Dental Practice Integration into Primary Care: A Microsimulation of Financial Implications for Practices

Abstract

Given the widespread lack of access to dental care for many vulnerable Americans, there is a growing realization that integrating dental and primary care may provide comprehensive care. We sought to model the financial impact of integrating dental care provision into a primary care practice. A microsimulation model was used to estimate changes in net revenue per practice by simulating patient visits to a primary dental practice within primary care practices, utilizing national survey and un-identified claims data from a nationwide health insurance plan. The impact of potential changes in utilization rates and payer distributions and hiring additional staff was also evaluated. When dental care services were provided in the primary care setting, annual net revenue changes per practice were −$92,053 (95% CI: −93,054, −91,052) in the first year and $104,626 (95% CI: 103,315, 105,316) in subsequent years. Net revenue per annum after the first year of integration remained positive as long as the overall utilization rates decreased by less than 25%. In settings with a high proportion of publicly insured patients, the net revenue change decreased but was still positive. Integrating primary dental and primary care providers would be financially viable, but this viability depends on demands of dental utilization and payer distributions.

How Patient-Centered Medical Homes Integrate Dental Services Into Primary Care: A Scoping Review

“…Demonstrating value is especially important for adults whose oral care is not evidently financially viable within the current health insurance reimbursement models. Some recent simulations have illustrated the financial viability of dental care integration in primary care by showing that the net revenue per annum remains positive after the first year of integration, even though the amount of profit can vary with the overall utilization rates and with the proportion of publicly insured patients (Choi et al, 2020). While there are real world examples of cost-effectiveness of integrating activities for pediatric populations, such as the IMB program of North Carolina (Stearns et al, 2012), similar real-world evidence will be important to make a business case for dental–medical integration for adults.…”

Modeling the Impact of COVID-19 on Dental Insurance Coverage and Utilization

“…With the expected changes in insurance coverage, we estimated changes in dental procedures at a general dental practice, using a previously developed microsimulation model, which uses nationally representative data on dental utilization patterns by insurance type ( Choi et al 2020 ). We estimated changes in the number of dental-related ED visits due to the change in insurance coverage by obtaining the rates of dental-related ED visits among private, Medicaid, and uninsured populations based on a prior analysis of the Nationwide Emergency Department Sample (NEDS) ( American Dental Association 2019 ).…”

The Changing Face of Dentistry: Perspectives on Trends in Practice Structure and Organization

“…Medical and dental integration can be limited by the lack of appropriate cross-discipline training and available time among dental and medical providers, the lack of electronic record interoperability, and insufficient insurance coverage. Providers have reported a lack of information about treatment guidelines outside their existing scope of practice, as well as the need for sufficient training and available time to integrate new services into busy workflows (Adibi et al 2020; Choi et al 2020).…”