Traditional models won't work for patients with special needs

Achieving oral health equity for adults with intellectual and developmental disabilities requires improving provider availability and embracing new financial models, according to a symposium held on April 5.

The AHEAD symposium, an acronym for Achieving Health Equity Through Access for All with Disabilities, was held at the New York University College of Dentistry. Presenter Mary Foley, RDH, MPH, emphasized the need to identify nontraditional pathways for delivering and administering dental services as well as training dentists and dental teams to meet the needs of this population.

"We are years down the road, and we haven't made the gains that we need to make for this particular population. We really need to look outside the box," said Foley, executive director of MSDA, an organization that seeks to improve oral health services for Medicaid, Medicare, and Children's Health Insurance Program (CHIP) beneficiaries.

Though they are at increased risk for oral conditions and diseases, adults with disabilities generally have limited and inequitable access to dental care. Historically, dental care and benefits, as they are currently developed in policies and programs, do not adequately meet the needs of those with intellectual and developmental disabilities because they are not risk-based, Foley explained.

To improve care, dentistry needs to address the two greatest obstacles for this population.

Challenge No. 1: Inadequate provider training

Many dentists and dental hygienists do not feel they are adequately trained to treat adults with intellectual and developmental disabilities, Foley said. One particular issue is that the needs and service requirements of this population are broad.

"Some individuals that fall into this category have fewer needs than others in this category," Foley explained. "We have to be really careful about the way we talk about this and not generalize, because even within the population itself, there are variabilities."

Increased education and universal curriculum likely will help reduce that barrier and improve provider availability, according to Foley.

Challenge No. 2: Siloed care models

While programs may say they support the treatment of adults with intellectual and developmental disabilities, they don't support the true length of time that it takes to treat these patients. People with special needs can require lengthier visits or multiple visits for care that others wouldn't require, Foley said.

Billing for appointment times and not outcomes traces back to dentistry's financial care model. For the most part, dental care is delivered and billed through a fee-for-service model, providing reimbursement for services that use Code on Nomenclature (CDT) codes from the ADA. However, this model does not factor in patients' unique needs or care outcomes, which also means it doesn't work particularly well for adults with disabilities.

"We have no way through the dental delivery system to actually document health outcomes and to be able to determine whether or not we are moving the needle in the right direction," Foley said. "As we deliver care, as we create policies, as we create programs, as we cover benefits, it's very hard for us to say that we're doing a better job when we can't make a statement about health outcomes."

Foley pointed to one potential solution: using International Classification of Diseases (ICD) codes from the World Health Organization. These codes note diseases, external causes, and abnormal findings to aid coverage determinations. While this solution requires identifying policy pathways to create patient-centered, risk-based care models, it would also allow dentists to coordinate with medical providers and medical insurers that use ICD codes.

"We talk a lot about integrated healthcare, integrating medical and dental," Foley said. "But at the end of the day, our systems don't talk. This needs to change to improve the quality of care for this population."