First, the ACA includes pediatric oral health benefits among its list of essential health benefits, giving insurance plans the opportunity to embed pediatric dental benefits within the medical plan. Second, the ACA strives to improve quality of care while containing costs via health care delivery reform in patient-centered medical homes and accountable care organizations (ACOs).
The ACA’s construct of health care places the patient at the center of care delivery of all kinds, including behavioral, mental, dental, and vision care. Early ACOs provide useful lessons about this move toward patient-centered care, but financial and practical barriers often stymie a more coordinated effort to join dental and medical care.
Dental care in hospital emergency departments (EDs) provides an excellent opening to improve, integrate, and coordinate care via ACOs or other kinds of clinically integrated networks. The majority of ED visits for dental care involve only symptomatic management, with prescriptions for antibiotics and analgesics. While timely for the patient, such care bypasses definitive treatment, fails to address the source of infection, and increases costs associated with that tooth’s eventual treatment.
Most ED dental visits are financed by Medicaid or self-paying patients. In 2012 these visits accounted for nearly 2 percent of all ED visits, consumed $1.6 billion—roughly 3 percent of all ED expenditures—and averaged $749 per visit. It is estimated that 79 percent of ED dental visits could be avoided if preventive care were more routine, translating to as much as $4 million savings to a single state Medicaid program. Realizing such savings helps achieve the triple aim goals of the ACA.