The maxim "Put your money where your mouth is" speaks to doing what you say. For The John A. Hartford Foundation last week, it also took on a more literal meaning, as the Foundation funded an important convening to explore the best ways to enhance access to oral health care for older adults.
The Foundation-supported convening was organized by the Santa Fe Group, a unique collection of internationally renowned scholars and leaders from business and the professions bound by a common interest to improve oral health. The convening brought together an interdisciplinary set of thought leaders to discuss the inclusion of an oral health benefit as part of the Medicare program.
The point of the meeting, held in Arlington, VA, was this: 10,000 Americans reach the age of 65 each day and discover that Medicare does not cover dental care. As a nation, we are leaving our older adults bare of basic benefits to ensure continued oral health.
Moreover, it's becoming increasingly clear that oral health is linked to general health, especially diseases associated with inflammation such as diabetes, coronary artery disease, and stroke. A 2016 study by the American Dental Association (ADA) Health Policy Institute based on data from multiple insurance companies confirms that there is a substantial reduction to total health care spending when dental services are provided.
Meeting attendance was happily over-subscribed and included leadership from: the ADA; academic and professional institutions of dentistry, medicine, nursing, and dental hygiene; the Centers for Medicare and Medicaid Services (CMS); health economists; health plans; and community activist organizations such as the Center for Medicare Advocacy, among others.
During the course of two days, this amazing group of leaders—which included Dr. Terry Fulmer, president of The John A. Hartford Foundation—discussed the need, the rationale, the cost, and the benefits of expanded oral health care for seniors in order to shape policy, optimize benefits, foster health literacy, and drive changes necessary to achieve the important goal of expanded access to basic dental care.
It’s natural in a meeting with so many people of diverse interdisciplinary skills and training for members to increasingly parse the nature of the coverage question: Should an oral health benefit in Medicare cover preventive care or restorative care? Should it only cover people with certain diseases that have an inflammatory component like diabetes or coronary artery disease? Who should receive the benefit—everyone, only those with medical need, or only those dually eligible for Medicare and Medicaid? Would a potential benefit reside in Medicare Part B, Part D, or somewhere else? What about Medicare Advantage plans?
I suggest they think broadly and go big. With the rise of value-based care and payment systems, this is yet another area where I think demonstrated value will lead to true coverage gains and that’s exactly the message I imparted at the meeting. They need to show CMS the cost savings to demonstrate that providing oral health benefits will provide net savings to the system.
There is evidence from one study that they can achieve savings of $124 per-member, per-month by providing health plan members with a good dental plan. And it can be done! We at The John A. Hartford Foundation have already seen the power of demonstrating financial savings to CMS translated into new Medicare benefits in two of our grantmaking areas:
- A new Medicare-covered benefit for the Y-USA’s Diabetes Prevention Program, and
- Expansion of the Independence at Home program for home based primary care.
The mouth is an intrinsic human organ system. Of course oral health matters to the health of the rest of our bodies! It also matters in broader ways that include some of the social determinants of health we all know are so important: nutrition, self-esteem and one’s ability to smile and interact socially.
Making oral health care widely accessible to older adults will improve their health and well-being and result in savings in overall health care spending. It’s time to lead the charge as a society to put our money where our mouth is.