Ep 145 – Oral Health and Value-Based Care: Creating a More Integrated, Accessible, and Equitable Oral Health Landscape, with Kaz Rafia, DDS, MBA, MPH

Did you know that an estimated 80 million Americans currently lack access to dental care? As oral health is essential to the overall health and well-being of an individual, the high volume of those without access can have potentially devastating health consequences such as an increased risk of developing cardiovascular disease, respiratory disease, diabetes, and adverse pregnancy outcomes.  Oral health can also influence eating habits and sleep patterns, which in turn can adversely impact both physical and mental health. And tragically, research shows that poor oral health is more common among individuals with lower income and educational attainment. And in value-based care, the growing number of emergency department visits for conditions related to poor oral health clearly shows the relationship between oral health and physical health. (There are approximately 1.8 million hospital ED visits annually for non-traumatic dental conditions which cost $3.4 billion to treat!)

We need to establish a more integrated, accessible, and equitable oral health landscape in our country. In this special episode, you will hear from a leader in the field of oral health who is working to reduce disparities in access to and quality of care. Kaz Rafia is the Chief Health Equity Officer for the CareQuest Institute for Oral Health — a leading national nonprofit focused on creating a more accessible, equitable, and integrated oral health system. At CareQuest, he leads strategic initiatives to advance access to integrated oral health care for ethnically and socially diverse communities. He is someone definitely leading us in this Race to Value!

If you like what you hear, you can also access a companion blog to this episode entitled, “Why Oral Health is Critical in a Value-Based Systembrought to you by the Institute for Advancing Health Value and the CareQuest Institute for Oral Health!


Episode Bookmarks:

01:30 An estimated 80 million Americans currently lack access to dental care.

01:45 Lack of dental care can lead to devastating health consequences and an increased risk of developing chronic disease.

02:30 Introduction to Kaz Rafia and the CareQuest Institute for Oral Health

03:30 Companion blog to this episode: “Why Oral Health is Critical in a Value-Based System

04:30 The link between oral health and community health.

06:30 Kaz speaks about the work that CareQuest is doing in building alliances to create a more accessible, equitable, and integrated oral health system.

07:00 “The inability of a person to receive oral health care is a clear threat to their overall health far beyond the mouth.”

07:30 Chronic periodontitis results in a higher risk of developing Alzheimer’s disease.

07:45 Oral care is a key intervention for reducing the risk of aspiration pneumonia.

08:00 The link between poor oral health and adverse birth outcomes.

08:30 CareQuest has developed MORE Care to integrate oral health capabilities into a person-centered primary care model.

09:30 Community Oral Health Transformation (COrHT) initiative and framework for safety net dental clinics to transform oral health care delivery.

11:00 Health disparities data showing that oral health varies across racial and socioeconomic lines.

12:00 Drivers for lack of access to dental care include geographic isolation, lack of transportation, and poverty.

13:00 How poor Medicaid reimbursement and “provider clustering” due to compensation economics contributes to oral health disparities.

14:00 Black adults are 68% more likely than white adults to have unmet dental care needs.

14:30 Dental coverage gaps contributing to oral health disparities in rural communities.

15:30 Alabama is now the only state currently lacking adult dental care benefits in Medicaid.

16:00 “The work done to evangelize value-based care models in dental care are reducing barriers to access nationally.”

17:30 World Health Organization recognition of dental care as a fundamental human right and their landmark global strategy on oral health.

18:30 Kaz discusses the importance of value-based care in oral health and how we define it.

19:00 Examples from Sweden and other countries on how to provide universal access to dental care.

19:45 The use of dental therapists to expand access to dental care and the recent legislative win for dental therapists to practice in Oregon.

22:00 The importance of clinical integration and how the “100 Million Mouths” campaign is integrating oral health into primary care.

23:30 Complications associated with lack of oral health, e.g. high blood pressure, diabetes, Alzheimer’s, poor pregnancy outcomes, behavioral health issues.

24:00 Research showing that medical-dental integration can enhance closure of medical care gaps.

24:30 Value-based opportunities to lower costs and improve clinical outcomes, e.g. checking Hemoglobin A1cs at dental appointments for diabetic patients.

25:30 Kaz discusses how the 100 Million Mouths campaign is integrating dental health into medical school curriculum.

26:45 There are 1.8 million hospital ED visits for non-traumatic dental conditions (NTDCs), which cost $3.4 billion to treat.

28:00 Kaz discusses the financial impact of non-traumatic dental conditions and how trends in ED utilization for NTDCs relate to social determinants of health.

29:00 Out-of-pocket expenditures are 40% of overall dental care spending and how this contributes to lack of optimal oral health outcomes.

30:30 “Accrued interest” that occurs when delays in front-end dental care treatment and prevention results in costly ED visits.

31:00 NTDC-related ED visits costs 3X what a regular dental visit would cost.

31:45 90% of NTDC-related visits are only given treatment for pain and then referred back to the dentist!

33:00 The mouth horror scene in Cast Away and how that relates to the millions of people facing access challenges to dental care!

33:30 6 million adults lost their dental insurance during the COVID-19 pandemic!

35:00 Kaz discusses the impact of the pandemic on dental care delivery and the potential for telehealth innovation in the long-term.

37:00 Teledentistry as a successful modality for triaging care needs to avoid unnecessary ED visits.

38:00 Investments to scale a value-based care infrastructure for oral health.

40:00 Kaz discusses the recent progress being made by CMS to include dental benefits coverage in the Medicare program.

42:00 “Oral health care is, in fact, health care.” – Kaz explains why preventive dental care coverage makes sense in value-based care transformation!

44:00 Anti-Racism in Dental Public Health: A Call to Action and the recent CareQuest collaboration to expand research in this area.

45:00 “Racism is a public health epidemic, and having difficult conversations is a key ingredient to change.”

46:30 “Being anti-racist is not a zero-sum game that takes away from anyone else. It is about the betterment of our society.”

49:00 Investing in Health Equity Innovation – how CareQuest Innovation Partners through a new initiative called SMILE Health will scale early-stage startups.

50:00 How do we effectively invest in health equity in a sustainable and meaningful way?

54:00 A recent CareQuest Institute survey revealed that more than half (51%) of oral health providers surveyed had never heard of APMs in dentistry.

55:30 Kaz on the importance of understanding the past to envision a more optimistic future for value-based care.

57:30 “The misnomer of dental insurance is that it seems more like a luxury than an absolute need and human right to ensure population health.”

59:00 nspiration from Michael Leavitt in the building of alliances to impact health inequities and low value care.