Advantage Dental Services and the University of Washington Partner to Improve Oral Health

Recently the joint project received a Robert Wood Johnson evaluation grant and its project could become a nationwide model.

Tooth decay leads to increased healthcare costs, missed school days and chronic pain. Even so, oral health often takes a back seat to preventive health measures such as eating right, being active and having annual wellness exams. And for children in Oregon, as in most of the U.S., poor oral health runs rampant. In fact, according to the American Dental Association, Oregon ranks low in dental care use among children, and access to care is a challenge. Fortunately, Advantage Dental Services together with the University of Washington are about to change those dynamics.

Starting next spring, Advantage will target 82,000 children and mothers enrolled in the Oregon Health Plan in seven rural counties to increase access --- Coos, Deschutes, Douglas, Jackson-Josephine, Klamath, Morrow and Wasco.

Advantage will deploy expanded practice permit dental hygienists to do screening, tooth decay risk assessment and preventive care in WIC, Head Start, schools and other non-traditional settings.

Community liaisons and regional managers will foster cooperation among parents, school and other partners.

“We’re looking at how we work together with the community,” said Mike Shirtcliff, DMD, who’s CEO of Advantage.

By focusing on preventive oral health measures rather than fixing problems that could have been avoided, Advantage expects to produce significant cost reductions and improvements in oral health.

“The solution is dental care and managing the population, not having as many teeth to fix,” said Shirtcliff, and focusing on outcomes. “Dentistry is a reflection of the overall healthcare system. How do we measure success? With fee for service, we know the number of procedures we’ve done, but we don’t know the impact.”

Under Medicaid, dental clinics receive a rate based on the number of members per month, but the per member per month rate paid to clinics is not enough to provide all the care, especially curative and surgical needs.

“The per member per month amount is really a small amount of money,” said Peter Milgrom, director of the Northwest Center to Reduce Oral Health Disparities. “It’s very difficult to deliver care for that little. To treat even 80-90 percent of all children (in Oregon) is an enormous task and to do it the traditional way, where providers sit in the clinic and wait for the children to come, simply doesn’t work.”

By changing the way care is delivered and offering payment incentives, Advantage hopes to reach more children, and make certain those at higher risk receive the necessary care to avoid more serious long-term, and more expensive problems.

“Not all poor children are high risk,” Milgrom explained. “Currently, all children are treated the same, even though only a minority are moderate to high risk. It’s a waste of resources to do a blanket approach. It’s enormously expensive to put someone in a dental chair.”

Under the program, hygienists will do a risk assessment, with children needing intensive services referred to a dentist.

“This is a radical change from the way things have been done,” Milgrom noted.

“We’ve learned how to break the cycle (of poor oral health),” Shirtcliff said.

Advantage is underwriting this program, along with a three-year, $488,434 evaluation grant from the Robert Wood Johnson Foundation in collaboration with the University of Washington’s Northwest Center to Reduce Oral Health Disparities, which will monitor patient satisfaction and other aspects of care.

This project could become a nationwide model, said Dr. Marshall Chin, director of the Reducing Health Care Disparities National Program Office. “The University of Washington/Advantage Dental Services proposal is at the cutting edge of efforts to reduce healthcare disparities by changing the way we deliver and pay for care. We hope it will be a successful model for the nation.”


Joanne can be reached at [email protected].