In a provocative article in the NEJM Catalyst, the leader of a major healthcare organization wrote:

the health care system, which was not designed to handle the fact that three out of four Americans aged 65 and older are living with multiple chronic conditions. If we want this system to effectively handle the chronic disease epidemic, we must evolve our clinical mind-set and fee-for-service reimbursement structure from the episode-driven “one-and-done” system to a consumer-centered, integrated care approach supported by value-based reimbursement. And doing so requires us first to remember how we were trained.”

In considering this statement, first, let’s agree that poor oral health (dental decay and periodontal disease) is the most common chronic disease in our community.

Second, let’s also agree that when it comes to the senior citizen with multiple other chronic conditions, he or she has limited access to oral healthcare services. Statistics Canada reports that a small minority actually visit the dentist regularly.

And lastly, let’s agree that the “one and done” approach to caries and gum disease isn’t effective. Recurrent decay and ongoing sore gums are the most common forms of these diseases even when the dentist is involved.

I see lots of discussion and experimentation for medicine to move to a new model of care. Frankly, from many angles, it has no choice if medical care is going to be affordable and outcomes improved.

But what about oral healthcare? Is it going to adjust to serve a much different community and to get past the “one and done” approach?


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