Young children visit a primary care provider (PCP) more often than a dental provider, making PCPs uniquely positioned to deliver oral health preventive services and help connect children and their families to dental care.1
From 2020-2023, CMS led a learning collaborative focused on advancing oral health services in primary care. This initiative, which included a webinar series and affinity group, highlighted strategies state Medicaid and CHIP programs can use to improve children’s oral health outcomes.
QI Resources
These QI resources are designed to help states design and implement QI projects focused on oral health in primary care settings:
- Advancing Oral Health Prevention in Primary Care Driver Diagram and Change Idea Table. This tool includes a driver diagram that visually maps the key factors (“drivers”) that can contribute to improved oral health outcomes in children. It shows the relationship between the primary drivers (the high-level elements, processes, structures, or norms within the system that must change to improve oral health outcomes) and the secondary drivers (the places, steps in a process, time-bound moments, or norms in which changes are implemented to spur improvement). The tool also includes change idea tables containing Medicaid-and-CHIP-specific examples of evidence-based or evidence-informed QI interventions that advance oral health prevention in primary care.
- Advancing Oral Health Prevention in Primary Care Measurement Strategy. This resource provides examples of measures states can use to monitor QI projects focused on advancing oral health prevention in primary care.
State Stories
State Highlights Brief from the Advancing Oral Health Prevention in Primary Care Affinity Group
The fourteen states highlighted in Figure 1 participated in CMS’s action-oriented Oral Health Prevention in Primary Care affinity group, where teams designed and implemented QI projects to advance oral health prevention in primary care. The state highlights brief shares key learnings and success stories from participating states, offering examples of strategies that can be adapted by other Medicaid and CHIP programs.
Figure 1. States participating in the Advancing Oral Health Prevention in Primary Care Affinity Group
Video | Transcript: State Story—Increasing Oral Health Services in Pediatric Primary Care Offices in Connecticut
This brief video gives an overview of Connecticut’s utilization and revenue report, which identified primary care practices that were billing for oral health assessments and fluoride varnish, and those that were not. For practices that were not, the report calculated the “missed revenue” associated with not providing these services. By quantifying these missed opportunities, the report helped Connecticut address gaps in delivering oral health care to children in primary care settings.
Webinar Series
- State Spotlights: Advancing Oral Health Prevention in Primary Care (video, transcript). From February 2021 through March 2023, CMS worked with fourteen states participating in the Advancing Oral Health Prevention in Primary Care affinity group. CMS provided state Medicaid and CHIP programs and their QI partners, with tools, expert support, and TA to advance oral health prevention in primary care. This June 2023 webinar features several state QI projects from the affinity group, highlighting their strategies and lessons learned.
- Pathways to Improving Children’s Oral Health Using Silver Diamine Fluoride (audio, transcript). This May 2020 webinar introduces successful approaches for using silver diamine fluoride (SDF) to arrest dental decay and improve the oral health of children enrolled in Medicaid and CHIP. An oral health subject matter expert shares an overview of the science behind SDF and offers guidance on incorporating SDF into Medicaid and CHIP oral health delivery models. Medicaid and CHIP teams from Oregon and Virginia also present their approaches to policy design and reimbursement aimed at promoting the delivery of SDF for their beneficiaries.
- Improving Children’s Oral Health Using Fluoride Varnish in Non-Dental Settings (audio, transcript). This September 2020 webinar features successful Medicaid and CHIP approaches from Maine and North Carolina for advancing the use of fluoride varnish in non-dental settings. Maine shares lessons learned from its QI initiative aimed at increasing the uptake of fluoride varnish in primary care practices. North Carolina provides an update from its longstanding, evidence-based Into the Mouths of Babes program, which trains medical providers to deliver preventive oral health services, including fluoride varnish application, to young children enrolled in Medicaid. Both state teams discuss strategies for leveraging fluoride varnish programs as a pathway to connect Medicaid and CHIP beneficiaries to the broader oral health care system.
- Oral Health Care Coordination and Effectuated Referrals (audio, transcript). This October 2020 webinar features Medicaid and CHIP initiatives in New Jersey and Colorado that successfully advanced care coordination between medical and dental providers. New Jersey shares an overview of its collaboration with managed care organizations and the state’s chapter of the American Academy of Pediatrics to engage pediatric primary care providers in fluoride varnish delivery and dental referrals. Colorado discusses its model for integrated care coordination, which embeds oral health care providers directly in primary care settings to streamline coordination.
[1] Krol DM, Whelan K; AAP Section on Oral Health. Maintaining and Improving the Oral Health of Young Children. Pediatrics. 2023;151(1):e2022060417