Babies needing root canals. Sounds crazy, right? But it’s something I witnessed firsthand, time and time again, when I worked as a pediatric anesthesiologist at Driscoll Children’s Hospital here in Corpus Christi.
After seeing enough root canals and cavities in baby teeth, I knew that as a health care community – doctors, insurers, hospitals, facilities – we could partner together to solve this problem.
This plan is one of many that contracts with the State of Texas to manage part of the Medicaid program in Texas, a program that provides affordable health coverage for more than 4 million Texans, including children, their mothers, the elderly and individuals with disabilities. This approach is called the “managed care model,” in which insurance companies are tasked by the state to provide health insurance coverage for Texas Medicaid enrollees – some of the most vulnerable individuals in our state. The hope is that private health insurance providers, who compete for business and have proven records of performance, will do a better job than the government in running a public health program like Medicaid. In Texas, that hope is becoming a reality.
In the managed care model, we can focus on preventive care – improving immunizations, compliance with medications for asthma and diabetes, and yes, prevention of this devastating disease that affects baby teeth. I had read a study that showed that the application of fluoride varnish to baby teeth could prevent and even cure early childhood cavities. At-risk infants and children might not be seeing a dentist regularly, especially before the age of two years, but they certainly were seeing their pediatricians for regular well-check visits and immunizations. These were the perfect opportunities to apply the varnish. Driscoll Health Plan developed our Healthy Smiles program, initially with the help of Methodist Health Care Ministries. Initially, I met a lot of incredulous faces and resistance. Pediatricians told me, “We aren’t trained for this. We’re not dentists. This will be way too expensive.” But I persisted, and showed them the number of infants and children affected by this disease – the cost and disability.
Under the old way of running Medicaid, the state focused on the quantity of services a patient was receiving – not the quality of those services. With Medicaid managed care, however, the focus is on healthy results – ensuring that patients are leading healthier, fuller lives because of the quality care they receive. This focus lends itself to creative solutions and investing in preventive efforts like the fluoride varnish for children in Nueces County.
Under our Healthy Smiles program, we hired dental hygienists to go into pediatricians’ offices and train doctors on how to apply fluoride varnish. We paid for pediatricians to have their electronic medical records systems updated accordingly. We bought thousands of fluoride varnish kits, and delivered them to the pediatricians’ offices. We did everything to make the application of preventive fluoride varnish on children’s teeth a reality. Ultimately, it became an integral service offered during well-check visits for children in our area.Today, we are seeing the incredible benefits of this work. We’ve had a 70 percent reduction in the number of root canals or surgical dental procedures for children who have received the fluoride varnish. And as more and more children avoid these costly surgeries, we are saving Texas taxpayer dollars in the Medicaid program – with nearly $8.5 million in savings achieved over the past 5 years.In Texas and across the nation, our complicated, costly health care system leaves much to be desired. As the debate continues on how best to reform this broken health care system, I hope leaders will take a look at efforts on a smaller scale, like ours, that are having a big impact. Through creativity, community, and a focus on prevention, we are saving money and ensuring healthier children, one smile at a time.
Mary Dale Peterson, M.D., M.H.A., serves as president and chief executive officer of Driscoll Health Plan.
Ninety-five percent of Texans believe it is important to have a strong, sustainable Medicaid program.