronic referral communication to dental practices.
So really we focus our work around strengthening provider communications,
which is really, really important in the midst of one of our initiative in Ohio.
And then, and the number of wins the quanti quantifiable wins and,
and the impact are just really astonishing. Uh,
our state-based partners in Ohio have been able to work with local dental
providers, the,
and organized dentistry to create this referral relationships so the patient are
actually seeing in primary care practices and these can actually be scaled. Um,
and so they're all rooted around strengthening those provider communications,
um, that Maisha was talking about.
Thank you both.
Are there any cost savings to medical dental integration?
Uh, we begin with you. Yeah.
So, so dovetailing from that, that provider communication,
I think when systems talk and connect,
there is an inherent benefit in terms of savings,
savings from reduced errors,
proper diagnostic imaging and labs that can be shared instead of duplicated,
uh,
institutes of medicine and approximate really the cost of medical errors to be
around anywhere between 18 to 30 billion annually.
And this is medical demotion can actually be a solution that can have economic
impact in a, in a positive manner. Um, and, and this loss, if you'll,
the medical errors doesn't even capture the cost of cost Implications of
misdiagnoses is oral health cancer screenings that go missed cost of days
missed from work, uh,
because of dental decay cost of individuals who did not get the right referral
to their primary care providers because we did not have the right setting to
have the A one C testing done.
So when you do implement these systems in place, these efficiencies,
cost savings are not just to the system, but also to the individual as well,
who's, who's most, uh, most impacted by, by, um, by the high cost of care.
Thank you. That's really unique way of putting it. Maisha,
do you have any hook ons here?
Yes, I would say, um, we,
we know that the C D C estimates that integrating basic health screening into a
dental setting could save the healthcare system up to $100 million every year.
Additionally, um, we know that um,
many individuals seek care in the emergency department for dental, um,
for dental care because they don't have a dental provider.
So we know that up to $520 million, um,
that of Medicare spend happens because of dental emergency department visits.
And so we know just in addition to what Cass has said,
that there are significant savings that can happen, um,
once we think more holistically about care and hold the patient at the center.
Thank you, Kass. I'm curious,
how does medical dental integration address health equity?
I know you talked a lot about that, um, earlier as well, but as a whole, um,
thinking about health equity,
how does medical dental integration address that?
So while not a silver.
Bullet to addressing health inequities,
a medical dental integration is an important component and part of the solution,
uh,
for one integrated models of care that are co-located could result in
physical health as well as behavioral health issues and concerns being
identified through a dental provider or vice versa,
followed by a seamless and successful warm handoff to the appropriate
providers for the next steps.
And this could translate into closing critical care gaps and improving
health outcomes that are really long impacted underserved communities.
Additionally, um,
I think medical dental integration would ease transportation concerns for
patients as it would allow for, you know,
one stop provision of care and reduction of the negative impact on
patients employment through missed work right away.
This would create improved access and remove the potential of having to
prioritize healthcare concerns of one part of patient's body
over other parts of the patient's body.
I also think that medical dental integration can lead to cost savings that were
mentioned earlier through early and preventative interventions,
um, reduced medical errors and higher patient and provider satisfaction,
which are all components of the quintuple aim.
Thank you, Maisha. I'd love to hear your thoughts here as well.
Yes, I mean, just building upon what CAS has said,
part of what we know will happen with medical or dental integration is an
increase in access for vulnerable populations.
Recent data from Care Quest Institute shows that, um,
61% of black Americans,
58% of Hispanic adults were less likely to visit the dentist in the last year
than white adults.
We know that gum disease is almost 20% more prevalent among Hispanic adults
and black adults as compared to non-Hispanic white adults.
We also know that black and Hispanic adults are more than twice as likely to
report that they had never been to a dentist as compared to white adults.
So part of this is an access issue,
and when you are tapping into the medical visit to
begin to then incorporate and, uh,
provide access to the dental community,
you are helping to provide access for patients who you two,
four have been marginalized and have had reduced access, uh,
resulting in the outcomes that I stated. So part of what we're,
what we're positing is that when we address this issue around
integration by creating a more holistic approach to care,
you have dental providers, you have primary care providers,
keeping the patient at the center referring to one another, sharing data,
treat the patient holistically, um, as we all would want, um,
when we encounter the medical system.
Fantastic. Well, Maisha Ka,
thank you so much for your fascinating insights in this discussion today.
I look forward to connecting with you again in the future. Thank.
You so much for the opportunity. Thank you very much.
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