Mar 10 2014

Improving quality, cutting costs

Published by at 8:07 pm under Trahant

trahant MARK
TRAHANT

 
Austerity

The challenge in health care can be boiled down to two ideas: Improve the quality and cut the costs.

It’s a fact that the U.S. spends too much, both private and government money, on health care, nearly nearly 18 percent of all goods and services. The good news is that cost has been slowing, partly because of the economy, and most partly because the Affordable Care Act.

But this is just a first step. We have a long way to go. The reason is the country’s demographics: We have smaller population of young people, a huge baby boom generation, and people are living longer. Add this all up and the numbers are not sustainable by any metric. So math, not politics, ought to determine the route forward and that means looking for innovation to make health care less expensive. So when something comes along that does just that, you would think that it would be worth a celebration. But that’s not how change works.

As I have written before, the Alaska Native Tribal Health Consortium’s Dental Health Therapist Program is such a model. The Alaska program trains young people to practice mid-level dentistry, something that’s common around the world. This program expands access, improves quality, health, and is less expensive. It’s backed up by rigorous studies, that show mid-level providers offer “safe, competent and affordable care.”

So where is the celebration? Well, that will have to wait until the fight is over.

Washington state is considering legislation that would expand mid-level providers and the Washington State Dental Association is opposed saying that “midlevel providers will not make dental care more affordable, how dental residencies are a superior alternative, and how dentists in private practice are reimbursed 25 cents on the dollar for adult Medicaid patients.”

There is an interesting history here. The dental association in Alaska, and nationally, had long opposed the creation of the mid-level providers or Dental Health Therapists, and even sued to try and stop the program. Only now dental associations sort of praise the program, saying that it might be “appropriate” because of Alaska’s remote locations. The dental trade groups just don’t want that program to expand again.

One of the reasons why the Washington legislature is considering changing the law is that some tribes in the state are keen on a mid-level provider as one way to make it easier for tribal members to get better dental care.

But in Olympia, Alan Wicks, general counsel for the Washington State Dental Association, testified that “it’s not a question of tribal sovereignty; it’s a question of federal law.” He pointed out that the Indian Health Care Improvement Act authorizes the Alaska program and prohibits mid-level practice anywhere else in Indian Country unless that state offers mid-level profession.

But what Wicks failed to say is that the reason for this prohibition was that the American Dental Association lobbied to make it so. This was a legislative attack on tribal sovereignty.

And this is a prohibition that makes no sense given the challenges ahead.

As National Congress of American Indians President Brian Cladoosby recently wrote in Indian Country Today Media Network: “Our population is still underserved. We do not have enough chairs and dentists to service the people who come into our clinic. We reviewed our charts and found that about half of our work could easily be done by dental therapists, and it would take a huge burden off the dentists.”

Tribes are meeting later this week at NCAI to talk about new steps to push the mid-level provider issue forward. It’s clear that dental health therapy works in Alaska — and the same idea could improve oral health across Indian Country. Plus it meets the larger health care tests, improving quality and lowering costs.

Mark Trahant is the 20th Atwood Chair at the University of Alaska Anchorage. He is a journalist, speaker and Twitter poet and is a member of The Shoshone-Bannock Tribes. Comment on Facebook at: https://www.facebook.com/TrahantReports

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