The oral health opportunity for accountable care

August 13, 2019
Rachel Gershon
Rachel Gershon, JD, MPH
Senior Associate, Health Law & Policy

Even though most Medicaid Accountable Care Organizations (ACOs) are not responsible for the cost of  dental office visits, they can still improve patient care and reduce their costs by focusing on oral health. How so? 

Unnecessary emergency visits for dental pain are costly and do not address the root causes of that pain. ACOs are usually responsible for at least some of the cost of emergency department care.

We looked at this issue in depth in a new report, Opportunities for MassHealth ACOs to Improve Oral Health and Reduce Cost through Emergency Department Diversion, produced with funding and the support of the Southern New England Practice Transformation Network through the Transforming Clinical Practice Initiative, an initiative of the Centers for Medicare and Medicaid Services.

Our report is the result of interviews with experts and analysis of data from MassHealth, Massachusetts’ Medicaid and CHIP program. Here are some key findings:

  • MassHealth ACOs have resources to contact (listed in the report) who can help design and implement programs to decrease dental emergency department visits and increase connection to dental offices.
  • There are already successful oral health diversion models in the state. In October 2016, the Community Health Center of Franklin County (with the support of a grant from the Health Resources and Services Administration, or HRSA) set up a dental urgent care clinic within Baystate Franklin Medical Center in Greenfield, Massachusetts — across the hall from the emergency department. The dental urgent care center became sustainable quickly due to the steady demand from the emergency department, walk-ins, and referrals from the community health center.
  • Dental emergency department visits are more expensive than dental office visits. The most common dental emergency department visit is for dental caries (tooth decay or cavities). An emergency department visit for dental caries had paid claims that were 2.6 times more than a dental visit for restorative services (Source: our analysis of MassHealth 2017 claims data).
  • Emergency departments are not set up to provide dental care. In general, emergency departments cannot definitively address dental conditions. For example, dental x-ray machines are generally not available to diagnose the scope of dental disease. One of our interviewees, Dr. Rakesh “Kishi” Talati (medical director of Baystate Franklin County), agreed. “I cannot think of a dental [tooth] pain patient who comes to our emergency department who wouldn’t be better served by a dentist.”
  • Appropriate dental care is associated with positive health outcomes. Positive health outcomes, in turn, can improve an ACO’s performance on quality measures. For example, here are some select MassHealth ACO quality measures potentially affected by better dental care:
Select MassHealth ACO quality measures potentially affected by better dental care: