Improving Dental Care for People with Disabilities

Recently we were excited and honored to have Dr. Ron Kosinski, Clinical Associate Professor at New York University College of Dentistry, as our guest for SKYGEN’s Client Clinical Council. Dr. Kosinski is a specialist in pediatric dental medicine and an advocate for improving dental care in the dental office for people with intellectual and developmental disabilities (DD/IDD). His presentation covered strategies dental practices can use to better serve special needs patients.

About one in six people in the U.S. has a disability. The pandemic disproportionately impacted this population, especially children with special needs. However, even before the pandemic, challenges in providing oral care for DD/IDD patients have often made it common to shift patients to the operating room for simple procedures that for other patients, would be handled in the dental office. 

High Vulnerability to Poor Oral Health and Related Complications

The number one gap in care for special needs patients is dental care. As Dr. Kosinski shared, ID/DD patients have greater needs for oral care due to frequent multiple medical conditions such as diabetes and inflammatory diseases, as well as extensive medication lists – many of which have negative effects on dental diseases. 

In addition, these patients often have barriers to oral care, including those listed by Dr. Kosinski such as:

• Respiration issues
• Coordination or dexterity issues
• Swallowing and feeding issues
• Sensory aversions 
• Difficulty with communication

The key for dental practices, noted Dr. Kosinski, is to realize ID/DD patients can’t be expected to move through the usual care process. They need more time and different practices for successful oral care in the dental office. Training and education is available through schools such as NYU, Penn State University, the University of Washington and others that can help providers better support special needs patients. 

Immediate Strategies for Insurers 

Dr. Larry Paul, SKYGEN’s Chief Dental Officer, offered financial strategies insurers can use to better serve special needs patients and help support a shift in care from the OR to the dental office:

• Adjust business rules. Insurers can adjust diagnosis codes to increase benefits such as more frequent preventive visits. Individual procedure rates for this population can also be modified.
• Pay for desensitization. Efforts to introduce ID/DD patients gradually to the dental office experience can lead to successful treatment in the office, but they require more time, and often multiple visits. 
• Cover duals. Many ID/DD patients have dual eligibility. 

1,284 total special needs plans in US, in 48 states, DC and Puerto Rico, and 789 dual special needs plans (SNPs).

Source: Kaiser Family Foundation, 2023 

With SKYGEN’s SaaS platform for dental benefit administration, insurers can quickly implement and automate any or all of these strategies with accuracy and efficiency. For insurers partnering with SKYGEN for our TPA solution, we can make recommendations for implementing different types of care plans and rules in addition to automating them on our platform.

Need for a Dental Home

As Dr. Kosinski stated, ID/DD patients need a dental home that understands their needs and is trained to provide oral care experiences that meet those needs.  SKYGEN is prepared to help insurers advance a dental home approach that allows more ID/DD patients to be treated in the dental office, with less OR cost and a better care experiences for them.