Provider updates

According to the Centers for Disease Control and Prevention (CDC), the prevalence of diabetes among adults continues to grow. About 30.3 million Americans — that’s about 9.4 percent of the US population — had diabetes in 2015. Diabetes shares a bidirectional relationship with oral health. Diabetes and periodontal disease are both chronic inflammatory diseases. Research shows diabetes with poorly controlled glycemic levels can lead to an increased prevalence and severity of periodontal disease. Moreover, there is strong evidence that patients with diabetes who have periodontal disease are at an elevated risk for insulin resistance. Addressing periodontal disease through dental cleanings has been linked to improve HbA1c levels.

Even though there has been a lot of movement towards integrating health disciplines, oral health and physical health often still operate in siloed systems. To facilitate integration and improve health outcomes, the Oregon Health Authority (OHA) has adopted a new metric to promote patients with diabetes receiving an annual dental exam.

The metric focuses on members age 18 and older with diabetes identified from medical or pharmacy data from the measurement year or previous year. CareOregon forwards Information on identified members to our primary dental provider network, which tailors their outreach, messaging and care coordination of these members.

To meet the metric, patients with identified diabetes must receive one of the following comprehensive or periodic exam codes during the metric’s calendar year: D0120 Periodic Oral Evaluation, D0150 Comprehensive Oral Evaluation, D0180 Comprehensive Periodontal Evaluation. To bill for D0180, a full periodontal charting must be completed. D0140 Limited Exam and D0191 Oral Assessment do not count towards the metric.

This metric is one of the first OHA metrics that require both physical and oral health disciplines to work together to be successful. The metric denominator is identified by physical health providers; however, the metric numerator can only be provided by a dentist. Primary care providers also have OHA metrics that focus on diabetes, so an interdisciplinary approach will support the success of all diabetes-focused metrics. To assist our partners’ efforts for patients with diabetes, CareOregon Dental has designed an outreach toolkit, and can provide additional technical assistance to our provider network for this metric. In addition, CareOregon is currently developing an oral health and diabetes curriculum for our primary care networks to further encourage oral heath integration and navigation of patients to dental services. Curriculum key messages include the bidirectional relationship of diabetes and periodontal disease, and the importance of completing an annual dental visit.

The official specifications for the Oral Evaluation for Adults with Diabetes metric can be found here: https://www.oregon.gov/oha/HPA/ANALYTICS/CCOData/2019-Specs-(Oral-Evaluation-for-Adults-with-Diabetes)-FINAL.pdf