Improving Access to Dental Health Care Through Case Management

“Many DentaQuest members have multiple health needs. Oftentimes, these individuals are more focused on addressing the more urgent health needs rather than scheduling their dental appointments and taking care of their oral health. That’s where we come in.” — Cheryl Denley, dental case manager, DentaQuest

It’s no secret that access to dental health care is an ongoing issue in our country, with particular emphasis drawn to it after last year’s conversation around expanding Medicare to include a dental benefit. Lack of oral health education, economic pressure and a strained health care system attempting to rebound from the peak of COVID-19 have made it harder than ever for individuals to prioritize their oral health care.

Nearly 74 million Americans lack access to dental coverage — and that was before COVID disrupted health care systems. Barriers to coverage exist everywhere — from socioeconomic factors, racial inequalities, or lack of transportation or insurance. In fact, 75% of Americans say they have experienced barriers to accessing dental care, most commonly citing the cost or lack of dental insurance. That’s where DentaQuest’s case management team steps in.

DentaQuest’s case management program helps connect members with the resources they need to achieve optimal oral health through one-on-one consultations. The team works around the clock with high-risk members — such as individuals with intellectual or developmental disabilities (I/DD), suffering from poor mental health or serious health complications — to get them the care they need by connecting patients directly to providers.

“It’s important that our members get the care they need from the right providers,” said Cheryl Denley, dental case manager at DentaQuest. “Sometimes these members haven’t been to the dentist in over two years or have never had dental care in their life. My job is to make sure they are connected with the best resources available.”

DentaQuest recently teamed up with Partners Health Plan, a nonprofit managed care organization serving individuals with I/DD and their caregivers, to improve access to oral health care for their members. Since the organizations began collaborating, significant progress has been made in securing dental care for PHP members with 63% of PHP members completing a dental visit – higher than previous years without DentaQuest.

Recently, Cheryl oversaw a case for a member who, despite visiting the dentist bi-annually for cleanings and preventive care, was experiencing considerable tooth decay and losing teeth. Through screening conversations, it was determined that the member had no education on oral health care and wasn’t brushing his teeth at home between bi-annual visits. As a result of Cheryl’s hard work, this member was able to obtain a second opinion and receive extractions and necessary implants.

“The work we do in case management is so important and rewarding. It’s extremely rewarding to hear how our efforts positively impact our members and make a real difference in their oral and overall health,” says Cheryl.