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We know that oral health is indistinguishably linked to overall wellness, but despite this well-documented fact, visits to a medical doctor rarely include any questions about oral health. Ignoring the interrelationship between medical and dental health can result in undiagnosed illnesses and diseases, causing long-term patient suffering, as well as social and financial ramifications.
The chasm between the disciplines has deep roots in our society and has existed since at least 1765 with the establishment of our nation’s first medical school, the College of Philadelphia, which excluded dentistry. In fact, the first science-based curriculum in dentistry was not established until 1840 when the University of Maryland became the first school in the world to offer it.
Sadly, not much has changed since then. Separation still exists as is evident in academia, where medical and dental schools are distinct institutions. It is further evident with the separation of payors, as it is rare that insurance covers both medical and dental together. Medical insurance premiums continue to rise, depleting patients’ disposable income, which includes income used for dental services, often incorrectly viewed by patients as a discretionary healthcare expense. Furthermore, other than in some pockets like Kaiser Permanente or academic situations, in true community-based settings, medicine and dentistry are practiced in silos.
One dental support organization that is trying to bring attention to and create a connection between the disciplines is ProHEALTH Dental. Established in 2016, their philosophy is that the existing medical-dental chasm is not in the best interest of the patient and that collaboration is essential to address overall wellness. To make this happen, ProHEALTH Dental provides the support and capital to establish dental offices that become, what is in effect, the community-based arm of established large medical groups or health systems.
Their mission and business model is to only establish dental offices in clinical partnerships with large, high-quality, well-established healthcare organizations. They co-brand with the medical groups, and when possible, co-locate. If that is not possible, they locate closely. However, they function as completely separate organizations.
They began carrying out their mission with ProHEALTH Care Associates on Long Island, which was the site of their first office. ProHEALTH Care Associates, a 900-physician group that has over 300 locations, is the largest non-hospital health care system in Long Island, servicing over one million active patients. ProHEALTH Dental is co-located in one of their buildings where they offer primary care, pediatrics, OBGYN, cardiology, urology, etc. Despite sharing a similar name and the same location, the two organizations are separate legal entities which work together under a clinical affiliation agreement.
The dental support organization (DSO) is also carrying out their mission with their clinical affiliate in Queens, The Mount Sinai Health Systems, where they have three offices. ProHEALTH Dental is in the process of expanding in New Jersey through its affiliation with Riverside Medical which serves over 250,000 patients, and they are currently finalizing an agreement with the largest medical group in West Chester County which treats about a half million patients.
The dental group, which currently has eight locations, two in development, and a goal of 15 by the end of 2019, is not focused on the number of locations. They have a strategic approach of being in the right locations, where their clinical affiliates have their medical services and are also conveniently located to their patients.
Breaking down the barriers of the past — the illogical separation of the medicine and dentistry — has proven to be their biggest challenge.
Patient education about the oral-systemic link is critical to the model. Their affiliated medical practices are asking patients for the first time about their dental history during their medical appointments, which triggers discussion about the importance of oral health. And educational materials are posted in medical offices and links to the dental office are on the medical groups’ websites.
They are also reaching out to relevant pockets of the community: schools, nursing homes, assisted living facilities, and are participating in health fairs. The DSO looks at specific service areas that they think are relevant, i.e. sleep apnea, care of diabetic patients, oncology, and pediatrics. They develop joint programs and educational materials with their medical affiliates to bring dentistry within the realm of healthcare services, and not something that is treated as a completely separate service line.
Still, there are other obstacles. Physicians, typically trained to see the mouth as a dentist’s domain, need to be educated in medical school about the oral-systemic connection. Dentists also need to be educated because they have operated in silos as well. Insurance companies also need to come on board. Ultimately, employers play a key role to this model’s success.
“We are saying to employers, ‘Spend a little more money on dentistry today, but you are going to save big time on healthcare.’ That doesn’t happen overnight and it is a challenge. But there are studies that indicate the economic impact is huge. Invest today to save tomorrow.” -Norton L. Travis, CEO of ProHEALTH Dental
Starting to hit their stride, they are rolling out a major marketing campaign this year largely focused on oral health. They have a clinical advisory board focused on integrated care with leadership representing both dental and medical. There is oral healthcare signage on all ProHEALTH Care buildings and they offer a VIP discount program to patients.
While the clinical affiliations are an important element of their business model, ProHEALTH Dental also looks to promote its oral health mission to the public at large.
“Getting a precise handle on how the patients get through our door is difficult. We estimate that between 35%-40% of our patients are coming from within the ProHEALTH Care population. And the numbers have grown. If you took a regular DeNovo office, and then look at where we are today in terms of volume, patients, and revenue, we’d be off the charts because of our relationships, our locations, and our approach to the practice of dentistry.” -Norton L. Travis, CEO of ProHEALTH Dental
The dental group is working on a study with the Harvard School of Dental Medicine, which has taken a very strong position on the need to integrate medicine and dentistry. They believe the study will also help to move the needle.
“At ProHEALTH Dental, we think of ourselves as doing well and doing good at the same time. We are optimistic that our investments in our clinical affiliation model will improve healthcare and will pay off from a business perspective as well,” said Travis.
ProHEALTH Dental photo gallery:
ScheinChat with Stanley Bergman, Chairman & CEO of Henry Schein, and Norton Travis, CEO of ProHEALTH Dental Management:
#ScheinChats is the company’s signature social media series that offers engaging conversations with health professionals, nonprofits, professional associations, and industry-leading supplier partners.
Sources: ProHEALTH Dental, Henry Schein, The Lancet, University of Maryland
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