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The Missing Piece In Health Care

The Missing Piece In Health Care

Mariya Filipova, Chief Innovation Officer at CareQuest Innovation Partners.

Reflecting on my time at CareQuest Innovation Partners, I realized there’s one question I’m frequently asked: Why oral health?

The simple answer: Because there is so much opportunity.

Nearly everyone understands the importance of keeping teeth and gums healthy, but many don’t understand how oral health impacts the rest of the body, or how much we could save in total health care spending by closing big oral care gaps in the system.

Gaps In Oral Care Cost Us Billions In ED Visits

Today, many of the 76.5 million Americans without dental insurance cannot afford routine dental care. This often leads patients to seek medical attention for preventable conditions. In 2019 alone, we saw 1.8 million emergency department (ED) visits for non-traumatic dental conditions.

Although significant, the rate of ED visits for non-traumatic dental conditions has actually decreased since 2014. Here’s the catch: The average annual charges associated with these visits have increased by 62%.

At a system level, we spent $3.4 billion on ED visits that are largely preventable when people have access to routine oral health care.

A staggering amount. Yet, given everything we could do to rein in our trillion-dollar health care spending in the U.S., why should we focus our attention on oral health?

In trying to answer that question, I found experts who share the belief that oral health is critical to overall health, and who would typically point out the following.

Our mouth is the gateway to our body. As the start of the digestive tract, what happens there impacts our overall health. In fact, many inflammatory diseases that cause the disruption of our systemic health have been directly linked to chronic inflammation in the mouth.

Chronic inflammatory disease in the mouth, or periodontal disease, can expose parts of the body to various illnesses or symptoms. One of the bacteria that causes these diseases—P. gingivalis—is one of the seven most aggressive bacteria that causes inflammation of the mouth. Scientists like Dr. Hatice Hasturk have found this lethal, toxic bacterium in the carotid artery that supplies the brain with blood, and in patients who suffer from various diseases including Alzheimer’s disease, pancreatic cancer, leaky gut and inflammatory bowel disease.

So, when we think about those conditions, and how these pathogenic bacteria in the mouth travel to the rest of the body, we start uncovering what Jonathan Levine, DMD, describes as a linked, intricate network of bacteria highways that allows bacteria to travel from our mouth throughout the body. This can lead to a variety of serious, costly conditions.

Investing In Systemic Health

The evidence is clear. Oral health is foundational to the health of the rest of our bodies. But the majority of our care delivery, administration and payment models do not currently reflect this connection.

The common misconception is oral health solutions are scarce, expensive or difficult to integrate into the overall patient journey. But there is no shortage of cost-effective solutions available to integrate into and augment existing workflows and care teams. Savings associated with integrating oral health care into broader patient care are real and achievable for health plans, employers and the system at large.

At a payer level, looking at gum disease and diabetic patients alone, incorporating periodontal treatment in diabetes management programs is associated with reduced overall health care costs in Medicaid and commercially insured patients. For commercial plans, periodontal treatment was associated with reduced overall health care costs for diabetic patients of 12% compared to diabetic patients with no periodontal treatment. For Medicaid patients, the reduction was 14%. The total cost of care goes down when patients receive appropriate oral care.

For self-insured employers, six years of claims data analysis done by Guardian show that employers who invested in preventive procedures such as extra cleanings for their employees and oral health education spent 39% more on preventive care over a six-year period, but 86% less on major and restorative dental services (e.g., fillings, crowns, implants, etc.). Employers save when employees use preventive dental benefits.

For employers, this is also a productivity issue that disproportionally impacts diverse and low-wage-earning employees. Studies show that Latinos are 52% more likely to report having difficulty doing their job due to poor oral health. People living in poverty are 102 times more likely to report having difficulty doing their jobs due to poor oral health. This adds up to millions of workdays and an estimated $1.6 billion lost in productivity yearly.

With the clinical connection and cost-of-care in mind, I see an abundance of opportunities for executives and investors. It begins with putting the oral-systemic health connections on the executive agenda and a set of starter questions.

For employers, what is the total cost of care for my employees?

• Are we looking at specialty care (vision, dental) separately from medical claims?

• Are we incorporating the fully loaded costs (i.e., productivity and absenteeism) into that analysis?

• Are all our employees experiencing that cost equally across ethnicity, pay scales and zip codes?

• For health care investors, are my existing portfolio companies tapping into the opportunities in oral health?

• Am I considering oral health companies in my pipeline? For the second year in a row, we’re running SMILE Health—the only systemic health accelerator. We received over 100 high-quality applications each year: 90% of them new submissions, 20% from medical and other industries, and 50%-plus with granted patents and proprietary IP. There is no shortage of high-quality, early-stage companies to consider.

• How am I keeping up to speed on where the oral health industry is trending? With 176bn and 7% ARR, there are so many opportunities to look into: care coordination; delivering care in the community rather than in a clinical setting; and next-generation innovations like salivary diagnostics.

Investing in the mouth-body connection and integrating oral health into overall health care practices opens opportunities for entrepreneurs as well. In the next part of my series, I’ll share specific examples of promising companies’ solutions in the areas above.

In the meantime, I leave you with this question: Why not oral health?

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