First in a Series: A Call to Action on Oral Health Care
On July 13, the Institute of Medicine released reports calling for expanded access to oral health care. In this post, Denise Davis, Dr.P.H, M.P.A., an RWJF program officer and the guiding force behind the Robert Wood Johnson Foundation (RWJF) Dental Pipeline program, discusses the consequences of a decade of inaction, the most promising courses at this time of fiscal constraint at the federal and state levels, and invites readers to share their views. See all the posts in this series.
Ten years after the release of the Surgeon General’s report describing the oral health crisis in America, little has changed. This year, in an effort to bring this critical issue back into the spotlight for policy-makers, clinicians and the American public, the Institute of Medicine (IOM), released two reports – one in concert with the National Research Council.
These reports, Advancing Oral Health in America and Improving Access to Oral Health Care for Vulnerable and Underserved Populations, build on the Surgeon General’s report of 2000 highlighting the importance and centrality of good oral health to overall health. The former highlights the need for leadership in this area by the U.S. Department of Health and Human Services and presents a set of organized ideals for creating improvement while the latter provides a vision for oral health access and quality for all Americans.
These reports reiterate where persistent gaps in oral health access and care delivery exist and suggest what organized principles and system-level changes should be adopted to improve the current status of many underserved and vulnerable groups.
Unfortunately, progress in the area of oral health for the most vulnerable within our population is painstakingly slow, as evidenced by the previous decade of inaction. Given the current fiscal constraints at the federal and state levels, it will be critically important to give consideration to the recommendations in these reports while simultaneously looking into other approaches such as foundation studies, creative multi-stakeholder innovative demonstrations, state-level projects, etc. in order to stimulate future progress.
Several factors have contributed to the current state of affairs. These include the way policy-makers and the public value oral health versus medical care, as evidenced by distinct insurance coverage packages; the current federal “piecemeal approach” to oral health policy and programs with no sense of urgency associated with this issue; supply side challenges such as the clustering of dentists; the lack of coordination across dentistry and medicine; and the limiting scope of practice legislation for mid-level providers across states.
There is little information about prevention efforts due to the lack of tracking systems in place, which in turn reduces the opportunity to spread effective practices. Low reimbursement and the lack of parity across insurance provider payments is a major impediment to access and significantly contributes to oral health disparities, particularly for those covered by Medicaid and Medicare or the uninsured. In addition, with no performance standards or benchmarks in place, few accountability metrics associated with best practices or quality outcomes exist.
Given these challenges, what possible solutions or strategies might we look to, to begin to change the existing landscape and accelerate progress? Improvement must be driven by a consistent, strategic, coordinated level of federal support and the prioritization of this issue across agencies. Additionally, we need the ongoing involvement of key stakeholders to stimulate innovation, identify as well as fill gaps, and drive continuous program and policy improvement.
We should identify and incorporate promising lessons from foundation-funded demonstrations. These projects include those supported by the Robert Wood Johnson Foundation, the Kellogg Foundation, the California Endowment, the Josiah Macy Foundation, Pew Trust, the Connecticut Health Foundation, and the Colorado Health Foundation, to name a few. These foundations have made many investments in promising demonstrations over the years (some in partnership with each other and with govenment). Lifting up the many promising practices from our previous investments in oral health may provide the best opportunity to identify approaches with the potential to realize improvement.
Over the last 35 years, RWJF has funded many dental projects. These investments have focused on improving access to oral health and have supported programs that included prevention, diagnosis, treatment, advocacy and training of providers. There is much to be learned from these investments, and particularly from the recently ended Dental Pipeline program which focused on increasing access to dental care for underserved populations through: recruiting and training more low-income and minority students in dentistry; and expanding community-based dental education in dental schools.
Program investments supported by other funders have also contributed valuable lessons. For example, the W.K. Kellogg Foundation is currently supporting efforts in five states that use dental therapists as part of an expanded dental team to end severe dental care shortages. The foundation is supporting community-led efforts in these states to establish dental therapist programs as a way to expand access to oral health care, prevention and oral health literacy.
Through conferences and grants, the Josiah S. Macy Foundation has continually supported the work of academic educators engaged in changing the ways health care providers are trained. It is essential to promote educational innovation and academic as well as clinical leadership models and strategies.
Central to all these investments is that we understand what works and how to create sustainable models from effective demonstrations. Also, the development of strong public-private partnerships and the continued involvement and commitment of multiple stakeholders to this issue will go a long way to effect change.
The Robert Wood Johnson Foundation looks forward to continuing its work on this critical issue and we would like to hear from you. What did you think of the IOM report? Do you think they left anything out? What would you like us to know as we’re thinking about the findings in this report and our future programming investments in oral health?