As previously discussed, teledentistry is an innovative strategy to increase access to dental care services. Currently, 49 states include Medicaid reimbursement for telemedicine programs (Center for Connected Health Policy, 2018). However, not all states include teledentistry as part of telemedicine programs. Nationally, dental coverage for pregnant women varies per state and therefore telehealth coverage is also affected (AZDHS, 2009). Few states offer teledentistry reimbursement through the state’s Medicaid program and it is often limited to “synchronous” (live video) interactions (ASTDD, 2019). Additionally, there are challenges with reimbursement as some insurances do not consider dental hygienists a part of teledentistry services as a rendering provider.
Arizona is one of the few states where teledentistry is recognized as a reimbursable service under telehealth through the Arizona Health Care Cost Containment System (AZDHS, 2009). While it is an innovative service to increase dental care access, there are financial barriers associated with its use. Costs to implement teledentistry may be expensive. Exact financial figures of teledentistry costs have not been reported. Teledentistry requires data management and imaging software compatible for synchronous interactions, digital oral cameras, radiographic equipment transferrable to digital images, and computer equipment. These equipment costs are vital to the operation of teledentistry and may be associated with surmounting financial costs.
Although dental care providers may oppose teledentistry due to startup costs to implement it, these costs may be alternatively considered as an investment. Benefits of teledentistry may reduce total billed claim costs. If hypothetically, a teledentist visit costs $50 and at least half of dental clinic members utilize the services, the overall claim may counterbalance fees associated with the digital service (Fontana & Wix, 2018).
Teledentistry’s unique virtual capabilities may make it easier and more likely for patients to utilize these services especially in the context of preventive health. Increased participation in teledentistry may lead to better oral health outcomes and fewer higher cost services for advanced oral health treatment. California’s Virtual Dental Home is a great example of how teledentistry is cost-effective and can increase access to vulnerable populations. In dental care for children, VDH costs were approximately 40% less for diagnostic and preventive procedures compared to the state’s dental Medicaid program (Fontana& Wix, 2018). These same successful models can apply to pregnant women with teledentistry. The challenge in implementing this service for pregnant women would be stakeholder buy in from Medicaid insurance programs and dental care providers. However, it is necessary to look past profits for this service and work towards providing services that decrease gaps in health equity for pregnant women.
References
Arizona Department of Health Services. (2009). Teledentistry in Arizona. Retrieved from https://www.azdhs.gov/documents/prevention/womens-childrens-health/reports-fact-sheets/oral-health/teledentistry-arizona.pdf
Association of State & Territorial Dental Directors. (2019). Teledentistry: How technology can facilitate access to care [White paper]. Retrieved April 17, 2020, from Assosciation of State & Territorial Dental Directors: https://www.astdd.org/docs/teledentistry-how-technology-can-facilitate-access-to-care-3-4-19.pdf
Center for Connected Health Policy. (2018). State telehealth laws. Retrieved from https://www.cchpca.org/sites/default/files/2018-10/CCHP_50_State_Report_Fall_2018.pdf
Fontana, J., Wix, D. (2018). Value proposition of teledentistry: Cost savings, improved services, and more [White paper]. Retrieved April 17, 2020, from Milliman: https://careers.milliman.com/uploadedFiles/insight/2018/value-propostition-teledentistry.pdf
Oral Health Care Screening in Pregnancy 
Kendra,
This was a very informative post. I did not realize that teledenistry was a possibility, or that it is a covered service in Arizona. This increases access to dental care for so many who would otherwise not have access to it. This seems like a much-needed service given the current importance of social distancing. Estai et al. (2020) utilized teledentistry for children in a rural area. The images allowed for prioritization of needs and a treatment plan without unnecessary travel. This application demonstrates how this can be applied with ease for patients in rural areas or who may have challenges with transportation to get to appointments. The fact that this service is reimbursable in the state of Arizona is quite exciting. Challenges that may occur with implementation may require creative measures to offset initial costs but may result in long term improvements to access to care that will help to mediate costs over time.
References
Estai, M., Kanagasingam, Y., Mehdizadeh, M. et al. Teledentistry as a novel pathway to improve dental health in school children: a research protocol for a randomised controlled trial. (2020). BMC Oral Health. 20 (11) 1-9. 11. https://doi.org/10.1186/s12903-019-0992-1
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I had not heard of teledentistry until recently with all of the healthcare changes due to COVID-19. Your blog post this week provided a very interesting look at this innovative approach and the financial barriers to implementation. You report that many insurance programs are not on board with reimbursing for teledentistry despite evidence of cost-savings. I hope that those states and healthcare organizations that are pioneering this technology and approach will continue to prove its benefits so those gaps in care that you mention can be filled.
I have heard of mobile dental clinics that will go to primary care practices to treat patients. Also, in one of my clinical rotations an eye doctor came to a behavioral health clinic to perform eye exams for their patients and they were able to meet their goals for eye exams that year. I thought this was such an amazing idea and I think that this approach could be another innovative way to bring dental professionals to women at their OB appointments. Especially for women who have trouble attending healthcare appointments, it may be better to allow them to receive all their care in one place.
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