Expand HealthFacts with dental claims

The birth of HealthFacts RI, the state’s all-payer claims database launched last year, is a laudable and transformational milestone. Now the official source for insurer health-payment information, its primary mission is to drive improved health outcomes for patients, monitor provider metrics, and identify potential health care cost-savings opportunities.

To date, it includes 78 percent of our population, roughly 824,000 residents.

Unfortunately, unlike elsewhere in New England, the database does not currently accept – and there are no plans to change this – claims for oral health care services. Without dental data, there is a significant information gap in HealthFacts RI, diminishing the quality of analysis of the connections and opportunities to address health care disparities such as diabetes and heart disease across our populations.

From the inclusion of comprehensive pediatric dental in the ACA Essential Health Benefits, to efforts to improve coordination of care among providers in community health centers, policymakers and health care leaders have begun to recognize the links between oral health and overall health. We urge the state to reconsider this decision and expand the database to include dental claims for one simple reason: Oral health is essential to a person’s overall health and well-being.

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Several years ago, Delta Dental of Rhode Island partnered with the State University of New York at Buffalo on a clinical study to determine if dental offices would be an effective setting to screen patients for undiagnosed diabetes and pre-diabetes, since periodontal disease can be an indicator. Of 1,000 adult patient-participants, nearly 40 percent were referred to a physician for further evaluation. This one study strongly suggests there can be concrete health benefits from sharing and integrating oral-health information; imagine, then, the impact of consistent and thorough data that represents the whole body of every Rhode Islander.

Early diagnosis and treatment may also help to reduce costly care for untreated conditions. The Journal of the American Medical Association recently published a study citing diabetes and heart disease as the two most costly health expenses in the United States. A 2014 study cited in the American Journal of Preventive Medicine looked at insurance claims for those with diabetes and periodontal disease and found that those who maintained periodontal treatment had considerably fewer hospitalizations and doctor visits. The study also found that such treatments contributed to a decrease in annual medical costs of 40 percent, or $2,840 per year in patients with diabetes, in addition to other health savings.

The first report issued with payment-claims data cited the opportunity to prevent costly and unnecessary emergency room visits. Teeth problems were cited among the top 10 preventable reasons for these visits, with more than 2,500 in 2014.

Most emergency rooms are not staffed with dentists or oral surgeons. If patients have infections and severe pain, physicians are faced with the decision of whether to issue antibiotics and opioids. Not only does this put off treatment for the actual dental issue, it further exacerbates the challenges health care practitioners face on a daily basis.

Armed with complete and integrated data, state leaders can look for ways to improve access – and the oral health – of all Rhode Islanders, regardless of whether they have dental insurance.

We applaud the state’s Oral Health Commission, which works tirelessly to raise the visibility of the importance of access to quality oral-health care. Preventing oral-health problems is more than a cost issue – it is a quality-of-life and economic-development issue. It is difficult, if not impossible, to study, work or seek employment when one is experiencing severe dental pain. •

Joseph A. Nagle is the president and CEO of Delta Dental of Rhode Island.

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