Dealing with change while keeping your teeth

Commentary by Dr. R. Mike Shirtcliff

Brush twice a day, floss twice a day and rinse twice a day. That is what we were all taught as children and told by our dentists twice a year.

While that advice still holds true, the business of being a dentist is changing, and it is imperative that we dentists change with it — if we want to stay in the game.

It wasn’t long ago that we could pick our doctors, get treatment and share the cost with our insurance provider. Now that is changing, as a system known as managed care becomes the norm. Under this model, unnecessary care is eliminated and preventative care is stressed, ultimately reducing the costs of health care. The managed care model is very successful in our neighboring state of Oregon, and it is making its way to Idaho now.

Sixty percent of our country’s health care costs, and that includes dentistry, comes from government entities including Medicaid, Medicare, Veterans Affairs, cities, counties and state workers. Our current system, which can be classified as a fee for service model for those who are sick, is not working and is becoming unaffordable for everyone. The current sick care delivery system pays for the results of people’s behaviors — which many times causes the illness or issue being treated. This model treats the sick and pays providers for the procedure that is immediately needed.

Take a cavity for example; it may have been prevented with cleanings, but the infection was left to grow into a toothache that now requires a filling or crown. People are being treated for their illness after they are sick, and this is happening more and more in dentistry.

What we need now is being described as a Triple Aim. The goal of the Triple Aim is to provide better care, better health for a better value.

At Advantage Dental, we use managed care and work with our network of dentists on the idea of disease prevention, and finding a way to avoid expensive restorative procedures. We were formed to provide access to care for all of the citizens in the communities we serve, and we are working hard to grow our network in rural Idaho communities to ensure the best dental health care for residents. We work with the mouth, and now it is time to use our mouths to explain this more cost-effective approach that is already saving money for our neighbors in Oregon.

Remember that dental health affects a person’s overall health. If we can prevent dental disease we can lessen many other serious medical diseases such as heart disease, diabetes, hypertension and hypercholesterolemia. Under the managed care model it is critical that all medical disciplines (physical, mental, dental) work together to accomplish the same goal. Community outreach and programs that educate citizens, to the resources and programs that can help them, are instrumental in the success of this new model of health care.

Just a few areas of special interest to Advantage Dental are: increased preventive visits for pregnant women and children, a decrease in hospital operating room cases, a decrease in emergency room visits, decreasing any unnecessary drug use including opioids and antibiotics, and to control infection and decrease disease burden for chronic disease patients. Some of the ways Advantage Dental accomplishes the above goals is through community collaboration. Advantage works with other community entities and programs such as: Public Health, Head Start and Early Head Start, School Based on-site Early Prevention Programs, Department of Health and Human Services, Senior and People with Disabilities and through Medical and Dental Integration with various physician groups.

Advantage Dental promotes prevention and disease management through a proven strategy. This strategy starts with a “carries risk assessment” that results in a preventive or disease management plan based on the risk status. Early detection and prioritized treatment designed to reduce the burden of disease comes next. We will treat the infection before repairing the damage. Integration and continuity of care across a person’s lifetime is critical. This strategy ends with self-management and continued education for the patient.

The process is starting with Medicaid recipients and is a managed care model that incentivizes dentists through a monthly capitated payment system with the goal of reducing costs while improving the quality of care for patients, again, resulting in better overall health.

Managed health care has been proven to be successful in a number of ways. We at Advantage Dental are a great example of how successful managed care can be and how much better it is for the communities and people it serves. Our track record proves it through:

1. Promoting preventative care of our patients.

2. Identifying a designated list of health care providers. Currently there are more than 400 dentists in our Idaho network, which is continuing to grow throughout the state.

3. Setting high standards for the dentists in our network.

4. Setting incentives to encourage our dentists to be the most efficient with their care.

There are a handful of dentists who provide care to Medicaid patients, and our list of 400 Medicaid dentists is growing as more and more dentists in private practice see that they are going to have to make the change to some form of managed care as the future moves more toward the concept of disease prevention and finding ways to avoid expensive restorative procedures.

If you are still unsure about the managed care model, keep in mind that 30 percent of the work being done is not necessary and 50 percent of the work that needs to be done is not getting done. The current system is asking for 10 to 20 percent insurance premium increases each year. The government, which includes city, county, state, federal, military and veterans affairs, pays 50 to 60 percent of the bill.

Times are changing, it is easy to see. What hasn’t changed is that we all have and need our teeth and we only get one set in our lifetime, so let’s do everything we can to take care of them now.

About the author

Dr. R. Mike Shirtcliff is founder and president of Advantage Dental, a company that manages a network of over 1,000 dentists in Oregon and Idaho. The goal of the company is to create access to dental care for community members regardless of economic status. Dr. Shirtcliff was in private practice for more than 20 years before founding Advantage.