Oral Health in America: Advances and Challenges– a look at Veteran oral health care
The NIDCR released Oral Health in America: Advances and Challenges report in December 2021, a culmination of two years of research and writing by over 400 contributors that explores the nation's oral health over the last 20 years. The report outlines interprofessional care delivery models, barriers to accessing care, and opportunities to advance innovative oral health for veterans. During this session, Dr. Rena D’Souza and Dr. Renée Joskow present an overview of the report, highlighting the oral health landscape for veterans and their dental care. An overview of NIDCR’s 2021-2026 strategic plan is also presented.
Improving Data Collection and Centralizing Reporting for Veteran Dental Care
With most veterans accessing dental care outside of a centralized VA structure, advancing health information technology and creating data-driven solutions will constitute significant steps toward improving oral health care for veterans. Traditional communications between primary care and dental providers have usually occurred through paper and email attachments, generating inefficiencies and a fragmented referral process. Dentistry and oral health providers have new opportunities to participate in health information exchange which can support interprofessional practice, population health management, and value-based care for veterans. Hear about the latest developments, projects, and initiatives underway to help strengthen and build a coordinated oral health infrastructure.
Exploring Value-Based Opportunities in Oral Health Care for Veterans
The Department of Veterans Affairs (VA) Center for Care and Payment Innovation (CCPI) is implementing value-based pilot initiatives focused on improving quality of care, health outcomes, and care models within VA to serve Veterans. As one of these pilots, CCPI launched VETSmile in July of 2021 to connect Veterans to low-cost dental care. Acknowledging the impact poor oral health has on whole health, VETSmile increases access to oral health care in the hopes of deterring comorbidities, thereby improving quality of life for Veterans and saving money for VA by preventing the need for more costly care. The program has served over 800 Veterans since its inception and is rapidly expanding into new service areas. VETSmile partners with nearly a third of US dental schools and is engaging FQHCs in rural areas. During this presentation, Dr. Roshni Ghosh will discuss the vulnerable population of Veterans unable to receive dental care at VA and provide a snapshot of how CCPI is transforming the approach to improve health equity and decrease the costs of neglected comorbidities and oral health ED visits.
Advancing Medical-Dental Integration for Veterans
The oral-systemic connection influences chronic disease management and requires a holistic model of health to improve total health. Integrated and interprofessional care delivery is important in facilitating whole-person health with an interdisciplinary care team of oral health and medical professionals working in concert on both care delivery and community assets. Integrated initiatives for veterans with the VA and the Military Health System have reduced disparities and improved health outcomes, creating opportunities for oral health to extend this existing framework. To this end, advancing medical-dental integration places the veteran at the center of a comprehensive care team that collaborates seamlessly to address the veteran’s medical, dental, and behavioral health needs.
Expanding the Role of Rural Health Clinics in Veteran Oral Health Care Delivery
As part of the 2018 MISSION Act, the VA expanded access to care for veterans through the Community Care Network (CCN). The CCN comprises six regional networks that serve as the contract vehicle for the VA to finance care for veterans from community providers. The expansion is particularly helpful given the innovative model of care integration that FQHCs are uniquely positioned to provide. The CCN can not only expand access points for veterans as the network broadens but can also explore value-based care integration that prioritizes the health outcomes of veterans. Similarly, extending the reach of rural health centers is critical to meeting the needs of rural veterans. The VA Office of Rural Health has implemented several initiatives to not only support the needs of veterans living in rural areas but also to train providers to support rural health. These rural initiatives often include an integrated and whole-person approach to care that includes nontraditional stakeholders like clergy, social workers, and disability advocates in the health care process. Asset-based approaches to care in rural areas with both FQHCs and rural health clinics should be supported and expanded to support all facets of health, including oral health.
Plenary Panel: Fostering Care Team Innovation for Veteran Oral Health Care
Increasing access to care and improving both oral health and overall health require an oral health workforce working in concert. Increasing access to care and stimulating oral health innovation to include rural and underserved areas will be more successful if diverse intra- and interprofessional care teams are deployed. Regulatory and scope of practice requirements that govern all health care team members should be evaluated to ensure that access to high-quality care is a possibility for all veterans regardless of geography, level of need, or disability. Alongside traditional clinical care teams, new oral health team members such as physical therapists, community health workers, behavioral health specialists, and health informaticians can innovate care delivery for veterans. The VA has promulgated a keen awareness in innovating health workforce solutions, encouraging opportunities for oral health to be considered and elevated within an existing whole-person framework. Congress will need to ensure that VA oral health care teams have the resources and staffing to drive integrated approaches to care and achieve whole-body well-being. A focus on a diverse, efficient workforce will streamline the delivery system to meet veterans where they are, while enriching the communities they call home.
Prioritizing trauma-informed approaches to clinical care for veterans
For the nearly 19 million veterans and approximately 2 million active-duty members, a positive connection to peers and a sense of duty to their country is typically central to military service. Service personnel may have experienced traumatic events during and outside of deployment. While research indicates that both Adverse Childhood Experiences (ACEs) and trauma that occurs in adulthood are unfortunately extremely common, the impact on individuals, families and communities can be addressed to mitigate potential cumulative effects on health outcomes. As one of the “Strategic Recommendations for Improving Quality of Care” outlined by CareQuest and the AIDPH, prioritizing trauma-informed approaches in oral health care can ultimately support veterans on their path to wellness. True TIC transformation can also improve clinical workflows, patient interactions, and staff engagement. TIC approaches in the health care setting are aligned with the full integration of patient-centered, team-based, and can lead to value-based care. This presentation and discussion will provide participants with foundational knowledge about trauma and the potential manifestations in clinical care settings. Practical tips for oral health professionals to consider, with use of universal trauma precautions, will be provided.
Expanding Veteran Oral Health Care Delivery Beyond an Urgent Needs Model
Many veterans who are low-income, unemployed, and struggling with chronic disease or unmet health needs often experience inadequate access to dental care. Episodic and urgent dental care may not be sufficient in alleviating poor oral health to establish overall health outcomes. Recent American Dental Association Humanitarian Award Winner Theresa Cheng will describe her approach to filling gaps for veteran dental care as part of her work with Everyone for Veterans. Speakers will share strategies and opportunities for dental clinicians to meet the oral health care needs of veterans beyond an urgent needs model by generating a whole-person approach.
Veteran Voices: Dental Care from a Patient Perspective
Veterans cannot be healthy without good oral health. Veterans experience poorer oral health outcomes than nonveterans. These disparate health outcomes are exacerbated by a historically fragmented dental care system. Clear evidence underscores a need to improve the US oral health infrastructure to support all patients, including veterans. Understanding how veterans perceive their own oral health and how they access oral health care will be critical to implementing systemic changes that improve oral health in this population. This panel of veterans will highlight patient voices to share how their lived experience has shaped their perception and access to dental care.