The New HPI Report – NCOHC’s Perspective

What does “access” really mean?

The American Dental Association Health Policy Institute (HPI) released a report earlier this year analyzing access for those with Medicaid/CHIP insurance across North Carolina. After taking a deep dive into the contents of the report, those of us at NCOHC kept reflecting on what access truly means, how our definitions of access can impact data collected, and how that data can in turn influence policy.

We recently published a summary of the main points in the HPI Report, which you can find here. As a brief recap, the report found that:

  1. Supply of “meaningful” providers —meaning providers who meet a benchmark of $10,000 in Medicaid claims each year — varies geographically for both children and adults.
  2. While overall utilization among children is above the national average — with 58.9 North Carolinian children seeing a dentist within the past year versus 51.7 percent nationwide — there are also areas where utilization falls below 25 percent.
  3. Dental care utilization among Medicaid-insured adults is low, at 18.7 percent statewide, versus 23.2 percent nationwide.
  4. Medicaid-insured individuals are less likely to secure appointments compared to their privately insured counterparts.

So, What’s Next?

The bottom line is that, as long as disparities exist in our oral health system, structural change will continue to be needed in order to bridge divides and increase equity in care.

At NCOHC, we believe that a future where those with Medicaid insurance or who lack coverage altogether can access care just as easily as their privately insured counterparts is not only achievable but absolutely necessary.

We believe that where you live, how much you earn, your race, ethnicity, or any of the other social determinants of health that have been shown to impact access to oral health care shouldn’t determine whether you can achieve optimal oral health. And we believe there are simple steps that North Carolina can take to structurally change inequities that exist along these lines.

Policy change will be an important piece of the puzzle as we work to change how care is provided and received. NCOHC released its first policy brief in 2020 outlining a variety of changes that are evidence-based and shown to successfully and equitably improve access to care.

At NCOHC, we are particularly interested in the potential that community-based models of care offer. One step in connecting community-based dental sites is through the promotion of remote care technology. This is especially critical to increasing access in rural North Carolina, and when coupled with enhancement strategies to more effectively utilize the dental hygiene workforce, leads to greater and more equitable access to critical oral health care services for all.

Keep your eyes on House Bill 144 and corresponding Senate Bill 146, which were recently filed in the North Carolina General Assembly. Along with defining teledentistry and authorizing patient evaluations to be conducted through remote technologies, the bill would allow dental hygienists to administer local anesthesia.

Stay up to date on the status of House Bill 144 and Senate Bill 146, as well as hear about additional oral health content by signing up for NCOHC News today!

Equity in Data

There is another conversation to be had — one about equity in data. It is easy to see data as a race-neutral, impartial juror in the realm of scientific discovery and analysis. But that’s not always the case.

Recently, data collection and equity have become prominent in the COVID-19 conversation. As states distribute vaccines, data collection is proving to be a critical step in equitable distribution planning. In fact, North Carolina is one of the more equitable states in vaccine distribution, thanks in large part to an early focus on data collection.

In future research pertaining to oral health care access, NCOHC hopes to see a greater stakeholder focus on the social determinants of health and their impact on health outcomes. For example, access to care was measured in the HPI report by a 15-minute travel time between patient and provider, but does 15 minutes mean access if a patient lacks transportation, childcare, or time off from work?

It is important to note that NC Medicaid offers transportation to appointments, an important step toward navigating transportation barriers.

Access can mean different things to different communities, and as oral health professionals seek to understand the landscape of access, and work to remove barriers to care, it will continue to be important to improve how we collect and analyze data.

For anyone interested in learning more, this Urban Institute webinar is a good resource on centering racial equity in data use. The Urban Institute also has a well-developed white paper titled, “Principles for Advancing Equitable Data Practice.”