Community health workers hold promise for oral health equity

By: Colin Reusch

This post is cross-posted on Connecticut Health Foundation's blog.

The Connecticut Health Foundation recently released a policy brief highlighting the potential benefits of utilizing Community Health Workers (CHWs) to fill the gaps in our health care system and outlining strategies that Connecticut can use to pave the way for these providers. Given the recent increases in health coverage as a result of the Affordable Care Act (ACA), the release of this brief is nothing if not timely.

In fact, the ACA itself established new opportunities for integrating non-traditional providers like CHWs into public programs like Medicaid. In addition, CHWs have recently been at the center of national discussions on health care transformation, including a National Health Policy Forum meeting just last month.

At the Children’s Dental Health Project (CDHP), we’ve been contemplating how CHWs might serve to address the gaps in oral health care delivery; in fact, in New York, Dr. Burton Edelstein (CDHP’s founder) and his colleagues are piloting a CHW-focused childhood caries management approach with support from the Centers for Medicare and Medicaid Innovation.

Innovation is warranted — tooth decay remains the most prevalent chronic condition among children and while it’s nearly completely preventable, maintaining good oral health requires more than just clinical treatment. An important key to preventing and managing tooth decay as a chronic disease is establishing healthy behaviors and self-management goals, a task for which CHWs are well-suited. In addition, CHWs may be one of the best mechanisms for care coordination, which is especially important for Medicaid beneficiaries who often have trouble accessing necessary care.

Recent research conducted in part by CDHP indicates that some the most cost effective approaches to preventing early childhood tooth decay are those that do not take place in a clinical setting. For example, programs designed to encourage regular tooth brushing with fluoride toothpaste have the potential to save state Medicaid programs as much as $3.21 for every dollar spent while motivational interviewing aimed at identifying self-management goals and healthy behaviors could save more than $2 for every dollar invested by Medicaid. Utilizing CHWs to reach and engage families where they live and play has the potential to dramatically improve children’s oral health while also reducing the need for costly restorative care down the road.

States should consider policy options that make CHWs a standard component of the health care team, allow them to be reimbursed by Medicaid and CHIP, and incentivize them to manage and prevent chronic diseases whether it be diabetes or early childhood tooth decay.


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52% }
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