Getting Patients out of the ER and into the Dentist Chair


Since Better Health Together’s inception roughly two years ago, we have been looking for scalable and proven solutions to improve the health of our region.

We are excited to share our excitement and support for the Medicaid Global Waiver.

One of the most promising practices is the use of community-based community health workers. Through generous philanthropic funding from Empire Health Foundation and others, we have added eight community health workers to our team who are serving some of our region’s most economically vulnerable and chronically ill—individuals who are high utilizers of our emergency rooms and 911 services and who have high Medicaid expenditures.  This year we will work with over 2,500 clients, but we know the need is higher.

One of our most successful efforts is in reducing the number of emergency rooms visits for dental emergencies. Imagine if you didn’t have a dentist and a really bad tooth ache, where would you go? Probably to the emergency room.

As you can imagine, most emergency rooms do not employ dentists. So, you probably will receive some pain medication and possibly an antibiotic. But chances are high you are going to end up back in the ER, in fact our research shows that if you go to the ER for a dental emergency you are likely to go back three or four more times.

This is a critical issue for our region. It’s an inappropriate use of resources and bottom line it isn’t making people healthier.

But we’re making progress. Through a partnership with Providence, Washington Dental Services Foundation and Empire Health Foundation, we are reducing the the number of repeat ER visits for dental emergencies and increasing the number of dental appointments for Apple Health enrollees.

Our team is recruiting new dentists each week. In the past year, we have increased available dental slots from 52 per month to over 300.  When we started there were five dentists to whom we could refer; now we have 47.

We see patients who have never been to a dentist. Our Community Health Workers (CHW) provide behavioral coaching to each of our patients, an overview of what to expect and make sure they make it to the dentist on time and understand their follow up care instruction. This may seem basic to some, but it’s critical for people who may not have had dental care before.

The Medicaid Waiver would help us take this program to scale with more referral partners and serving more counties.  It would allow us to get further up stream, right now our CHW are working with people who are already showing up in the emergency room. What would happen if every enrollee in Apple Health had a dental home—a place to get their regular cleanings? What would it be like if dentists were able to take their fair share of Apple Health clients and still run a financially viable practice?

A week doesn’t go by that we don’t get a call from a provider who has a person who can’t get their cancer treatment, their heart surgery or to get on the transplant list because of an oral health issues.  What great things might these patients accomplish if they had the care they needed to be healthy.

We know this vision is possible. The Medicaid Global Waiver is a key tool in our toolbox to radically improve the health of our region. Thank you to Health Care Authority, Washington State Department of Social and Health Services, Department of Health and our other partners that are not just sharing a vision for a Healthier Washington but pushing each of us to find new ways to do things. The Medicaid Global Waiver will be a key component to making this new vision a reality.