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NBTH: Understanding the State of America’s Oral Health

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Graphic with headshot of podcast speaker and saying The Next Big Thing in Health: Understanding the State of America's Oral Health Featuring Wells Hutchison President and CEO of Delta Dental Plans Association

Published Jan 12, 2023 • by AHIP

The Next Big Thing in Health is a podcast where we explore the new big ideas that will help make health care more affordable, more available, and more effective.

AHIP President and CEO Matt Eyles and co-host Laura Evans were joined by Wells Hutchison, President and CEO of Delta Dental Plans Association, for a wide-ranging discussion on the state of oral health. They covered where the oral health industry stands right now, areas of improvement, and the opportunities this industry has in store for the future.


Eyles:

Hi everyone and welcome to The Next Big Thing in Health podcast from AHIP. I'm your co-host Matt Eyles.

Evans:

And I'm Laura Evans.

Eyles:

Today our guest is Wells Hutchison, President and CEO of Delta Dental. He has some unique and compelling insights about where the oral health industry stands right now, areas of improvement, and the opportunities this industry has in store for the future. It's a great conversation and we hope you enjoy.

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Eyles:

Wells, thanks for joining us here today.

Hutchison:

Thank you for having me. It's a pleasure to see you, Matt.

Eyles:

We always like to go ahead and jump right in with a first question on the next big thing in health, and why don't we maybe just go right to the state of the oral health industry, if you don't mind. I know that the surgeon general hasn't published a report on oral health in a really long time. I think 2000 was the last one. But there's been a lot of progress over the past two decades. And we know that the industry has come a long way and maybe you could share again, just your perspectives about the current state of America's oral health.

Hutchison:

Absolutely, and thanks again for having me. You know, it's great to be able to have the opportunity to message and re-message the importance of oral health and overall health. I'd say there's awakening underway in the United States right now about the critical relationship between oral health and overall health and wellness. And it's something that we're passionate about I and my team and all of the Delta Dental member companies across the country, because we realize the importance of good oral health and the many associations between oral health and overall health and various chronic conditions.

So according to our state of America's oral health and wellness report, which is published by Delta Dental and yes, we filled a gap there with some data and reporting where the Surgeon General may be a bit a bit behind. The good news is that adults and children are making oral health a priority in their daily life and habits. Nearly 90% of children visited their dentist for preventive care last year, which is a little more than the year before. 94% of adults report that they plan to visit the dentist this year. And even during the pandemic, 86% of adults reported that they made it a priority to maintain their oral health, because they see it as an essential part of their overall health. We're also seeing great trends around preventive care at-home oral health care, which is such a huge part of oral wellness is what we do every day on our own. Adults are generally following the recommended guidelines. Most are brushing their teeth twice a day, and flossing, and using mouthwash once a day. More than half of U.S. adults follow the guidelines from our friends at the American Dental Association on replacing toothbrushes, and a vast majority of us are doing a good job with replacing the toothbrush for our children, over 93% replacing every several months for the kids. That's just one of many ways to help demonstrate to our kids the importance of establishing lifelong healthy oral care habits you know when they're still young and those are habits that are gonna follow them the rest of their lives.

We also have research showing that the dental benefits are playing a critical role in improving oral health by making dental care more affordable. About 90% of adults report that they feel their dental insurance helps them maintain good oral health and bring some peace of mind with savings of money. That helps them overall live a healthier life. So we are happy to be to be part of that. Another data point that's interesting is that the ADA tells us that people who have dental insurance are actually significantly more likely to go in for their appointment. So just the reminders and things that they get from their provider, from their dental carrier when they have coverage is important in getting them in for their preventive treatment, which again is so critical to the overall trajectory of their oral health.

On the other hand, it turns out that most people still don't fully realize that oral health is linked to serious health issues. For example, many people didn't know that poor oral health can be linked to strokes and high blood pressure and diabetes. And that lack of understanding is is something that sticks with us despite our best efforts to overcome it but we think that that's moving in the right direction with respect to people's awareness. Another related issue is people still continue to think of the mouth and the body as two distinct parts. You know, historically that's the way that medical and dental schools have approached it is two separate bodies of work, two separate disciplines.

Fortunately, organized dentistry the ADA, and others are working with dental schools to change that and to bring greater awareness of the relationship between oral health and overall health. And the great strides are being made with respect to that so that we no longer look at medical school and dental school and the disciplines that underlie them as separate things but as part of a whole and I look forward to being part of a discussion that will continue that trend.

Evans:

It's such an interesting discussion, Wells, and you bring up stroke and diabetes that in doing research for this, you know, I found that and I didn't know this, that gum disease is linked to also heart, well I knew about the heart disease, but osteoporosis, rheumatoid arthritis, respiratory disease, and then I also read that researchers have found that people with gum disease were twice as likely as others to die from a heart attack and three times as likely to have a stroke and you did mention stroke. But I mean, just all of these other health you know, these health issues that are related to oral health so it's the why behind exactly what you're saying. You know, and interesting to know that gum disease is the most common chronic inflammatory condition in the world, but it's a silent disease. We just don't talk about it a lot.

So it's interesting that oral health facilities are not located in clinics or hospitals that sort of, you know, when you start to think about this, that maybe they should be integrated. Maybe it's also part of the challenge and the opportunity that we have. So should we be integrating oral health into overall health care in a bigger way? And how do we do that? What are your thoughts on that?

Hutchison:

Yeah, so a couple of things. We actually have some research going, some just wrapping up, and others underway. We're in partnership with Harvard School of Dental Medicine, the University of Colorado School of Dental Medicine, and the University of Iowa. And I want to tell you a little bit about those research results. But first, going back to something you said about, about the dentist and the gum disease. I would like to see us elevate the role of the dentist in the person's overall health care journey. You know, a lot of people will skip their annual physical sadly, people seem to do a little better job of getting in for their annual or twice annual dental visits and the gum disease, periodontal disease, other things that a dentist can observe during an oral health exam could be critical in staving off some more serious health conditions, because a lot of times a dentist can see there's anywhere from 100 to 150 different diseases depending on which study you look at, where a dentist is probably the most likely person to see the early signs of that chronic condition. And we need a way to integrate the practice of dentistry with overall medicine so that that data and those observations can be shared from dentists to their friends in the medical side of it through patient-centered home, and other things.

And so yes, the integration of data and results and treatments is critical. And so with respect to the research at Harvard, we're working with Sung Eun Choi, who is evaluating the feasibility of policies to reduce disparities in oral health. At the University of Iowa we're assessing the use of mobile apps to improve oral health literacy and care among caregivers of older adults, and the University of Colorado who is wrapping up some research and reporting to us on a review of the success and the barriers in dental medical collaboration models, which is what I was speaking of a moment ago. And these models will help inform future dental-medical collaboration and integration strategies. So you know, research is a key part of what we're doing.

And at the end of the day, what we're looking for are compelling models to coordinate oral and medical care. You know, for older adults, for children for pregnant women, and those in need of chronic disease management, the studies are showing that medical-dental integration can elevate the outcomes of their care. And these models, we have strategies to integrate care based on the needs of the patient and the providers. Some of it involves co-location that you mentioned of having medical and dental practices in a shared space. Some are integration models through technology where providers can collaborate directly with each other and create a back-and-forth flow of information and referrals, which is so critical if you've ever had a loved one or a parent trying to navigate our healthcare system in the United States, you need an advocate, you need a communicator just to connect all the different people on the medical side, let alone between medical and dental.

So, we've got a ways to go. The good news is there seems to be a recognition within the provider industry and amongst carriers and amongst the general public that we need to do better with this integration and realizing the problem of course is the first step towards solutions.

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Evans:

Let's talk about another challenge in the health industry you know as a result of the pandemic and even going into the pandemic before it. We had a shortage of healthcare workers and it's kind of on steroids right now. In fact, according to a 2021 report by the industry market analytics firm Mercer, by 2025 there will be a shortage of more than a half a million healthcare professionals, which is really alarming. On top of all that, all aspects of health care need to make sure that the workforce matches the population it serves. So what are the workforce challenges facing your industry both in terms of meeting demand but also meeting the populations you serve?

Hutchison:

Yeah, there's a couple of things you put your finger on. Just the general shortage of oral health care and health care professionals and the support staff, the hygienist, and the other practitioners that are so critical to a successful plan of treatment and a successful practice. We just don't have enough people going into the professions. The people that are there are sometimes just part-timers for various reasons relating to the pandemic, maybe combination of working in the office place but also wanting to be home with family and realizing the priority of that. And so we don't have enough hours of treatment for people coming out of medical and dental school.

Another challenge which Delta Dental is addressing and working with our fellows in the dental profession to address is that the pipeline of individuals entering oral health professions is just not diverse enough. Minorities and underrepresented people, Black, Hispanic and others in this country, just historically haven't gone into the oral health professions and as a result, there's a real lack of people of color and minorities in the dental space. And the reason that's so important is because there's research which shows that when a minority person doesn't have the opportunity to ever be treated by a person of a similar background, their outcome is just not as good. You know not to put too fine a point on it, but a young African-American woman trying to treat with an obstetrician for example is a 62-year-old white male is an example of something where there's some disconnects with respect to the backgrounds and understanding and health habits and all the social determinants of health that go into that. And that disconnect can often lead to a subpar outcome. The same thing in the dental space with not enough...And trust issues too and all manner of things that go into that. And so one thing we're looking at and we've made a commitment to nationally is to fund grassroots programs that are focused on exposing minorities at a much younger age, to the oral health care profession, whether it's dentist, hygienist, technician, other office staff that are so critical to a successful practice, because we need to expose people a young age so that they understand it's a realistic life path for them to pursue a profession in dentistry, where for many of them up to now they haven't thought in those terms. And so that's a critical part of an overall pipeline that includes scholarship money for people to go to dental school. But it doesn't matter how much scholarship money you have, if you haven't exposed people at a young age to the profession to look at that as a realistic life path and to position themself to be able to succeed in dental school or dental hygiene school. And so these things have to go hand in hand the scholarship money but the much earlier exposure. And so we're looking at several grassroots programs across the country where they do just that, they expose people at a young age. And when I say young I'm talking sixth, seventh, eighth grade for people to look at that as a realistic path for them going forward.

Eyles:

So, Wells, you've touched on, I think some important, you know, solutions there to some of the problems and to hear you describe it, it reminds me of some of the other challenges that we've heard about or we know that we're facing, for example, in the area of mental health, and money is not just going to solve this problem, right? We can throw all the money at this problem and you can't just mint new dental oral health professionals, right. It's going to take time it's going to take other investments. So what types of investments can we make in the oral health workforce to address the challenges that impacts all aspects of healthcare? And you touched on a really important one, including health equity?

Hutchison:

Yeah. So clearly, investing in partnerships with institutions that serve minorities, such as historically Black colleges and universities, and Hispanic-serving institutions, and other institutions of that nature is critical. But then the other thing is to start, as I say, getting people exposed at a very young age, which really is a grassroots roll-up-your-sleeves, get out there. I don't look at it as a huge boil the ocean thing, it's not a top-down approach. And as you say, Matt, no amount of money will fill this gap, this diversity gap that we have within the healthcare professions. If we don't have the exposure at a young age, you know in an elementary school setting, really to get people to think and for them to see practitioners from similar backgrounds.

There's a wonderful program that we're exploring in Tennessee called Determined to Be a Doctor Someday, where a woman of color has gone through the training and become a medical practitioner, and she's now back in the city of her roots in Memphis, working with underrepresented kids, who probably most of them never were exposed to medicine or dentistry as a profession that was a viable life path for them, and she's showing them it yes it is. And the more these children see that people from similar backgrounds have succeeded and gone into the professions and are making living and changing people's health for the better, the more likely they are to consider that as a career for themselves.

So these are it's a patchwork to start with, of wonderful grassroots organizations across the country, and as we bolster those and they get legs, we'll be able to stitch those together into a more uniform approach to get minorities and underrepresented people into the professions.

Evans:

Let's talk about technology and dental care. Can you give us some insight, Wells, on what Delta Dental has seen in recent years in terms of opportunities for improvement, and maybe what's on the horizon, incorporating technology into dental care?

Hutchison:

Yeah, so there are a couple of things I mentioned earlier about electronic health records and the need to have interoperability of those records between different disciplines of medicine, but also between institutions and between medical and dental. And it's a big lift, and it's expensive, but we've got to get to a point where we have easy exchange of electronic health records because just critical for all the practitioners to be able to have access to the outcomes of a person's oral health exam or their physical. We have to have that kind of coordination so that we can have meaningful, coordinated treatment of the whole person for treatment of chronic diseases and otherwise. And so, electronic health record interoperability is something that we have to make investments in.

Also telehealth and tele-dentistry, are going to continue to be more popular. There are examinations that can be done remotely. For people who don't have ready access to a dentist, you know, we have large swaths of this country, which we don't think about if we live in a metropolitan area. But within certain states, such as South Dakota for example, you could drop an area the size of Rhode Island and not hit a dentist. We have terrible under representation and lack of access among the Native American population. There are cities, there are rural areas, peppered throughout the country, where there just aren't any dentists, and so having access to telehealth and tele-dentistry to at least do an exam remotely. We're going to continue to be key, and those are things that we are interested in.

Eyles:

Wells, if you've listened to our podcast before, you know what's coming, we're getting down to our last question here, and it's one that we asked all of our guests. So what is the next big thing in health?

Hutchison:

The next big thing in health is for the practitioners, the patients, and the payers, whether that's private insurance or the government, to have aligned interests by having skin in the game. And what that means is to reward all those stakeholders for good health outcomes. Not just diagnosing problems when they arise and then performing procedures to address them. But putting ourselves on a trajectory toward better health from the get-go. Now in dentistry, that's particularly important because so many problems are preventable, are reliant on good habits from an early age. And so we're gonna get to a point where, through co-ownership of our delivery models, we're gonna all have skin in the game and be pulling with the same war. And we're going to start to look at our health as an asset like anything else, like you could look up the value of your home or what's in your retirement fund or how much you've put away for your kids' college education.

We will start to measure and assess our own overall health and start to view that as an asset, to be protected and to be nurtured and be grown over time and to reward ourselves for doing well in that area. Which is a contrast of what we've historically done here in the U.S., which is to wait for problems to arise and then address them.

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Eyles:

Isn't that so true? And this has been great speaking with you today, Wells, thanks so much for being with us today.

Hutchison:

Hey, it's been a pleasure. And thanks for all your hard work.

Evans:

Great conversation, Wells. I really hope that this conversation in your industry continues because I think there's so much here and it would really be great to see some of these solutions come to fruition.


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