The Group Dentistry Now Show: The Voice Of The DSO Industry – Episode 41

The dental & medical teams at Humana have joined forces to address a huge barrier to care – social determinants of health or SDOH.  SDOH are often the root causes of why people don’t achieve their best health outcomes. SDOH, especially food insecurity and loneliness, are increasing due to the pandemic. The team presents the problems faced by patients, dentists, & dental organizations and offer practical solutions which can be implemented immediately. If you are a dental, hygiene, or medical school student or resident, clinician in any phase of your career, or work for DSO/dental group in any capacity, this podcast is for you!

Our podcast series brings you dental support and emerging dental group practice analysis, conversation, trends, news and events. Listen to leaders in the DSO and emerging dental group space talk about their challenges, successes, and the future of group dentistry.

The Group Dentistry Now Show: The Voice of the DSO Industry has listeners across North & South America, Australia, Europe, and Asia. If you like our show, tell a friend or a colleague.

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Full Transcript:

Bill Neumann:

I’d like to welcome everybody to The Group Dentistry Now Show, I am Bill Neumann. And we have three distinguished guests here today, and this is going to be a really interesting conversation. Topics that we really haven’t discussed here on the show, so I think it’s really important and it’s very, very timely. We have three doctors with us today from Humana. We have Dr. Dean Fry. We have Dr. Andrew Renda and Dr. John Yamamoto. And I’ll give you a little bit… First off, gentlemen. Thanks for joining us here. We appreciate it. Give you a little bit of a bio on each individual, and then we’ll get into the Q&A. So first up we have Dean Fry, who is a DDS. And he earned his bachelor of science degree in biology from Abilene Christian University in 1987. And his DDS degree from the University of Texas branch in Houston.

Bill Neumann:

Dr. Fry was in private practice until 2001. During the course of his 29 plus years in the dental industry and dental benefits industry, Dr. Fry has consulted for PricewaterhouseCoopers’ healthcare regulatory group, working with a variety of healthcare entities across the nation. While still in practice, Dr. Fry began working with the health insurance industry back in 1999, helping to define utilization measures, access standards, plan development, and oral health standards. Utilizing clinical knowledge and experience coupled with data analytics, Dr. Fry and his team remained focused on oral health, wellness, and life long well-being for the entirety of a Humana membership. So Dean, thanks for being here.

Bill Neumann:

Next up we have Dr. Andrew Renda. So Dr. Andrew Renda is Humana’s associate vice president of Bold Goal, that’s population health. And we’ll tell you what Bold Goal is in a second. His work includes bleeding, strategy, pilots, metrics, research, and knowledge, management tools and communication related to making progress towards Humana’s Bold Goal of improving community health by 20% by 2020. CDCs Health Days survey instrument is used as the primary means of assessing population health. This is supported by clinical leading indicators, business performance metrics, and a robust research agenda that drives insights on how best to improve community health. He is a published author and speaker in the fields of population health, social determinants of health, which we’ll discuss in great detail here on the podcast, and chronic disease.

Bill Neumann:

Dr. Renda has a BS in psychology and biology from the University of Kentucky, where he was a National Science Foundation undergraduate fellow. He received his medical degree and a diploma in clinical psychiatry from the Royal College of Surgeons in Ireland, followed by a master’s in public health from Harvard University.

Bill Neumann:

Last but not least, we have Dr. John Yamamoto. He is a dental director at Humana. After receiving his DDS from UCSF in 1992, he spent seven years in private practice in Southern California. From this private practice experience he developed an interest in the issues of quality and access to dental care and returned to school. Dr. Yamamoto completed a master’s in public health and health services policy from UCLA in 2001, and completed a dental public health residency from UCSF in 2003. Dr. Yamamoto joined the UCLA School of Dentistry faculty and served as an adjunct assistant professor in the division of public health and community dentistry, and dental director of the UCLA Venice Dental Center from 2001 to 2008.

Bill Neumann:

Dr. Yamamoto left academia for the dental insurance industry. Prior to joining Humana, he served as the dental director and vice president of professional services for Delta Dental of California and its affiliate companies for 12 years where he was responsible for quality assessment, utilization management, dental policy, and research. So those were some deep bios there. So thanks gentlemen. I also want to mention this, that I forgot to mention that Dr. Fry currently serves as the chief dental officer for Humana, heading up clinical quality and analytic teams, which continue to make strides in oral health protocols, indicators, and oral health integration. So Dr. Fry, can you go into a little bit about your role at Humana?

Dean Fry, DDS:

Cheers. Thanks for having us Bill, we really do appreciate it. As the chief dental officer at Humana, really the role is really clinical and business guidance relating to the dental industry for the company. And certainly that’s inclusive of oral health and overall health, how that integrates into what we do at Humana with regard to caring for our members. And so we do things like implementation of initiatives in and around maybe members with diabetes, to help improve their health. Member messaging and education, that really helps educate our members. And the clinical team really work hand in hand with a lot of different entities within Humana, not just on the dental side, in order to help improve our members’ overall health. And certainly pilot new things that we can, whether that be plan design, or the use of codes in ways that really help our members improve their health. And that’s really the crux of my role, is really providing that guidance to help and aid our members improve their oral health and overall health.

Bill Neumann:

Dr. Renda, can you talk a little bit about what your role is? You are the associate vice president of Bold Goal. Talk to us a little bit about that. And it sounds like 2020 is the year, so talk about Bold Goal and your role there at Humana.

Andrew Renda, MD, MPH:

Sure, absolutely. Thanks Bill. So this is Andrew Renda, I am the AVP of population health. And what I really get to lead is our Bold Goal. And our Bold Goal we declared back in 2015, and that is to improve the health of the communities we serve by 20%, because we make it easy for people to achieve their best health. So there’s a lot baked into that. It starts with improving health related quality of life, which as you said in my bio, is we base that on the CDC Healthy Days measure? I think it’s a really neat measure because it balances both physical health and mental health. And it’s a nice self-report measure.

Andrew Renda, MD, MPH:

So we start with that. And then what the strategy really is about is about going upstream and addressing those social determinants of health with a view of improving health outcomes. So we do that in a number of different ways. There’s informatics work streams, there’s insights and research, strategy and execution, where we deploy pilots and interventions and benefits to try to improve these things. And then there’s a thought leadership component. We really want to be out there and speaking and advocating both on a policy level, but also just on a general industry thought leadership level. Really, to eliminate the fact that social determinants often are the root causes of why people don’t achieve their best health outcomes. And so we want to address them so that they can.

Bill Neumann:

Next up we have Dr. John Yamamoto. And tell us a little bit about your role as the dental director at Humana.

John Yamamoto DDS, MPH:

Thank you for having me Bill. My role as dental director, I’m really focused right now a lot on utilization management and claims, but also supporting Dr. Fry’s initiatives around improving oral health and overall health, and supporting the Bold Goals that Humana is launching. Really, it’s trying to implement the projects that Humana has developed.

Bill Neumann:

This is the beginning of the Q&A, and there’s some really… They said some of the topics that we’re going to discuss, I think are really important. And we’ll start off with Dr. Fry, and want to discuss what you’re seeing as an organization in terms of dental health relating or impacting overall health. I mean, it’s one of those things that we’ve known for quite a while in the dental industry, they’ve been tied together. Really interesting with COVID, and how there were certain procedures that were considered essential versus non-essential. And I think a lot of people said, “Hey, dentistry’s essential and it’s tied to overall health.” And I think that message really needs to get out there. But what is Humana seeing as far as how dental health is relating to overall health, or how it impacts overall health? Dr. Fry.

Dean Fry, DDS:

A great question. I think that you’re exactly right. I mean, I think it’s been talked about for a lot. It’s something that we’ve inherently known, that oral health relates to overall health. And it’s sad. I think now it’s really coming to light even more, the true importance of overall health and how oral health relates to that. And we’re seeing that with regard to mostly during the COVID season, we’re seeing those things. They say, “Oh, well this is essential. This has to be done in order to help members stay healthy.” And so, we worked with things like tele dentistry and things like that to help the members have access to care if they couldn’t get to the office. And really be able to speak to clinically what’s going on, and help them in that way.

Dean Fry, DDS:

But I think one of the real movements, we’re also seeing one of the critical components is the health record. Having a dental health record is so now terribly important with regard to being able to create that consistency across the health care regimen. Not just for the dental provider, but also for the medical provider. And I think that especially is true in areas where there are things that we call comorbidities. People may have certain chronic elements, like maybe diabetes or cardiovascular disease. And being able to see what’s going on from an old health perspective from that health record, and being able to share that and transfer that across the spectrum of care is hugely important. Because as, Bill, as you said, and as we stated and as we’ve been studying, it ties together. And the importance of having that information is critical.

Dean Fry, DDS:

And we know that research shows that as many as 120 systemic diseases actually present themselves or show signs in the oral cavity. I mean, that can be anything from cancer, to dry mouth, pneumonia, bacteremias, all sorts of stuff like that. And especially periodontal disease. I mean, that is one of the critical components about inflammation in the body. And really, what we’re seeing is, and what is becoming even more true, is the mouth really is a window into what’s going on. And oftentimes we know that members will see their dental provider, their dentist more often in a year than they see their healthcare provider. So it could be that something gets seen there in the dental office as a gatekeeper that is critically important to their overall health that the physician absolutely has to know about. And so when you get into things like risk factors and chronic diseases, and cardiovascular disease and cerebrovascular disease, and even things that show up with regard to eating disorders. And we talked about certain cancers, Sjogren’s syndrome, it shows up as dry mouth and yet affects other organs in the bodies.

Dean Fry, DDS:

There’s a lot of stuff that we see that goes on in the oral cavity that’s critically important to oral health. And so as we look at that, and we look at, how do we help facilitate that? Being able to capture that and be able to share that across the spectrum of care is hugely important, and certainly something that we’re working on.

Bill Neumann:

We understand the connection. What about the population? How do you educate the population? This is for Dr. Yamamoto. And then how do you incentivize them? How do you make it important to them? Also curious, to maybe build on that. Do you have any understanding of how much of the population even understands the connection? I mean, has there been any studies done on that? That would be interesting.

John Yamamoto DDS, MPH:

Yeah, that’s a great question. This year is the 20 year anniversary of the US Surgeon General’s report on oral health, which really was the landmark study that put a focus on the connections between oral health and general health. Right? The takeaway message from that report was that you can’t be healthy without good oral health. And that oral health is integral to overall health. And they’re working on the 20 year updates, so I’m really excited to see that come out, and read it when it’s published. But I think that will be just as powerful as the first report in launching the dental profession, as well as the rest of the healthcare profession in taking a lot of the information of where we were and where we are now, and where we’ve had successes. And I think that would be a good launching pad to really start to educate the population.

John Yamamoto DDS, MPH:

I know that most people don’t read the Surgeon General’s report, but really it does become a valuable resource for anybody interested and involved in healthcare. But importantly, Humana really does recognize the valuable role that dentists play in overall health. And most people don’t think of going to their health insurance as a place for health information. And so we look to our dentist partners, our dental provider partners, to really play a role in educating and incentivizing patients and members to understand the role of oral health and overall health. One of the ways we can do this is really by creating dental plans that address the connections between oral and systemic health, which is really making sure that the periodontal care and treatment is up to the standards that would be able to maintain good periodontal and overall health. Health promotion in terms of promoting annual exams and prevention visits, really to drive patients for regular care really helps improve early detection and intervention.

John Yamamoto DDS, MPH:

And as Dr. Fry had noted, there are so many other things that dentists could be looking for in the oral cavity. And I think that, again, you mentioned during COVID. There’s opportunities of, what role can dentists play in the future? We’re talking about salivary testing for COVID. And I was thinking, why couldn’t dental offices be screening, or places where more general health types of activities can go on? You’re seeing that in other states as well. But really, I think that in terms of what the overall… Your second question was, what does the overall population know about these connections? And I think in my experience, I think there’s a much greater understanding. I think we see reports in media and in the news of the connections. I don’t know if it’s as well known as we’d like it to be, but I think, again, we need to keep pushing that oral health is just as important to your overall health has other parts.

Bill Neumann:

Let’s pivot a little bit here, and this is for Dr. Renda. Let’s discuss social determinants of health. That’s something that I think most dentists might sort of understand, but they may need the definition. So I think it’s really important to highlight that, and then as we tie it into dentistry.

Andrew Renda, MD, MPH:

Yeah, Bill, I think that’s a great question. And I think it’s really, really important to go back to basics and first principles, and always define our terms. So social determinants of health, here’s the definition. The conditions and the environment in which people are born, live, learn, work, play, and worship, and age, that affect a wide range of health functioning and quality of life outcomes and risks. So what that really means is that they are the barriers to health upstream from our traditional healthcare system. So that’s everything from poor education, low income, lack of transportation, food insecurity, loneliness, social isolation, and there’s a host of other ones. Okay, so there’s a lot of them there. But the context that’s really important is that the reality is research has shown us that 60% of what creates health actually has to do with the interplay between socioeconomic, community environments, and lifestyle behaviors. Right?

Andrew Renda, MD, MPH:

And it’s really only 10% of the contribution to your health is made up of medical care. But we spend 90% of our healthcare dollars on medical care. So there’s this mismatch in how we allocate our dollars to what actually makes us healthy. Okay? And so we learn that social determinants are really key, in that they are really a key part of that 60%. And so, just some statistics to back that up. One in nine Americans doesn’t have enough healthy food to live basically an active life, so they’re food insecure. One in five Americans, either always or sometimes feels lonely or socially isolated. 3.6 million Americans every year don’t obtain the medical or dental care that they need because of a transportation barrier. Right? So those are pretty stark statistics that I think we should all be aware of, and research only gets you so far.

Andrew Renda, MD, MPH:

And I can tell you from experience, sometimes you have to prove it out in your own populations, your own patients, your own data. And so we did just that. We actually took a comprehensive social determinant screening instrument, the Accountable Health Communities screener, and we screened over 100,000 of our members and ask them all these questions. And what we found is that in our own membership, so Medicare Advantage, Medicaid, we found that 41% of our members had a financial strain, 29% are lonely or socially isolated, and 26% are food insecure. So this is not just an abstract concept, this is a reality of in our own membership and our own patients, these issues exist. And they’re really, really critical to health outcomes, and so we need to figure out how to address them.

Bill Neumann:

So, Dr. Yamamoto, what is the opportunity for dental health professionals to really contribute to that whole person health and screen for the social determinants of health?

John Yamamoto DDS, MPH:

Dr. Fry kind of touched on this earlier, but dentists are often one of the first lines of detection and treatment for people. Dentists often see patients much more frequently than their physicians, especially in adults who go to get a cleaning or go for regular visits. They often go more frequently than going to see their physicians. And so dentists, just like primary care physicians, have an opportunity to really engage with their patients and talk to them about concerns, not just about oral health, but overall health. We take a comprehensive medical history, and we do talk about all of the health issues that could be impacting their life as part of routine dental exams. And so dentists can play a role in identifying at risk patients, or patients who are having some issues with social determinants of health. And during these visits they can create an opening to really have conversations about other issues that may be affecting their overall well-being. Dentists can not only flag the clinical problems, but really, talk to their patients about other issues like health, overall health and food insecurity with their patients.

Bill Neumann:

So let’s get back to the SDOH, and then specifically in regards to food insecurity. What were you seeing? And now with the impact of COVID, how has that impacted the SDOH? And specifically in regards to food insecurity, what are you seeing? I’m just curious as to how COVID, it’s certainly had to have had an impact. Dr. Renda?

Andrew Renda, MD, MPH:

Sure, absolutely. I mean, I went through some of those statistics before, that was pre-pandemic. And we’re still in real-time in the pandemic, so it’s hard to say exactly how that’s changed. But what I will say is, for many people, social determinant issues existed prior to the pandemic. And then when the pandemic happened, they get exacerbated. And in other cases, people who didn’t have social determinant issues now have new ones because they’re socially isolated because of quarantining and lockdown and type mandates. Or they’re food insecure either because they lost a job, or because, frankly, they’re afraid to go to the grocery because of the virus. So we fully expect these rates to go up and get more complicated and exacerbated in those that already had the issues. So that’s kind of what we’re seeing.

Andrew Renda, MD, MPH:

Now, the reason that’s important is that loneliness has been associated with anxiety, depression, other behavioral health conditions. Food insecurity, similarly, has been also associated with a lot of different chronic conditions, both with the onset and with progression of conditions where they already exist. So that’s the context we need to put this in. Is if the situation was bad before, and it’s worse now. And so if we dive into food insecurity for a minute, again, I like to go back to basics and define terms. So food insecurity to us is a condition defined by limited or uncertain access to sufficient, nutritious food, to live an active healthy life. For any dentists out there, we recommend using the USDA Hunger Vital Signs food insecurity screener. It’s just two simple questions, as a really nice short, but validated way of assessing for food insecurity.

Andrew Renda, MD, MPH:

And food insecurity, it disproportionately affects low income communities, communities of color. And so that’s another reason we put a health equity lens on it, it’s something that we’ve really need to focus on and address. So getting back to your question about, what’s happening because of the pandemic? Well some early evidence from the National Institute of Health suggests that food insecurity is indeed getting worse. They had some statistics to show that household food insecurity has risen from 11% in 2018 to 38%, sort of at the mid point of 2020. And then there’s a statistic that in April of this year, that 35% of households with a child aged 18 and under were food insecure. And so that’s really, really significant, so that’s over a third of households with children have a degree of food insecurity. So, like I said, many were suffering before, many are suffering worse now. Or not having done it before, are now suffering from something like food insecurity.

Andrew Renda, MD, MPH:

And that’s just something that we really need to address because it both can cause and exacerbate other chronic conditions and worsen your overall health related quality of life. So the next question from that, literally to me and to others in our organization is, what is Humana going to do about that? And frankly, when COVID first happened we got a big group of folks together and we really decided that, okay, well the first things we need to do is ensure continuity of care. We need to make sure people have medications on-hand. So we eliminated copays and we expanded telehealth benefits, and did a lot of that kind of stuff. But what we found is, many of our members were calling in to call centers and things like that and saying, “That’s great and really important, but I’m food insecure now because of this virus. And we’re afraid to go to the grocery. I don’t have transportation, lost my job.” Whatever it is.

Andrew Renda, MD, MPH:

And that was on the order of, first it was a trickle, and eventually it was over 2,000 people a day were calling us in saying they’re food insecure. So we stood up what we call the basic needs program, which was, once we have an eligibility and all that kind of stuff, we had to figure out. We’d screen for food insecurity. And if somebody was food insecure, we built a program that could deploy a meal kit to deliver meals that would cover two weeks as a bridge to figuring out other community resources, and things like that. And you could reorder and so forth. And since we stood that program up back in March, we have deployed over a million meals to over 65,000 patients. And that’s something that is huge numbers and something that I’m really proud that we were able to do. But it also just blows you away that that many of our own patients that we’re responsible for are actually suffering from something like food insecurity.

Bill Neumann:

And Dr. Yamamoto, did you have anything you wanted to say on this?

John Yamamoto DDS, MPH:

Yeah. In the sense of, from a dental office perspective, food insecurity really probably isn’t something that’s a common topic in a dental office, or would you expect your dental patients to have that as a topic. But in dentistry we often talk about nutrition and diet. And I think that as part of that conversation, using those simple questions that Dr. Renda had talked about, dentists could be able to be able to screen for food insecurity and offer resources and referrals to individuals that they identify. So I think that there is opportunity here for dentists to participate and help.

Bill Neumann:

Dr. Fry, based on that knowledge, what are dental clinicians at Humana doing to help build plans and support efforts for dentists?

Dean Fry, DDS:

Great question. And certainly, we as clinicians leading the clinical team, we’ve created patients with ourselves. So it’s something that I value a lot in having been there. And, how does a dental practice work? How do you care for patients? And I think one of the things we’re doing is, first, getting educational pieces, like being able to do this podcast and talk about it, and help share that knowledge. But also working with Dr. Renda and his team on, how can we plug dentists into social determinants of health? How can we help educate them? How can we give them tools to be able to really capture that with regard to that being a part of the way that they deliver care?

Dean Fry, DDS:

And then, when you talk about the plans themselves, looking at ways to ensure that we’re promoting that overall health, that we have the coverage, that we meet within those plans, that the plan designs make sense. Make sense in the way a dentist would administer that plan and provide that care. And I can tell you that one of the things that we have with regard to that is, in our plans, is that we have one of the things called an extended annual maximum. And what does that mean? What that means is, is that when somebody reaches their maximum allowable, then in other words, oh, your benefit ends right here. We actually extend that and provide some coverage for them to continue treatment that’s needed.

Dean Fry, DDS:

We don’t want them to have to put that off. So we had know roughly 17,000 members use that extended max in 2019 to allow them to continue the care that they need. Adding things like extra cleanings in some of our plans that allow members that need to have more than one or two cleans a year. So they can go and get and get those, up to three cleanings a year, to help promote that prevention. And really focusing on that preventative care that is provided, and helping keep that focus. And then certainly covers for periodontal services, which is so important. We talked about how it really connects to other things, other disease states, and what we see in that. And the inflammatory process in the body and providing coverage for that. And full coverage for that in some of those plans. And allowing things like four periodontal maintenance cleanings a year, to be able to get that done and having thousands of members use that benefit. Because with periodontal disease being a chronic disease, that maintenance piece is hugely important to helping them not only get healthy, but remain healthy.

Dean Fry, DDS:

And so providing that type of coverage, and having nearly half a million members use their dental benefits just in 2019, is something we’re going to continue to support. And continue with those plan designs to really promote health and overall health, keeping both the provider and especially the member in mind for those plans, and what that does to help deliver care.

Bill Neumann:

Dr. Renda, this one’s for you. In regards to Humana’s approach to the STOH that we’ve been discussing, and then also population health, can you give us a little bit of background, what is that approach?

Andrew Renda, MD, MPH:

Sure, absolutely. And I think about this a couple different ways. But first and foremost, I think Humana has a really unique viewpoint into this space. Because we’re a dental insurer, certainly, but we have a medical parent, so to speak. So we get an insight into someone’s clinical issues and dental issues, and other things. And so what we really try to do is take what we call whole person health approach. That’s the bio-psycho-social model, but thinking about all those things, clinical risk, behavioral risks, social risks, and understanding somebody as a whole person. So Humana itself, we have a big Medicare Advantage plan.

Andrew Renda, MD, MPH:

And what comes with that plan is a number of benefits and services, which include your typical things like disease management, nurse hotlines, and transportation assistance, meals assistance in some cases, and dental care. Right? So that’s the big picture. Now if I could do a really quick deep dive into our population health and social determinant strategy, I think about this as a core and as some concentric layers out that build our strategy. So at the core we have what we call a social determinant care continuum that works around prevention and risk assessment, clinical treatment, social interventions, that kind of thing. And then a layer out from that, is I really feel like we need to build what I call a social health infrastructure. Which includes things like data, data governance, and understanding populations through that, data ecosystem, community engagement.

Andrew Renda, MD, MPH:

So really important that we work with community-based organizations. And policy advocacy. So once we establish that infrastructure, we go one layer out from that, and that’s where it becomes really incumbent on us to deploy evidence-based scalable solution. So those are the pilots that we do that we hopefully will scale into programs and benefits, and offer them more people on a longer term sustainable basis. But all of that is predicated on getting the health outcomes that we expect from these interventions. So it’s important to have good study designs with control groups and randomization so we can be really confident in the impact that we generate through these interventions. And then if you go one final layer out from that, I think about this work as being sustainable, if and only if we create a business model, a return on health and a return on investment.

Andrew Renda, MD, MPH:

And so as we find pilots and interventions that work, we try to scale them into other aspects of our business. And so we might put them into supplemental benefits on our insurance products. We might integrate them into risk adjustment models. So traditionally we have an MRA or a medical risk adjustment, we are now developing social risk adjustment models. Another way we can do this is that two-thirds of the physicians that we work with in primary care are in value-based relationships with us. We are now beginning to integrate social determinants into that. So we can incentivize and work with our primary care providers to screen, document, refer. And the same is true with our dental colleagues. So we want that to happen in dental offices as well, screen, documentation, referral to resources when those gaps exist.

Bill Neumann:

Let’s see how we can actually take this discussion and make it valuable for the audience. Our audience are DSOs, and the clinicians that work for the DSOs, or some of the clinicians that actually own the DSOs. So how can the providers at these groups, and this is for Dr. Yamamoto, recognize… So first off, how do you recognize these SDOH? And then secondly, how do you address it in dental patients?

John Yamamoto DDS, MPH:

Yeah. I think, as Dr Renda said, we want dental providers to do just as primary care physicians in terms of screening. And I think earlier in the conversation, I think we acknowledged that social determinants of health is probably not on the top of most dentist’s minds, or even in their vocabulary at this point. I think probably the first thing is really starting to educate our dental providers. I think probably the newer grads who are coming out are probably aware of the social determinants of health, but I think the dentists that have been practiced probably need some CE. Something that I’ve tossed out an idea about how to start to develop some dental CE around this.

John Yamamoto DDS, MPH:

But yeah, first of all is really to educate ourselves as dentists, and learn what social determinants of health are. And really, what we got at Humana are some tools. We can help DSOs in some ways by really providing some of the tools that we have at Humana. We have a population website that has a really clear and concise guide to addressing social determinants of health in patients. As well as food insecurity toolkit, they’re very simple and easy. And I think that, again, I think as we look towards how to include dentistry in value plans, and becoming much more involved in overall health, we do want to bring these types of greening projects and pilots to dentistry as well.

Bill Neumann:

And you really touched on it, there was a second part to the question. Which is, what can DSOs do to support the providers? And I think you’ve really touched on it from an educational perspective. And I believe you’re accurate in saying that it’s probably not in a lot of dentist’s vocabulary. So it’s that education piece that’s so important, Dr. Fry, we’re going to end this podcast with you, so no pressure. But from a future state of dental care, how do you think things are going to change as it relates to overall health? So we know the connection. How does dental care evolve as providers understand it more, as patients understand the connection? Talk a little bit about that.

Dean Fry, DDS:

A great question, and certainly really touches on what Dr. Renda and Dr. Yamamoto have talked about. I think the dental communities are really starting to realize that practice of dentistry is changing in the sense of it entails a lot more than simply filling the tooth or putting a crown out. I mean, prevention being a big part of it. And the recognition of the relation to overall health, I think, is a hugely important insight. I think there is that realization that is changing. And using the great work that Dr. Renda and his team have, and how they talked about using the social determinants of health and beginning to place those in primary care physician practices. And using those. We want to take those learnings and do that the same way in dental, and really create that true holistic view, and move to that value base.

Dean Fry, DDS:

Right? I mean, we see that movement kind of moving that way. And so I think that’s really important because we want to see those outcomes. We want to see that happen. And the industry has to be a part of, really, that outcome and the implementation of value-based care. And you heard Dr. Yamamoto talk about education, and I think that’s just absolutely critical. And I think one of the first pieces of that is it does start in the schools, both in the medical and the dental schools. I mean, I think that that’s hugely important that we begin to talk about social determinants of health, and educate people in and around that and how that fits into patient care in general. And so I think that that’s just massively important, and we start there. And then we take the current practicing population and educate them as well.

Dean Fry, DDS:

So, starting in the schools, that flows into creating that base that has acknowledged when they come out. And taking the base that’s already there and educating them, I think, creates a really nice whole view of social determinants of health. And then I think one of the critical components that absolutely also has to happen, is an integrated electronic health record. Right now there’s not, there’s a chasm that exists. And I know that we have a number of vendors that are working on that to get that done. But I think that to really get a true holistic view of care, to really treat the whole person. That’s inclusive of both their oral health, their physical health, and make that holistic overall care, we have to have an integrated health record. It has to happen. Because you can’t carve the mouth out and say, “Oh, it’s something separate.” And say, you’re really treating the whole patient.

Dean Fry, DDS:

So I think those electronic health records are hugely, hugely important. And of course, with all that, you really have to have funding. Right? And so, I really think that some of the national institutes, like the National Institute of Dental and Craniofacial Research, federal funding programs, state programs, foundations, to continue to do the research, to continue to educate and fund those is highly critical in supporting this and really living into the dental community. I’m excited for the future of oral health and tying that together, and really creating one of the things that I like to call lifelong wellbeing. It’s one of the terms we use at Humana, because it really encompasses everything when you talk about somebody’s well-being. Not just their health, but the whole person.

Bill Neumann:

Well that is a great way to finish off the podcast. I appreciate our three esteemed guests attending The Group Dentistry Now podcast, it’s been a pleasure. Like to thank Dr. Dean Fry, Dr. Andrew Renda, and Dr. John Yamamoto for being here today. And until next time, I’m Bill Neumann with Group Dentistry Now Show. Thanks, gentlemen.