PCC’s New Report Highlights Deepening National Crisis in Access to Oral Health Care, Presents Solutions to Transform Broken System through Integration of Oral Health and Primary Care

WASHINGTON, Mar. 31, 2021— As the COVID-19 pandemic continues to exacerbate health inequities, the Primary Care Collaborative (PCC) today released a new report that sounds the alarm on a deepening national crisis in oral health care access and presents ways to integrate oral health and primary care to make it easier for millions of Americans to get the care they need to lead healthy, productive lives.

The PCC’s new report, titled Innovations in Oral Health and Primary Care Integration, provides a comprehensive look at the social and economic costs of unmet oral health issues and showcases the innovative ways that healthcare clinicians, community, and public health leaders are working together across the country to enable oral health to be part of primary care.

Even before the pandemic, at least one-third of Americans had no dental insurance. New economic reports show that while all U.S. health spending continues to lag pre-pandemic levels, dental services saw the greatest decline in spending at over 17% over the past year. Millions of people across the country struggle with unmet oral health needs (gum disease, broken teeth, oral pain, and more) because are they are uninsured, underinsured, or they live in areas where they cannot find a dentist to treat them. Oral health problems can complicate chronic conditions like diabetes and heart disease. Barriers to care can leave patients with serious conditions that can threaten their overall health, quality of life, and long-term economic health and well-being. For people of color, residents of rural communities, people with disabilities, older adults, and other historically marginalized groups, these problems are compounded.

“The COVID pandemic has undoubtedly worsened the oral health crisis, but it also gives us an opportunity to transform our broken system,” said Darilyn Moyer, MD, FACP, FRCP, FIDSA, chair of PCC’s board of directors and Executive Vice President and CEO of the American College of Physicians. “This report shows that by training members of the primary care team to offer first-line oral care in primary care settings – and reimbursing them for doing so – we can make it easier for everyone to access the care they need to lead healthy, productive lives. It also helps makes the job of primary care clinicians more fulfilling in the long run because they are better able to meet patients’ needs.”

The reports curates extensive data on barriers to oral health care including these key findings:

• The uninsured rate for dental insurance is four times higher than that for medical insurance.
• Uninsured and publicly insured adults make up to 70% of all the 2.4 million emergency department visits each year for a dental problem, and in many cases these are preventable.
• Traditional Medicare offers no dental coverage for the 37 million adults and people with disabilities it covers.
• For low-income adults on Medicaid, it depends on where you live. 
  • 11 states provide no dental benefits; 35 states limit coverage; and 19 states require a copay. Even when dental coverage is provided, as for low-income children who receive insurance through Medicaid or the Children’s Health Insurance Program (CHIP), access is limited.

“Lack of access to oral health care is a national crisis, and primary care is poised to play a pivotal role in opening the door for millions of Americans to get the oral care they need and deserve,” said Ann Greiner, PCC’s President and CEO. “It’s not only a moral imperative, it’s also an economic one. We need a new model of care, one that enables oral health to be part of primary care and that expands who can deliver oral care.  This report presents the way forward.”

The study lays out key policy recommendations:

• Expand oral health coverage access by developing a Medicare dental benefit and expanding Medicaid adult benefits to all states
• Align oral health and primary care with new payment models
  • Develop and pilot oral health quality measures across primary care/oral health
  • Move away from fee-for-service reimbursement, focusing instead on value-based models centered on care delivery and patients’ oral health outcomes
  • Incentivize the development/adoption of health records that work seamlessly together and include medical and dental health records
• Grow the oral health workforce
  • Incorporate oral health learning into all health professions training programs
  • Ensure health professions trainees are taught about racial/social justice as driver of health equity
  • Broaden scope-of-practice laws to allow all clinicians, including dental therapists, to deliver oral health services consistent with their full scope of practice

The PCC convened an advisory group of experts in primary care and oral health to help inform the report, which was produced with financial support from the CareQuest Institute for Oral Health, a nonprofit with a bold mission to overhaul the oral health care system.

Advisory Group

• Chair: Anita Glicken, MSW, National Interprofessional Initiative on Oral Health
• Lynda Flowers, JD, MSN, RN, AARP
• Dean Fry, DDS, Humana
• Ann Greiner, MCP, Primary Care Collaborative
• Judith Haber, PhD, APRN, FAAN, NYU College of Nursing
• Lawrence Hill, DDS, MPH, American Association for Community Dental Programs
• Alan Morgan, MPA, National Rural Health Association
• Cheryl Parcham, MSW, Families USA
• Russ Phillips, MD, Center for Primary Care, Harvard Medical School
• Jason Roush, DDS, Association of State and Territorial Dental Directors
• Ann Salamone, DDS, New York Hotel Trades Council (formerly)
• Hugh Silk, MD, MPH, FAAFP, University of Massachusetts Medical School
• Howard Straker, EdD, PA, MPH, George Washington University
• Capt.Pamella Vodicka, Health Resources & Services Administration
• Marko Vujicic, PhD, Health Policy Institute, American Dental Association
• Lisa Simon, MD, DMD, Harvard School of Dental Medicine (contributing author of report)