14:55 PM

The “Aha” Moment that Helped Lead to Expanded, Integrated Dental Care in Virginia

Debbie Oswalt, Executive Director of the Virginia Health Care Foundation, is a 2021 DentaQuest Health Equity Hero.

Eleven years ago, Deb Oswalt had what she calls her “aha moment.”

As executive director of the Virginia Health Care Foundation, a position she has held since the organization’s founding in 1992, Oswalt has been working for almost 20 years to increase access to primary and preventive health care for uninsured and medically underserved Virginians. But it was 10 years ago when it all really clicked.

“I was always surprised that the mouth and the brain have traditionally been cared for separately, as if they are not a part of the whole body, yet we know very clearly that they are very much a part of the whole body,” Oswalt says.

It was the passage of the Affordable Care Act in 2010 that really changed her perspective--and motivated her to change others’ as well.

“I was reading through different things that were promoting integrated care, and the more I looked into it and talked to folks, I realized we needed to do more to change this system,” Oswalt said. “It was at that point the Health Care Foundation started emphasizing caring for the whole person and the whole body, and taking a number of steps to get others to think that way.”

Since then, under Oswalt’s direction, the Foundation has worked on many levels to help Virginians receive the care they need, including:

  • provided more than $15.5 million in grants to help establish or expand 53 dental safety net programs statewide;
  • made more than 3.5 million patient visits possible;
  • generated more than $6.3 billion in free medications for more than 351,000 individuals;
  • enrolled more than 120,000 Virginians, including uninsured children, in state-sponsored health insurance; and
  • offered a wealth of resources for dental safety net providers, including trainings and opportunities for providers to share best practices and brainstorm effective ways to strengthen the dental safety net in Virginia.

Now, another big policy change will put that dental safety net to the test.

On July 1, the Medicaid adult dental benefit went into effect in Virginia, expanding dental coverage to more than 750,000 adults enrolled in Virginia’s Medicaid program and providing patients with expanded care, including preventive care, for the first time.

Oswalt and her team at the Foundation were key players in advocating for the bill’s passing. They will also play an important role as it takes effect. As a funder for more than half of the safety net clinics in the state, the Foundation has been working with safety net providers to help them manage an influx of patients – especially as many are already seeing a greater number of severe needs after delaying dental care during the pandemic.

With staffing a primary concern, Oswalt and her team have been working with dental directors at several sites to support the interview and hiring process to help build capacity, as well as ensuring they have the needed equipment. They also provide education and resources to implement integrated care, including training dental teams on things like the “deadly double” (depression and diabetes) and particularly how diabetes is linked to oral health and other chronic conditions.

The focus on integration is based on the Foundation’s firsthand experience.

“We’ve seen that the community health centers who have taken integration to heart – really examined the way they do everything, changed the culture in addition to workflows – in those instances, you see a really big difference in terms of patients' overall health and wellbeing,” Oswalt says. “That’s what we’re all striving for.”

Oswalt is optimistic about what these results promise for the future, but she acknowledges that a lot of work remains to be done.

“We’ve come a long way. When we started there was no dental safety net at all, and the only dental care being provided by the state was at a few health centers,” Oswalt says. “Still, we know dental access is largely lacking for underserved populations overall, and that has been especially compounded during COVID, which set a lot of people back."

Expanding the adult dental benefit in Medicaid, she says, “will make a huge difference” and is a really important step forward.

“We see more and more research every day showing how important oral health and mental health are to the whole body, and more and more people are embracing this knowledge and willing to think differently about how we can provide better care to our communities. That’s what I’m excited about.”

Deb Oswalt is donating her Health Equity Hero award grant to the Virginia Health Care Foundation, to help uninsured Virginians and those who live in underserved communities receive medical, dental and mental health care.