A powerful new impact report “The Collaborative Effect: Transforming Oral Health in North Carolina” showcases a coordinated effort to advance oral health equity statewide. In partnership with the North Carolina Oral Health Collaborative (NCOHC), CareQuest Institute for Oral Health, and the Blue Cross and Blue Shield of North Carolina Foundation, this initiative highlights how multi-sector collaboration and value-based care can reshape the oral health landscape for our communities.
What Was the Initiative?
From 2022 to 2024, 14 safety-net dental practices spanning 47 counties across North Carolina formed a learning community focused on person-centered, integrated, and preventive oral health models. With support such as funding, coaching, and an alternative payment structure, the initiative reached over 87,000 unique patients across the lifespan.
Key Outcomes
The results were nothing short of transformative, ranging from care delivery to patient experience:
| Focus Area | Outcome Achieved |
| Teledentistry | Increased by 635% (from 402 to 2,953 visits) |
| Silver Diamine Fluoride (SDF) | Grew by 423% (1,112 → 5,819 applications) |
| Self-Management Goals | Jumped by 285% |
| Chronic Disease Screenings | Up by 434% |
| Care Coordination / Referrals | Soared by 563% |
| Pay-for-Reporting Incentive | Practices earned 97.2% of available funds |
These metrics underscore a shift toward preventive, minimally invasive, and integrated care models – laying the groundwork for equitable, sustainable oral health delivery.
Comparing to Non-Participant Practices
When benchmarked against a non-participating Federally Qualified Health Center (FQHC), participating clinics delivered significantly better preventive care:
- Higher rates of prophylaxis, fluoride varnish, and self-management goal application.
- Increased use of silver diamine fluoride.
- A 1.3 percentage point reduction in surgical services (from 11.1% to 9.8%).
This suggests that value-based approaches enriched with support infrastructure can boost preventive services and reduce the need for invasive treatments.
A Roadmap for Structural Change
The report emphasizes that lasting oral health equity demands structural shifts:
- Robust Infrastructure & Workforce: Preparing clinics with tools and training to deliver complex, integrated care.
- Data-Driven Practice: Building capacity for reporting and using insights to drive improvement.
- Patient-Centered Models: Tailoring care to be inclusive, accessible, and preventive.
- Integrated Systems: Bridging clinical silos to promote coordinated, whole-person care.
Among its recommendations for North Carolina:
- Integrate dental providers into the state’s health information exchange (HealthConnex).
- Share value-based care best practices across safety-net providers.
- Expand teledentistry reimbursement and support.
- Continue training programs on dental practice management and operational improvement.
Why This Matters
- North Carolina faces stark oral health disparities: in 2019, nearly 76,000 residents sought emergency department care for dental issues, and 93 of 100 counties are Dental Health Provider Shortage Areas.
- With Medicaid expansion and broader health transformation initiatives underway in the state, COrHT demonstrates a viable, scalable model to make dental care more integrated, preventive, and equitable.
- The findings serve as a blueprint not just for North Carolina, but for any state seeking to elevate oral health through collaboration, data, and value-based investment.
The COrHT initiative stands as a landmark example of transforming oral health care through partnerships, innovation, and systemic change. By aligning stakeholders, centering patients, and committing to prevention, we can improve the overall health and well-being of all North Carolinians by ensuring everyone can access quality oral health care.
NCOHC, a Foundation for Health Leadership & Innovation program, works to advance systems-level changes, improving the overall health and well-being of all North Carolinians by increasing access and equity in care. Sign up for our monthly newsletter to join the network and get involved!