Overcoming barriers to health care access is a top priority in dentistry. It was the basis of the ADA’s Action for Dental Health, a community-based initiative to improve oral health in the United States. A 2014 report by the Health Policy Institute (HPI) found that in 2012, only about one in three working-age adults went to a dentist. A large part of the population doesn’t receive regular dental care. We know this can result in severe morbidities and, in rare cases, mortality.
Interestingly, there is a noticeable lack of utilization of both private insurance and federal assistance programs such as Medicaid. According to an HPI research brief on dental care utilization, the 2013 nationwide Medicaid utilization rate was low at 48.3 percent for children, 43.6 percent for working-age adults and 35.5 percent for elderly adults. Why? The report found that the top three self-reported reasons for not using Medicaid benefits were cost, inability to find a dentist accepting Medicaid and inability to travel to a dentist. How do we overcome these barriers? The community dental health coordinator (CDHC).
The CDHC program started in 2006. It creates a new member of the dental team who practices under the supervision of a dentist. They often are dental assistants or hygienists looking to expand their capabilities. Their training places heavy emphasis on the prevention of dental disease through education and social work. In turn, they educate patients to improve oral health literacy, hopefully improving long-term oral health. Furthermore, they help patients navigate their dental benefits and coordinate patient care, which includes arranging transportation. Ultimately, they connect community members with dentists who can provide the care they need.
The novel concept about CDHCs is they often grow up in the communities in which they work. This includes rural and urban areas and Native American lands. This gives them cultural insight to identify the barriers to care specific to their communities. This, in turn, provides tailored solutions to help community members overcome those barriers.
Take, for example, MiQuel McRae, RDH, a CDHC from Arizona. After getting her training to become a CDHC, she recognized a need and an opportunity in her hometown. Children in her county suffered severe oral health disparities, so she founded a 501(c)3 nonprofit called Tooth B.U.D.D.S. (Bringing Understanding of Dental Disease to Schools). The nonprofit functions to increase access to oral health prevention and early intervention via community programs. It also works to overcome disparities in oral health in rural areas.
The most important aspect of the CDHC model is that it works both for the patients and for the dentists. Case studies from the CDHC pilot program show community outreach screenings were successful in connecting patients with dentists when they needed additional care. In addition, the CDHCs provide economic benefit for the clinics they work with. Multiple case studies showed that CDHCs generated around $150,000 in total care services, while one case saw total care value generated by the CDHC at $600,000.
CDHCs are already showing proven success in tackling two of the main problems in access to care. Continued support and public awareness of the CDHC program will help the program grow and, ultimately, help dentistry address one of its greatest issues: helping patients get the care they need.
~Jon Vogel, Texas-Houston ’18, Council on Advocacy Chair
About Jon Vogel
Jon Vogel is a 4th year dental student at UT Houston dental school. He has a passion for oral health prevention and expanding access to care. Unsurprisingly, he is equally passionate about advocacy, whether it be advocating for our profession or for our patients.