Inflame in the membrane

Obamacare’s preventative services benefits are likely to continue to expand. Services are evaluating for no-cost share status by the US Preventive Services Task Force. This group is a leading collection of primary care providers and they evaluate treatments on a five mark scale. the highest two marks (A and B, like in school) are covered as no cost-share services under Obamacare. The current list of services is here

Recently preventative risk minimization breast cancer drug treatment have been declared a no-cost share service for some women:

The Department of Health and Human Services issued guidance Thursday saying that most insurance plans are required to cover the chemo-preventative drugs tamoxifen and raloxifene without co-pays or out-of-pocket expenses for women with an increased risk of developing breast cancer.

The Obama administration issued the clarification after questions arose about whether these medications count as preventative care, HHS Secretary Kathleen Sebelius and Florida Democratic Rep. Debbie Wasserman Schultz—a breast cancer survivor—wrote in a blog post Thursday.

The United States Preventive Services Task Force, an independent panel of experts selected by HHS, revised its recommendation in September to suggest the medications be available to women at high risk for the disease.

One of the likely targeted preventative service ad-ons is limited adult dental care to treat inflamation. Inflamation is an underlying issue with multiple and seemingly unrelated disease and condition clusters. US News had a good article on it a while ago:

“In recent years, we’ve come to accept that inflammation plays a role in many chronic diseases, but it’s about an imbalance—too many pro-inflammatory chemicals and not enough anti-inflammatory ones,” explains Moise Desvarieux, an inflammation researcher at Columbia University’s Mailman School of Public Health. Normally, hours after igniting the fires, the body shoots out anti-inflammatory substances to restore equilibrium.

There has been an interesting series of studies coming out of United Concordia, a dental insurer owned by a health insurance company, over the past couple of years that ties targeted dental care to significant health improvements and cost savings for people with heart disease, and diabetes. The study argues that untreated gum disease is a consistent source of background inflamation and that by treating gum disease, aggregate inflamation levels decrease and better health and thus lower costs follow. I would like to see an actual double blind study follow-up an interested party observational study, but this is an interesting first step on a question path.

There is one interesting side note on the United Concordia study, they were able to do a several hundred thousand person data dive because they are owned by a health insurance company. This ability to consolidate data and tease out unusual and perhaps less then fully intuitive links to save costs and improve only happens when the data sets are big and comprehensive. Medicare can do this, and some of the state Medicaid programs have big data sets that are clean enough to work with. But neither cover full dental/vision services, and have other limits, so there are public (and significant private) benefits to allowing some large scale vertical integration in the insurance market.

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19 replies
  1. 1
    aimai says:

    I really hope this comes to fruition, even if the impetus is merely utilitarian rather than humanitarian. I’d like to see full dental coverage for everyone with regular six month cleaning schedules for all kids and adults. Not only would these be good jobs, for dentists and technicians, but they would pay off in keeping people tied in with medical professionals who are trained (increasingly) to spot changes in the patients health (head, neck, throat cancers) and would also increase overall dental hygiene which we know is incredibly important both for appearance and for health.

  2. 2
    MomSense says:

    @aimai:

    I hope so too. Dental care and dental insurance are so expensive and the coverage options for dental insurance are maddening. In addition to dental health being important to overall appearance and health, it is also important for finding jobs.

  3. 3
    Belafon says:

    There is one interesting side note on the United Concordia study, they were able to do a several hundred thousand person data dive because they are owned by a health insurance company. This ability to consolidate data and tease out unusual and perhaps less then fully intuitive links to save costs and improve only happens when the data sets are big and comprehensive.

    That’s what the NSA says.

  4. 4
    c u n d gulag says:

    People with bad teeth often eat soft and mushy food because that’s all they can swallow with a minimum amount of chewing.

    I ought to know.

    If I had all of the money I’ve spent on dentists, root-canals, and bridge-work, I could comfortably retire.

    And most work-related health insurance only covers a bare minimum of the costs of going to a dentist. You have to make-up the difference.

    Every time I moved and found a new dentist, I could see his/her eyes light-up, thinking of their next Mercedes, Lexus, or Caddie!

  5. 5
    muddy says:

    The US News article link gives 404 error message.

  6. 6
    Poopyman says:

    In other ACA news,

    Accenture Plc (ACN), the second-biggest technology-consulting company, will take over construction of healthcare.gov, the Obamacare enrollment website that debuted with crippling computer problems in October.

    Accenture led construction of the California healthcare exchange.

    Accenture will help the federal system prepare for its second open enrollment period in October 2014, including “24/7 support of the marketplace application, eligibility and enrollment functions, generation and transmission of enrollment forms, and features related to special enrollment periods,” according to the statement. Accenture also will develop new features for future phases of the program.

  7. 7
    WereBear says:

    So it turns out the humanitarian approach also saves money! Wow, those compassionate conservatives are going to be all over this, aren’t they?

  8. 8
    Richard Mayhew says:

    @muddy:updated and thank you

  9. 9
    a hip hop artist from Idaho (fka Bella Q) says:

    I can’t provide links, but I can advise that many docs agree that inflammation is the culprit in many chronic – and some acute – diseases, including the autoimmune variety. Generally it’s in terms of exacerbation or speeding the onset rather than specific causation, but its pretty accepted as a hypothesis.

    Our environment has many more pro-inflammatory components than it once did, and fatty acid balance is a big part of that. When meat/poultry (and eggs) were free ranging, the omega 3 : omega 6 ratio was different in the food. Now that the food animals are fed primarily grain, that ratio is reversed, so that we’re consuming the wrong ratio, and then adding to it with direct dietary habits.

    I think the correlation between dental inflammation and cardiac issues – now recognized to be inflammatory driven in terms of onset and severity – has been observed for a while. But it’s not the kind of data set for which you can do readily (if at all) a double blind study as it’s observation instead of treatment based.

  10. 10
    Bobby Thomson says:

    One of the programs underwritten by my local United Way supports an organization of dentists that treats at risk school age children. I had no idea until learning about this just how important dental health is.

  11. 11
    aimai says:

    @MomSense: Right, thats what I was thinking about when I said appearance. There was a heartbreaking article a couple of years ago about the “backroom jobs” that people were condemend to once their teeth and smile had gone and weren’t considered presentable. Also gum and dental pain are just horrendous for people to endure, and yet the separation of dental health from other kinds of health insurance means that people routinely deny themselves costly medical intervention and try to do everything they can to self medicate and self treat–even to pulling their own teeth. Its crazy.

  12. 12
    Dennis says:

    The teeth are just another part of the body. What has dental health care always been treated as a separate THING that health insurance doesn’t cover?

    I’m assuming it’s some sort of historical accident motivated by doctors and dentists being separate professional organizations, protecting their own turfs.

  13. 13
    Mike in NC says:

    The United States Preventive Services Task Force, an independent panel of experts selected by HHS, revised its recommendation in September to suggest the medications be available to women at high risk for the disease.

    Has anybody alerted FOX News yet that the czars at USPSTF are coming to cram something down our throats?

  14. 14
    Belafon says:

    @Mike in NC: Fox won’t report on it. They’re saving boobs. At last, someone’s thinking about the boobs.

  15. 15
    Richard Mayhew says:

    @Dennis: yup

  16. 16
    Roger Moore says:

    @Belafon:

    Fox won’t report on it. They’re saving boobs.

    And without boobs, Fox loses their main demographic.

  17. 17
    StringOnAStick says:

    If someone has developed gum disease (periodontal disease, or PD), that is a chronic, permanent condition that requires a cleaning every 3 months, not just every 6. The bacteria that cause it require anaerobic conditions to live, and they only get that when the “turtleneck sweater” of gum tissue around a tooth is deeper than 5mm; in a healthy mouth that depth is 1 to 3mm, and 4mm is usually caused by gingivitis (inflamed gums, but not yet chronic or deep enough to progress to PD). The bacteria behind gum disease can be knocked back significantly every 3 months in order to keep things static (there is no cure for PD), and it takes 4 months for them to really get their party going again. Therefore, getting periodontal disease means you need twice the number of dental hygiene visits per year.

    The links between increased risk of heart attack and/or stroke with periodontal disease are well established, as is the fact that having diabetes makes you more likely to have PD. Diabetics with uncontrolled PD are more likely to have trouble stabilizing their blood glucose levels, and conversely, having unstable blood glucose levels is more likely to result in out of control PD. In general, having uncontrolled PD raises your systemic inflammation level which is definitely a bad thing. “Uncontrolled” means not having a hygiene apt every 3 months, and even more significant treatment if conditions indicate it is needed.

    Your mouth is actually attached to your body, period. If you don’t want to get PD, floss daily and get regular dental hygiene care (and even then some people have situations/genetic conditions where it develops anyway). If your hygienist is not measuring the “turtleneck sweater” depths once a year, find a new dental practice because without that annual measurement, there is no way to know if you are developing PD until it is too late. As a temp RDH, I end up working in practices all the time where the time pressure is so great that this essential part of ongoing care is not being done, and even older offices where it has never been done. The growing model of chop-shop discount dental care offices is a place you commonly see this substandard care as well. These practices are asking for a lawsuit alleging practice at less than the accepted standard of care, and they will lose the suit and their licenses to practice; I’ve seen it happen.

  18. 18
    Ruckus says:

    @Dennis:
    I have asked that question for decades.
    Why do we deal with dental and eye problems like they aren’t related to the rest of the body? It’s fucking insane. Bad dental health can lead directly to plain bad overall health and bad vision? Kind of difficult to work anyplace without decent vision or an understanding workplace that makes provisions. Like the VA. One of the front desk people at one clinic is very sight impaired, but the VA provides a sound system for this person which works great. If there wasn’t a sign informing you, you would never know. And what about aural health? My ears are a part of my body.

  19. 19
    Mnemosyne says:

    @Dennis:

    I’m assuming it’s some sort of historical accident motivated by doctors and dentists being separate professional organizations, protecting their own turfs.

    Fix’d, because it’s always been about doctors protecting their own turf from encroachment — not only dentistry, but also surgery, which for centuries was not considered “real” medicine. (That’s why in Great Britain surgeons are called “Ms.” or “Mr.” instead of “Dr.” — it’s a vestige of the days when they weren’t considered doctors at all.)

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