Medical-Oral Health Integration

On September 16th, 2020, MassHealth and Health Care for All presented an in depth virtual conversation about innovative practices to improve oral health integration for ACOs and CPs participating in the MassHealth DSRIP Initiative. The Panelists included: Dr. Matthew Horan, Executive Director of Dental Services for Harbor Health Services, Dr. Christie Lumsden, PhD, Associate Research Scientist at Columbia University College of Medicine, Dr. Hugh Silk, Professor in the Department of Family Medicine and Community Health at the University of Massachusetts Medical School and Dr. Lisa Simon, a physician, dentist and researcher at the Harvard School of Dental Medicine. The panel was moderated by Shannon Wells an independent consultant specializing in integrative public health. Full speaker bios are available here.

During the event, panelists shared examples of their work on integrating medical care and oral health. For example:

• Dr. Hugh Silk highlighted the silos that exist between medical and dental care. For example, a 2011 AHRQ report estimated that up to 111 million Americans had a medical visit but no dental visit in the past year. This has implications for both health outcomes and total cost of care. Dr. Silk described physician buy-in and engagement as one of the bigger barriers to improving integration. He developed the Smiles for Life curriculum (available here) to train primary care providers in oral health and to suggest primary care workflow changes that support better oral health outcomes.
• Dr. Matthew Horan described the impact of the COVID-19 public health emergency on dental services and oral health care. To provide oral health care while maintaining social distance, dental clinics such as his rely on telehealth and teledentistry flexibilities to triage patients and prioritize scheduling. Dr. Horan also highlighted the potential of silver diamine fluoride to help avoid tooth decay, caries and other negative outcomes potentially associated with foregone preventive pediatric dental care.
• Dr. Lisa Simon shared her experience piloting clinical interventions to support oral health integration in a various clinical settings. For example, she described one pilot program that embedded a dental hygienist into an inpatient general medicine unit to provide education, screening and preventive care during patients’ hospital stays. Ultimately, this project led to more patients following up with a dentist after their discharge. She described another pilot program in which Nurse Practitioners joined dental clinics to address patient medical needs. For both projects, Dr. Simon described physician education and engagement as critical to successful implementation.
• Christie Lumsden, PhD, and colleagues developed a community based oral health education and integration program called MySmileBuddy which relies on Community Health Workers (CHWs) to provide oral health education and referrals to patients and caregivers through home visits and remote patient monitoring. CHWs are able to connect with patients to address main behavioral drivers of oral health disease, and home visits allow providers to better understand the many barriers patients may face in engaging in their own oral health care.

A recording of the full event is available here. The agenda is available here.

View or download the Oral Health Integration Pop-up Event Infographic here.

MassHealth and HealthCare for All have also compiled a number of resources on oral health integration that may be valuable for ACOs and CPs as they consider ways to improve the oral health of their patients and families.