The $30 billion VA dental contract recently awarded to Optum is the latest signal that payers and large health systems are no longer circling dentistry — they’re moving in.
Optum will manage dental benefits for eligible veterans under the 10-year deal, and the network will cover general and specialty dental care, preventive services and pharmacy support. In fiscal year 2025, more than 800,000 veterans received dental care through the VA, and external providers delivered more than 3.5 million dental procedures.
The move arrives as a wave of private equity-backed consolidation has already reshaped who owns dental practices. Dental executives say the era of rapid consolidation is now over and financial performance will decide who survives.
Five dental leaders shared with Becker’s what they expect vertical integration to change, and what’s at stake for independent practices, DSOs and patients.
Note: Responses were lightly edited for clarity and length.
Question: Optum was recently awarded a $30B VA dental contract, and payers and large health systems are moving deeper into dental care. How do you expect vertical integration to change dentistry, and what’s the biggest opportunity or risk it creates?
Rocky Dhaliwal, DMD. Dentist and Owner of Redwood Shores Dental Care (Redwood City, Calif.): From a dentist’s perspective, I expect vertical integration to bring both significant opportunities and challenges to dentistry. Larger healthcare organizations can bring stronger infrastructure, technology, administrative support and access to broader patient populations. That can improve efficiency and potentially expand access to care.
At the same time, the biggest risk is the loss of clinical and financial independence. When the same organizations have greater control over insurance networks, reimbursement, referrals and practice operations, dentists may have less influence over fees and treatment decisions. It is important that growth and consolidation do not come at the expense of the doctor-patient relationship or a dentist’s ability to make treatment decisions based on what is best for the patient.
I believe the biggest opportunity is creating better coordinated and more efficient care, while the biggest challenge will be preserving clinical autonomy and ensuring independent practices can continue to compete.
Scott Kalniz, DDS. Chief Dental Officer and Vice President of Network Development at Beam Dental (Columbus, Ohio): I believe vertical integration will fundamentally change how dentistry is delivered, financed and managed. As large healthcare organizations and payers become more involved, dentistry has an opportunity to become better integrated into the broader healthcare system rather than continuing to operate largely in isolation. The greatest opportunity is improving access to care, particularly for underserved populations, while creating stronger connections between oral health and overall health. Greater resources, technology and coordinated care models could help practices operate more efficiently and improve patient outcomes.
However, the greatest risk is allowing financial and administrative priorities to overshadow clinical judgment and the doctor-patient relationship. As payers and large organizations gain greater influence over provider networks, protecting clinical autonomy and ensuring fair reimbursement will become increasingly important. Dentists must retain the ability to make treatment decisions based on what is best for their patients, rather than what is most financially advantageous to the organization. Reimbursement models must also recognize the true cost of delivering high-quality care and allow practices of all sizes to remain financially viable.
Having experienced the business and operational challenges facing dental practices, I believe scale can create tremendous value, but only when it supports the clinicians delivering care rather than limiting their independence. Ultimately, the success of vertical integration should not be measured solely by financial performance or network size, but by whether it improves access, protects clinical autonomy, fairly compensates providers and delivers better outcomes for patients.
Benjamin Golik, DDS. Co-founder of URBN Dental (Houston): I believe vertical integration will bring dentistry closer to the broader healthcare system, creating opportunities for better coordination, stronger provider networks and improved access to care. The recent VA dental contract highlights the potential for larger healthcare organizations and local dental providers to work together to better serve our communities.
The biggest opportunity, in my opinion, is helping more patients receive the care they need, especially veterans, seniors and those facing financial or administrative barriers. There is tremendous need in our communities, but affordability, coverage limitations and delays in treatment can prevent patients from receiving timely care. We have dental providers who want to help, and the system should make it easier for them to do so through streamlined approvals, stronger networks and sustainable reimbursement.
Connecting dentistry more closely with medicine could also improve preventive care, communication between providers and the management of chronic health conditions. Oral health is an important part of overall health, especially as patients age. Better coordination can help patients stay healthier, maintain their quality of life and receive more comprehensive care.
The biggest risk is allowing financial or administrative priorities to create additional barriers or interfere with clinical judgment. As integration expands, we need to protect clinical independence, support our dental teams and make sure patients remain at the center of treatment decisions.
Ultimately, success should not be measured by the size of a healthcare network, but by how effectively it helps people. If vertical integration can make quality dental care more accessible, especially for our veterans and seniors, it has the potential to make a meaningful difference in the health and well-being of our communities.
David Nguyen, DMD. CEO of URBN Dental (Houston): Vertical integration is moving dentistry from the edge of healthcare to the center of it. For decades, the mouth has been treated as if it were separate from the rest of the body, clinically, financially and administratively. That era is ending. When payers and health systems own the network, the referral and the data, dental becomes part of the care continuum, and it will be measured like it.
The next decade of dentistry won’t be won in the operatory. It’ll be won in the data. Integrated systems can finally connect oral health to the conditions it influences, from diabetes to heart disease, and reward the providers who move those numbers. That’s the real opportunity. Practices that can demonstrate access, outcomes and cost discipline will stop being vendors in a network and start being partners in a system. That shift changes who wins. In an integrated world, the best clinicians don’t automatically come out ahead. The best-run clinical organizations do.
The risk is mistaking a bigger network for better access. Access isn’t the number of names in a directory. It’s how fast a patient gets into a chair. If reimbursement drifts away from the true cost of care, participation erodes quietly, specialists first, and patients feel it in wait times long before anyone sees it in a report.
At URBN Dental, we’ve spent the last few years building for this moment. We’ve unified our data across 14 Houston locations, automated our revenue cycle and put AI to work on scheduling, verification and patient access. Nobody required it. We did it because payers don’t partner with practices, they partner with proof. The groups that thrive in this next era will be the ones that stop thinking like dental offices and start operating like healthcare organizations.
Niels Oestervemb, DDS. Owner of Smiles of Virginia Family Dental Center and Winchester Dental Implant & Sedation Center (Winchester, Va.): Vertical integration is the medical model arriving in dentistry, and we should be clear-eyed about what that model produced on the medical side: the most expensive healthcare system in the world, with as much as a quarter to a third of every dollar going to administration instead of care. Luckily dentistry has stayed lean because most practices still run on a simple model: a diagnosis, a fee, a CDT code. When a payer owns the network, it brings its whole playbook with it: ICD-10 diagnosis codes on every claim, medical-necessity narratives, prior authorizations, utilization review, credentialing cycles, narrow networks. Each one needs a person on the practice side to produce it and a person on the payer side to review it, and neither of them ever places a filling. That cost does not disappear; it lands on the premium, the taxpayer and the patient. Dentistry is about to become more expensive than it has ever been, and very little of the increase will reach a dentist or a patient.
The VA says a single national network will lower administrative barriers. Its own inspector general has already found the VA overpaid for dental services under the current third-party administrator structure. A bigger middleman with a 10-year, $30 billion ceiling does not fix that math. The biggest risk is the conflict of interest built into the model: the entity that profits when less care is delivered now sits between the dentist and the patient and decides what gets approved. The biggest opportunity belongs to independent practices. Patients who have spent years fighting medical billing increasingly value a dentist who quotes a price, does the work and answers the phone. We went out of network for exactly that reason, and that decision gets easier to explain every year.
