Clarifying the intent of the Virtual Dental Home: West Health Comments

Honorable Senator Richard Pan,

I am writing on behalf of the Gary and Mary West Health Institute (WHI), a San Diego-based applied medical research organization and part of nonprofit and nonpartisan West Health, which also includes the Gary and Mary West Foundation and the Gary and Mary West Health Policy Center. Our organizations work together toward a shared mission dedicated to lowering the cost of healthcare to enable seniors to successfully age in place with access to high-quality, affordable health and support services that preserve and protect their dignity, quality of life and independence. Through our combined policy, research and funding efforts, West Health is dedicated to addressing deficiencies in access to critically-needed oral healthcare for seniors and we believe it is important to clarify the intent of the Virtual Dental Home (VDH) (AB 1174 enacted in 2014) in the 2019-2020 California State Budget.

Lack of dental insurance coverage is a significant barrier to accessing oral healthcare for older adults—only about a third of seniors have dental coverage, compared with two-thirds of the younger adult population. Many seniors also have difficulties getting to a dentist’s office due to a lack of transportation options or because they face physical or frailty challenges that leave them unable to use available choices.

West Health believes it is crucial to develop and scale innovations in dental care delivery models to address the unique needs of our aging population, such as the use of teledentistry in the VDH. The VDH is a system of dental care that combines workforce and teledentistry technology innovations to deliver high-quality and safe dental care to patients in more accessible settings. Specially-trained hygienists in the VDH model provide oral healthcare preventive and early intervention services, within their scope of practice, that reduce the need for referrals to dental offices in the community.

The VDH model has been shown to improve access to oral healthcare for seniors living in long-term care settings, especially those who have difficulty traveling due to frailty or physical disability challenges. During the initial six-year VDH Demonstration conducted by the Pacific Center for Special Care at the University of the Pacific School of Dentistry, the oral health needs of nearly half of seniors and people with disabilities in long-term care facilities were seen by allied dental personnel without the need to visit a dentist in-person[i]. Using teledentristry or a VDH model to provide oral healthcare services in congregate settings, such as senior centers and residential care facilities, may help more individuals access care, as it is often more conveniently located to where seniors live.

The VDH has been an important factor in improving oral health access in multiple California communities since the passage of AB 1174 in 2014. A considerable share of that accomplishment has involved the sponsorship of VDH sites by Federally Qualified Health/Rural Centers (FQHC/RHCs). To ensure this progress is maintained and the potential for future improvements enabled, the West Health Institute urges you to clarify in the 2019-2020 California State Budget that the intent of AB 1174 allows FQHC /RHCs to establish a person as a patient of the FQHC/RHC through the provision of dental services via store-and-forward teledentistry.

This clarification will help ensure VDH can operate as intended and as efficiently as possible in community settings, providing increased access to safe and quality oral care for children and older adults.

Sincerely,
Shelley Lyford