09:04 AM

Putting Members First: The Rise of Case Management at DentaQuest

Helping a man find a home.

Connecting a single parent with care for their child.

Assisting a young woman with transportation after her car broke down.

These things may not sound like the purview of an oral health care company, but for DentaQuest’s case management department, connecting members with the resources they need to achieve better health is all in a day’s work. It’s why case management, something that is relatively new to the dental industry, has quickly become the beating heart of DentaQuest. It’s also growing — at DentaQuest and across the country.

“Case management is ubiquitous in the medical world — you see it in hospitals and community clinics, for example — but until recently, it has been uncommon in the dental world,” said Gonzalo Perez, manager of case management at DentaQuest. “Now, as we continue to confront inequities in health care and move toward more integrated care models, the value of case management as a part of the oral health system has become even more apparent.”

The Growth of Case Management at DentaQuest

DentaQuest’s case management department started in 2019 with a team of four people working to connect high-risk patients with care in Florida. In just two years, the team has more than tripled, with case managers now working in Florida and Louisiana, and plans to expand into Oklahoma and likely more markets later this year.

“What we do is at a crossroads of so many themes now — integrated care and medical-dental integration, social determinants of health, expanding access,” said Perez, who has a background in mental health work and a master’s degree in psychology. “The sad reality of our health care system is it’s very difficult to navigate — members who are at risk, not fluent in English and live in rural areas have an especially difficult time navigating the health care system. It’s essential for us to walk with them side-by-side from the moment they need something, to leave them with a healthier life.”

Case management is about more than just emergency or urgent care. Although many members connect with a DentaQuest case manager at a crisis point in their lives, one of the main goals of the program is to reinforce Preventistry. Day after day, case managers work with dozens of members and find them permanent dental homes so they can access the preventive care they need to improve their long-term health.

A Day in the Life of a Case Manager

What does the day-to-day work of a dental case manager look like?

Case managers work from an ever-evolving list of members that are identified as at-risk of not being able to access care. (In Florida, for example, the team connects with about 450 members each month.)

The list comes from several different sources — including claims data and a health risk assessment DentaQuest sends to new members. The assessment is the first step to determine if a member is low- or moderate-risk (and better suited to an outreach coordinator) or high-risk and in need of case management support.

“The data piece is particularly important because it allows us to be proactive when reaching out to potentially at-risk members," Perez said. "We're not just passively waiting for members to come to us. Many times, we call members and they are completely and pleasantly surprised to get a call from a dental case manager.”

Once DentaQuest case managers connect with a member, they have several goals:

  • First, case managers work with members to develop a plan of care.
  • Second, they determine if the member has a dental home or resources for preventive care.
  • Third, they work on education and promotion of healthy behaviors.
  • Fourth, they help members keep up with medical appointments, and provide tips and education about their health.
  • Finally, if applicable, they connect members with community resources to address broader, holistic needs, like mental health or substance abuse counseling, for example.

This process takes time — sometimes case managers work with someone for a year or more. And the results can be life changing.

In one example, a case manager returned a member’s phone call and learned that the member needed assistance scheduling a dental appointment due to end-stage renal disease and other chronic medical conditions. The case manager located a dental office convenient to the member's location and called to expedite the appointment due to his medical condition. The member completed the appointment and was successfully treated for his dental pain.

But that wasn’t the end of the story.

In a later conversation, the member revealed that he was homeless and on an organ transplant list. Understanding how crucial stable housing was for the member, the case manager immediately went to work contacting the Salvation Army and other shelters in the area. The case manager searched for rooms and studios in the member’s price range and called several landlords. Eventually, the member got a room of his own — his first one in more than a year.

The Future of Case Management in Dentistry

When you hear those powerful stories, it’s easy to see why case management is on the rise in the dental industry. The growth is likely to continue as the oral health system evolves toward a more integrated, patient-centered model of care.

“Dental can be a hub of health care,” Perez said. “When we reach out to members, the focus may be oral health, but during the case management process, we inevitably come across major gaps in physical or mental health and become a referral source. We constantly communicate with teams on the medical side to assist members.”

Still, there is significant work to be done to expand access to case management services and to oral health care as a whole. More than 65 million Americans still lack access to dental coverage. Many of those 65 million are a result of socioeconomic factors and racial inequalities that persist throughout the country and contribute to worse health outcomes for certain populations. It’s those gaps in access that the case management team at DentaQuest is focused on closing every day.

“We are very person-centered and very hands-on,” Perez said. “We prioritize long-term relationships so that members will have knowledge, resources and tools to take care of themselves — now and in the future.”