Dental service organizations are uniquely positioned to close the access-to-care gap

By Steven Barefoot, DDS

Like other traditional industries, health care has been slow to adopt change. Dentists, similar to other clinicians, traditionally grow their careers within existing operating structures. Now, however, dentists have more options for alternative and sustainable career paths.

Dental service organizations (DSOs) have seen significant growth during the last decade, in large part because of their role in expanding dental career paths. As of 2019, the American Dental Association reported that 10% of US dentists were affiliated with DSOs, up from 7.4% in 2014.

Why the growth?

I hear a lot about the benefits for dentists.

• DSOs are popular among young dentists who are starting out, or those nearing retirement.
• DSOs allow dentists to be dentists rather than small business owners.
• DSOs help take the business pressure off of dentists who are dealing with financial burdens, such as student loan debt or retirement savings.

But DSOs also benefit underserved populations and expand access to care. Nearly half of US adults ages 65 to 80 report having no dental coverage. This and difficulty finding a dentist ranked in the top four reasons people chose to forego dental care during the past two years. Nearly half said they were missing teeth but did not have dentures or implants. As we know, unmet dental needs, such as missing teeth, lead to increased health-care costs and bad health outcomes.

DSOs are well-positioned to provide care for Medicaid patients and close the access gap for millions of Americans. With 43% of Americans living in rural areas that lack access to dental care, the needs and opportunities are great. Access to capital allows DSOs to grow and innovate at scale.

At DentaQuest, DSOs have proven to be great partners as we work to expand access for our Medicaid clients and its members. This is reflective of a broader trend. According to data from the ADA, only 43% of dentists participate in Medicaid or the Children’s Health Insurance Program (CHIP) for child dental services. Of those dentists, 63% are affiliated with a DSO.

For example, in Ohio, where DentaQuest is the dental carrier for over one million Medicaid recipients, several counties do not have safety net dental offices. This means we should investigate the best way to bring care into these communities and reach families, and DSOs have the capacity to pivot quickly. In fact, we are working with one of the largest DSOs in the country to bring mobile dentistry to four Ohio counties that are considered dental deserts.

Something that would be a significant undertaking for an individual practice owner—opening a practice in a remote area or deploying mobile dental units and staff to multiple communities—is more feasible for DSOs. They have the scale and resources to bring care to places that require a greater up-front investment. Knowing the customer base will follow.

Just opening the doors, though, is not enough. We must reduce barriers and make sure patients are receiving routine care, regardless of where they live. In DentaQuest’s new contract with the Louisiana Department of Health, for example, we are specifically focused on ensuring that more people visit a dentist at least once per year. These programs establish dental homes for children and adults, support patients who have previously missed dental appointments, and enable much-needed care for those who have disproportionately lacked access.

Dental deserts, much like food deserts, impact the most vulnerable communities, and DSOs have been partnering in unique ways to address this systemic issue. Again, DSOs have a unique advantage when it comes to driving large-scale systemic change, having not only the capital and resources to take risks, but a business focus on disrupting the status quo and embracing innovation.

As preventive dental care becomes more accessible and affordable, more patients will have the opportunity to improve their oral and overall health. The nation’s overall health costs will go down, and we will be on our way to finally closing the gap in care for millions of Americans.

Advancing these issues—expanding access, reducing disparities, and changing the system so that it improves health outcomes for everyone—is more than a goal. It’s an imperative for the entire dental industry, and one that DSOs are uniquely positioned to help deliver.

Steven Barefoot, DDS, joined DentaQuest in 2016 as dental director for Indiana. He provides clinical input to develop new care programs, manages the design of quality measures, and responds to questions from providers participating in value-based programs. He has clinical experience in private practice, as part of an HMO dental clinic, via mobile dentistry serving Medicaid schoolchildren, and with other volunteers caring for rural communities in Honduras.