G-2406-21857

Cambridge Health Alliance (CHA) is a public, safety-net healthcare system that provides care to over 140,000 patients in Cambridge, Somerville, and Boston's Metro North region. CHA operates three hospitals, fourteen primary care clinics, three pharmacies and one dental clinic. CHA’s patients are largely from low-income backgrounds (60% insured by Medicaid), are racially/ethnically diverse (39% Latino, 17% Black and 9% Asian) with many receiving healthcare in a language other than English (40%).

CHA is a returning grantee to CareQuest Institute and, with this proposal, outline Phase 2 of their project work. Last year’s work focused on establishing a “Virtual Dental Clinic” within the dental department at CHA, which included preparing medical providers (15 – 18), dental providers, and patients to participate using teledentistry. Providers shared one of two handouts at a visit to promote oral health screenings and follow up appointment coordination (referral and scheduling) and the results of the study are now being examined to determine efficacy and engagement. Survey and post-service results are categorized based on the handout each patient received. In November and December 2024, CHA will conduct a patient evaluation with six focus groups who participated in the intervention. Those discussions will be translated, transcribed, and coded by the project’s research team.

The proposed project for 2024-25 focuses on the integration of dental hygienists into primary care teams within a MassHealth Accountable Care Organization (ACO). CHA will introduce higher tier oral health requirements modeled after the existing behavioral health standards in the MassHealth ACO contract and these enhanced oral health requirements will be proposed for inclusion in the next iteration of the MassHealth ACO contract. The integration of the dental hygienist will facilitate better care coordination between medical and dental teams and reinforce the potential for increased access as a complement to the teledentistry pilot currently being completed. The goal is to streamline the delivery of oral health care within the broader context of patient care, allowing for earlier interventions and better-coordinated treatments for patients. Another important consideration for this project’s impact is that Public Health Dental Hygienists (PHDH) in Massachusetts have the benefit of Direct Access and can bill MassHealth directly for oral health services. While the pilot will not employ a PHDH, these provisions make Massachusetts a fortunate and opportune place to pilot such system change because the policy already exists, thus making it a sustainable model for other ACOs in the state.

Through this project CHA will be able track the increased access to oral health services, especially for historically marginalized populations and will assess both patient and provider experiences with the integrated care model. The qualitative data collected will provide insights into barriers and opportunities to improve implementation efforts in the future.

This project is being recommended for funding in the amount of $95,000 and will support the principal investigator, research assistant, and interpreter roles on CHA’s staff. A smaller portion of grant funding will support the Public Health Dental Hygienist position for the pilot as well as incentives for patient participation in surveys and post-appointment feedback. This grant represents approximately 2% of the organization’s overall operating budget.