'Innovating the future of dentistry': 4 things to know about Capitol Dental Care's new initiative

Becker's talked with Manu Chaudhry, MS, DDS, President and Dental Director at Salem, Oregon-based Capitol Dental Care, about its new integrated expanded practice dental hygienist practice model.

"I have personally piloted this system of care over the last few months and believe it is the future of dentistry," Dr. Chaudhry said.

1. The integrated expanded practice dental hygienist practice model
While most DSOs only provide care for privately insured Americans — or roughly half of the U.S. population — Capitol Dental Care's sole focus is improving the oral health of Oregon's Medicaid population, who make up 1.28 million Oregonians, about 30 percent, of the state's total population, Dr. Chaudhry said.

The I-EPDH practice integrates a full-time expanded practice dental hygienist (EPDH) as the primary oral healthcare provider. The practice aims to empower mid-level providers with a focus on prevention and social determinants of health. The practice's pilot office opened July 7 in Madras — the most poverty-stricken city in Oregon. The rural area has a high unemployment rate and struggles to attract dentists, especially those paying off school debt.

The EPDH is present five days a week to diagnose periodontal health, treat periodontal condition, facilitate exams and provide oral hygiene instructions — shifting the conversation from treatment to prevention. The practice is outfitted for on-demand access to a dentist when necessary and the EPDH collects records for an off-site dentist to perform comprehensive and periodic examinations through asynchronous teledentistry. The dentist visits the practice one day a week to perform consultations and more complex care.

2. Why the program was developed & its key tenets
In August 2020, Medicaid in Oregon informed all dental care organizations of an 11 percent rate cut, which is extremely damaging to the program's viability. "That level of disruption requires innovation beyond what we currently know," Dr. Chaudhry said. "I've been envisioning this for years, but it wasn't the right time. Now we are in a perfect storm of reduced funds to support dentists in providing care to underserved Oregonians, dental workforce shortage and contributory access challenges in rural areas, COVID-19 pandemic and value-based systems to improve overall health."

This model of care takes the learnings from practicing amid the pandemic and brings them to a head, Dr. Chaudhry said. Growing public awareness about the link between oral health and overall health and social determinants of health are also driving traction.

The program utilizes a team-based approach in the office and through digital solutions to focus wholly on the prevention of dental disease and therefore reduce the burden of dental diseases and all other associated diseases.

The EPDH is placed at the center of patient care to achieve the quadruple aim, the key tenet of Capitol Dental Care:

  • Improving health of members
  • Providing better member experience
  • Reducing cost of care
  • Increasing care team satisfaction

3. What's been the most challenging part of starting this program?
All healthcare professionals try to do the best for their patients and follow evidence-based practices, Dr. Chaudhry said. The burden of dental disease in the most vulnerable Oregonians is exacerbated by behavioral health and other social determinants of health. The program effectively creates innovation in the dental field, he continued, improves the health of Oregonians and empowers the dental team to practice at the top of their license.

"It is challenging to implement new systems of health improvement especially through the pandemic and specifically for the safety net. To fully understand, I became an Oregon Medicaid dental provider myself," Dr. Chaudhry explained. He needed to meet the patients himself so he could operationalize more meaningfully and build the entirely new innovation required to improve overall public health.

"Dentistry itself is predictable," Dr. Chaudhry said. "But connected to individuals with trauma and societal challenges, it's hard to create real health improvements. We need to not only connect the dots, but build bridges that provide real change to improve overall health."

The practice model focuses on empowering providers, and is only the foundation, Dr. Chaudhry said. The end goal is to make the dental office a hub for care, while providing hope, courage and a safety net to underserved populations.

4. What influence do you believe this program will have on the dental industry?
"In traditional care models, the dentist is at the center of patient care. We're at the brink of diversifying this cycle and how care is delivered," Dr. Chaudhry said.

To create real change, leaders must innovate for medical-dental and dental-medical integration, he continued. Care needs to be integrated into one organization with one visionary purpose. The EPDH practice model is the ultimate starting point.

The fully integrated structure of a DSO provides appropriate, sustainable support for the program, while digital technology across an organization brings it all together.

“The I-EPDH practice model innovatively drives change during this time where we are taking more responsibility to serve Oregonians with greater needs using less resources than ever,” Dr. Chaudhry concluded. “We can make it better only if we try.”

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