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THE INTEGRATION OF PRIMARY CARE IN

DENTAL PRACTICE

Background Statement

If you have followed not only my work, but the work of many others over the last two decades, you are well aware there is growing agreement – many elements of primary care will be integrated into dental practice.

I have been here before in the dental industry when speaking about a future that hasn't yet happened. A response invariably occurs from dentists when a projected future conflict with the past. The predictable response – "It will never happen." I heard this about computerization, PPOs, MRIs, AI, CEREC, lasers in periodontics, and DSOs. All of them have come to pass.

Sincere conversations about integrating primary care into dental practices are now occurring far more frequently and broadly across the entire healthcare ecosystem. Furthermore, there are concrete actions currently being taken by numbers of people, from entrepreneurs to much larger healthcare institutions, to integrate elements of primary care into dental practice. When these kinds of conversations and intentional actions are taking place at this frequency, integration of primary care in dental practice has shifted from a possibility to a reality.

All of us who that have been engaged in making this integrated future a reality, fully understand what Mahatma Gandhi once said: "First they ignore you, and then they laugh at you, then they fight you, then you win." Integration of primary care in dental practice is starting to win.

Getting It Together

When I was with the DEO (Dental Entrepreneur Organization), I had Dr. John Snyder of the Permanente Dental Association (PDA), a unit of the Kaiser-System, speak at one of our conferences about the PDA's medical-dental model. As the leader, John did a brilliant job developing this model, which has now been in existence for several years. John figured out how to make this integrated model work for all the stakeholders of Kaiser – dentists, physicians, hospitals, patients, and their third-party component - demonstrating over time, improved health outcomes and reduced costs.

And yes, I understand, Kaiser is basically a closed system, whereas the majority of healthcare is much more an open system, making integration more complex, but the direct improvement in health outcomes and cost savings is now proven.

Another thing pushing integration forward, medicine is moving from pay-for-procedure to value-based care (performance-based care). Hospitals and hospital systems, along with their physician groups and payers, understand integrating dentistry is essential in a value-based / pay-for-performance reimbursement system. In this payment system, if patients don’t take care of their oral health, the other players, physicians, hospitals, and 3rd parties also have undesirable consequences.

Another critical driver in this integration will be the increased revenue for dental practices. Here is a recent abstract that is now circulating. Check out the revenue numbers.

Choi SE, Simon L, Barrow JR, Palmer N, Basu S, Phillips (2020). Dental Practice Integration into Primary Care: A Microsimulation of Financial Implications for Practices. Int J Env Res Public Health 17(6): 2154.

DOI: https://www.mdpi.com/1660-4601/17/6/21544601/17/6/2154   

At: https://www.mdpi.com/1660-4601/17/6/2154    

Description: Given the widespread lack of access to dental care for many vulnerable Americans, there is a growing realization that integrating dental and primary care may provide comprehensive care. We sought to model the financial impact of integrating dental care provision into a primary care practice. A microsimulation model was used to estimate changes in net revenue per practice by simulating patient visits to a primary dental practice within primary care practices, utilizing national survey and un-identified claims data from a nationwide health insurance plan. The impact of potential changes in utilization rates and payer distributions and hiring additional staff was also evaluated. When dental care services were provided in the primary care setting, annual net revenue changes per practice were−$92,053 (95% CI:− 93,054,− 91,052) in the first year and $104,626 (95% CI: 103,315, 105,316) in subsequent years. Net revenue per annum after the first year of integration remained positive as long as the overall utilization rates decreased by less than 25%. In settings with a high proportion of publicly insured patients, the net revenue change decreased but was still positive. Integrating primary dental and primary care providers would be financially viable, but this viability depends on the demands of dental utilization and payer distributions.

Given all the factors described above, integration of primary care into dental practice is a "fait accompli." I suggest you and your senior team begin to consider how you will adapt to this integration. Figure out what talent, structures, and systems you will need when mandated and regulated to deliver primary care in your dental practices – because it's going to happen.

The healthcare system is becoming acutely conscious of the role dental health plays in systemic disease. The proven reduction of cost and improved health outcomes in treating a people with chronic conditions, along with new ideas such as administering vaccines in the dental office, doing viral testing and antibody testing in the dental office, drawing blood for blood panels, taking other vital signs, having dentists connected to the Electronic Patient Records, combined with telemedicine, are all under serious consideration among the major switch-throwers.

Announcement: We have begun generating an international conference on the integration of primary care into dental practice. The dates selected at November 3rd and 4th, 2021. We’ll keep you posted. Integration of primary care in dental practice is a time that’s come.

Dr, Marc Cooper

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