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Exploring Alternative Payment Models for Oral Health Care

An examination of the cost and utilization of alternative payment models for oral health care over a patient’s lifetime.
By Sean G. Boynes, DMD, MS, Carolyn Brown, DDS, MEd and Eric P. Tranby, MA, PhD

According to a report by the Commonwealth Fund, the United States pays the most for health care and achieves the lowest performance among comparable countries.1,2 In fact, dissatisfaction with U.S. health care continues to shape political talking points. It also encourages disruptive business models and drives demand for greater transparency, accountability and consumerism.3–6 This changing health ecosystem also affects dentistry. Agencies, organizations and care teams are shifting operational and financial constructs to better align with the changing health care landscape. Currently, the transition includes a switch from a silo-based construct driven by tertiary care to a person-centered format based on inclusive, holistic health care and enhanced quality of life.7–11

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Oral health assessment of children in rural Pa. demonstrates disparities

UNIVERSITY PARK, Pa. — While the overall supply of dentists in Pennsylvania is sufficient to meet the current demand when assuming equal access for all residents, geographic access to oral health services is not equal across rural and urban areas. In a report, researchers in the Pennsylvania Office of Rural Health (PORH) at Penn State found that urban rates of dentist supply are nearly twice that of rural rates, and that inequalities exist between areas of higher socioeconomic status and those of lower socioeconomic status.

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Nonprofits, Medical Profession Tackle Human Trafficking as a Health-care Crisis

Washington Post, Jan. 4, 2020 at 7:30 a.m. EST


An emergency room patient has a broken bone. Could she suffer from human trafficking, too?

Thanks to a growing call to treat trafficking as a public health problem, an ER worker who treats a trafficking victim might be able to connect the dots.

Trafficking occurs when someone exploits someone else sexually or makes them perform labor against their will. According to the United Nations’ International Labor Organization, an estimated 24.9 million people are being trafficked worldwide. The vast majority are women, and 1 in 4 victims are children.

Because of a lack of data, it’s difficult to estimate how many victims live in the United States. In 2018, the National Human Trafficking Hotline, which is operated by an anti-trafficking nonprofit group called Polaris, helped identify more than 23,000 survivors. That’s thought to be just a tiny fraction of the real number.

Trafficking doesn’t just jeopardize human freedom — it threatens public health. Victims experience injuries, sexually transmitted diseases and problems with everything from cardiovascular health to teeth. Post-traumatic stress disorder, depression, anxiety and other mental health conditions are also common.

Trafficking happens under the table, but its survivors come into contact with health-care workers more than you might think. One study found that nearly 88 percent of victims interacted with a health-care worker while being trafficked.

There’s a growing push among doctors, paramedics and other health-care professionals to help end trafficking. Organizations such as HEAL Trafficking, a group of survivors and professionals in 35 countries, are teaching health-care systems to identify potential victims and respond to their needs.

In 2018, Congress passed legislation that created a federally sponsored trafficking-related continuing education program for health-care workers. The SOAR protocol trains health-care workers to Stop, Observe, Ask and Respond to potential trafficking and teaches them how to connect victims to needed care and relevant services. Data collection also is improving because of recently implemented diagnostic codes that allow health-care providers to identify cases of suspected and confirmed trafficking.

It will take more work to end trafficking, but change could well start in the doctor’s office.

If you are being trafficked or suspect someone else is, contact the National Human Trafficking Hotline at 888-373-7888, or text “HELP” or “INFO” to 233733.

New 50-State Study on Non-Licensed Substance Use Disorder Workers

As barriers to treatment continue to serve as an issue to those seeking care for substance use disorder (SUD), one of those barriers is a shortage of SUD professionals. A new study discusses ways to better utilize non-licensed employees in the behavioral health and substance use disorder workforce. The study was conducted by the National Academy for State Health Policy (NASHP) with support from the Health Resources and Services Administration (HRSA) through its cooperative agreement with the National Organizations of State and Local Officials.

State’s SUD Loan Repayment Program Is Now Open

Applications are now being accepted for the Pennsylvania Substance Use Disorder Loan Repayment Program (SUD-LRP). It provides grant funding for educational loan repayment to healthcare practitioners where the high use of opioids is evident and where a shortage of healthcare providers exists. The deadline for applications is 11:59 pm Jan. 21, 2020. All applications must be submitted via the SUD-LRP’s web-based application through the link on the above website. Questions regarding this RFA must be submitted via email to on or before Jan. 6, 2020. No questions will be answered via phone or e-mail. Answers to all question submitted by the deadline will be posted on the website by Jan. 13, 2020 and will be considered an addendum to the RFA.

Appeals Court Rules ACA Mandate Unconstitutional

On December 18, 2019, a federal appeals court ruled the Affordable Care Act’s (ACA’s) individual mandate unconstitutional absent a penalty. However, on the issue of severability, the court remanded the case to the U.S. District Court in Texas. The lower court will determine whether if one portion of the ACA is ruled unconstitutional whether the ACA is unconstitutional in its entirety. This case is one of several ACA cases that are wending their way to the U.S. Supreme Court.

New Study Assesses Factors Impacting Access to Reproductive Health for Low-Income Women

Beyond the Numbers: Access to Reproductive Health Care for Low-Income Women in Five Communities is a new study released by Kaiser Family Foundation (KFF). In the spring and summer of 2019, KFF, working with Health Management Associates, conducted interviews with clinicians, social service providers, community-based organizations, researchers, and health care advocates, as well as a focus group with low-income women in five “medically underserved” communities, including Erie, PA. Based on the interviews and focus groups, the study addresses how national, state, and local policies, as well as cultural factors, shape access to contraceptive care, sexually transmitted infection prevention and treatment, obstetrical care, and abortion services. Read more.

The Geography of the Opioid Epidemic

In December 2019, Pennsylvania Governor Tom Wolf signed paperwork authorizing the eighth extension of Pennsylvania’s emergency opioid declaration. Many key partners and stakeholders throughout Pennsylvania have worked hard to increase access to naloxone in case of an opioid related overdose. A new study by researchers at Syracuse University, Iowa State University and the University of Iowa indicates that although opioid overdose rates may be declining, the fight is still long from over. A study from the Atlantic’s CityLab focuses on how the opioid epidemic continues to impact urban and rural areas very differently. Both studies offer insightful perspectives for those working in the field.

Most U.S. Opioid Overdose Deaths Accidental, 4% Are Suicide

Accidental overdoses cause 90% of all U.S. opioid-related deaths while suicides account for far fewer of these fatalities than previously thought, a new analysis published Tuesday suggests. Rising use of heroin and illicit, highly potent synthetic opioids including fentanyl has likely contributed to the unintentional death rate, which surged nine-fold between 2000 and 2017, the researchers said. Opioid suicides also went up during that time but their share of all opioid-related deaths shrank. Read more.