From Silos to Shared Goals: Payment Reform and Medical-Dental Integration with Caroline McLeod-dental-patient-experience-satisfaction

In the newest Kinda Different episode, Matt sits down with Caroline McLeod, Value-Based Solutions Manager at CareQuest Institute and practicing dental hygienist, to unpack what it really takes to move medical-dental integration from idea to execution. They explore tech barriers, incentive design, and what CareQuest has learned running the MORE Care framework in multiple states. Caroline shares a practical view of shared goals, why some pilots stall, and one question every clinician can use to make care more human today.

Watch here, listen on Spotify or Apple Podcasts, or read the transcript below.

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Transcript: 
What's up, everyone? Welcome back to another episode of Kinda Different. Hopefully, your favorite dental podcast, where we talk about innovation in the dental space.
We connect with some of the best people, who you absolutely should know if you don't already, that are working to make this place more human. And we talk about how we can all do that together, how we can make dental care, health care more human together. And I'm thrilled to be joined by someone today who's working really at the frontier of what it looks like to think about payment reform.
We've talked about this concept here before as well. Just last week, we had an episode on it or just recently we had an episode on it. So I'm super excited to continue the conversation with someone who has a lot of experience and expertise in this kind of specific arena.
And so thrilled, thrilled, absolutely thrilled to be joined today by Caroline McLeod, who is the value-based solutions manager at CareQuest Institute. She is, like I said, doing some really cool stuff that is really pushing the boundaries of what's possible there. So Caroline, thank you so much for joining us today.
I love your fall background. It is very folly here in the mountains of Colorado today. Super fun as we start to get into the changing of the seasons.
So it just feels like we're ready for like a good, you know, get into a conversation as it's nice and cloudy and kind of chilly outside around how we can think about, you know, payment reform and dentistry. So thanks for joining us. We would love if you could tell us a little bit more about you and the work that you're doing and then we'll get into it.
Yeah, that sounds great to me, Matt. And I will say I'm a long-time listener, first-time guest, so I'm really excited to be here. So thank you so much for having me.
And it's turning fall here in North Carolina. So I am a North Carolinian, North Carolinian across the country from you. And I am a wife and a member of my community first and foremost.
But for work, I get the really cool opportunity to work for CareQuest Institute for Oral Health. And we really are a nonprofit focused on making the oral health care system more equitable, more accessible, and more integrated for all people. That way everyone can achieve their most optimal health through oral health.
And in my work that I do here at CareQuest Institute, I have the very unique privilege of working with all kinds of partners across the nation. And that could be from a small community organization or a dental clinic to bigger organizations that work nationally. I think that's one of the coolest parts about my job is I get to work with so many different kinds of people.
And I get to, in my role, support and manage pilot projects primarily focused on health transformation and medical dental integration. That includes, for example, the payment reform you were talking about. And I get to help design and publish research that's really focused on medical dental integration.
It's a little bit about me. And I'm also a dental hygienist. I probably should have said that too.
I work for CareQuest full time. And then on Saturdays, I do help work at a local dental office here in North Carolina as a clinical dental hygienist. So I think my role is unique in the sense of I still get to be a little bit in the clinical space, but also get to work more at a high level in systems change.
It's a really unique combination that I enjoy so much.
Yeah, I love that. I think it's... Yeah, I was gonna mention if you didn't, right, that you also are a clinical hygienist, which I think, you know, lends a lot of credibility, right?
Like, you understand what it's like to sit there and see patients, you know, consistently, right? And that's, that's, it's important as we think about how we design dental systems. And we have people who actually understand, I think, what it looks like to be in those systems.
So, yeah, totally appreciate what you're doing. And, you know, to that end, I think you said it is a very unique place, like we've already talked about. And so I would love to hear...
You've already mentioned kind of payment reform. You mentioned medical dental integration. These are concepts that, you know, I think we've explored some here on the podcast.
But I would love to just have you dive a little bit deeper then into how you're specifically innovating in that space, because there's a lot of different things that we can do in these spaces. Give us some examples of specifically some of those projects that you might be working with, whether that's, like you mentioned, kind of a big project with a large national organization or maybe a small community group as well. Just give us some examples of what that actually looks like.
Yeah, absolutely. Happy to do that. I think I agree with you that there are so many different ways to innovate when it comes to medical dental integration.
There's no one size fits all in the way medical and dental care are integrated. And that's because every practice, every health care practice is different. Every patient is different, so we want to make sure that while we're making sure care is collaborative and integrated, we want to make sure that it fits the unique needs of a patient, patient population, or a state or a region.
And so with what I have been able to work on over the past few years in medical dental integration at CareQuest Institute, I think what's really unique about what we've been doing is that we focus on collaboration when it comes to medical dental integration. Now, you might say that sounds, well, yeah, of course, that's what you're focusing on. But from what I know about the space and what I've worked with, with different partners and in research, a lot of medical dental integration initiatives, and rightfully so, they start small, work with medical providers, for example, to integrate oral health services into their everyday practice.
Or they work with dental providers to work in things like chronic disease screenings or referrals on their side of the practice. But the key piece of medical dental integration is that these providers are really communicating and collaborating and also using technology to do so. And I think that's where, in my particular role at CareQuest Institute, we've really been able to innovate because the medical dental integration pilot that we have operated for about 10 years now, actually.
It has an acronym, of course, like everything does in health care. It's called More Care Medical Oral Expanded Care. But it really, truthfully, is a medical dental integration framework that we've been operating for 10 years.
It's been operationalized in six different states. So we've gotten to work with medical and dental practices in six different states. I mean, that's been a really unique opportunity, like I said, to focus on collaboration that fits the unique needs of states, different states, and different communities.
And I think the collaboration piece especially comes into play in our program, where we help these dental providers, we give them, excuse me, dental and medical providers. We give them funds, of course, and technical support, but also relational support, to help them build relationships in their own communities. So certainly, it's nice to have technology that can communicate.
But one thing that we really support with our framework, not only is, you know, operationalizing oral health services in a medical setting, or helping dental providers refer as needed to medical providers, but really, we help support communication and true collaboration between these providers.
I love it. Can you give me some examples, kind of specifically, like, where you've seen, hey, this is like actually been really, like, this has worked really well, or, hey, like, we've, we tried to implement a technology, and it didn't work as well as we hoped, right? Can, like, can you give us some specific examples?
Because I think it would be really fascinating to kind of continue to kind of go under the hood there of, like, great, like, we want collaboration. We want, you know, doctors and physicians and, you know, dentists and hygienists and, you know, all the people in the system collaborating, right? Like, what has worked and what has been a challenge?
Yeah, that's a fantastic question. And I will say, when it comes to that true communication collaboration piece, one of the biggest challenges that we've come across, maybe as, well, maybe not as much of a surprise to some people, is really how technology is sometimes very clunky and doesn't necessarily work together to help providers collaborate. So, for example, our most recent more care pilot for the last two years has been in the state of Ohio.
And we worked with, again, medical and dental providers there that worked in health systems, dental private practice. And because they were in separate systems, their electronic health records did not interface with each other at all. And we tried to work towards, with the state, a solution, a technology solution that could, that the participants could utilize.
We didn't end up making it work because it was costly. It can be harder to implement, especially when you think about a pilot that, well, this is a year, this is two years. We don't necessarily have the time or the space with all these other new things that we're trying to implement a new technology.
We may not have the buy-in from, for example, while we work mostly with clinicians, they have leaders in their health system that may not necessarily see the value right away of implementing new technologies. And so because we weren't able to implement a technology that could help these providers interface, I would say that kind of the communication or collaboration process took quite a bit more time than we anticipated. Not that the intent was not there because, trust me, these providers are absolutely incredible.
It's not for lack of them not wanting to work together, but the technology to help, truthfully, just share health information and work together was something that we really ran into. And so that necessitated the need for a more manual process to communicate between providers. And certainly, we were able to, or they were able to make it work and did a great job, but the technology certainly would have made the collaboration more effective.
Totally. Yeah, I mean, I think we see, feel, hear that in so many ways, right? Not just from the, like, how do we do that, you know, like, provide those systems for care, right?
But then how do we, like, create the reimbursement angles, right? I talk about this all the time with folks where it's, like, great, if you're doing a A1C screening in a dental office and that data is flowing back to their PCP to close that care gap, and that PCP is part of an ACO or an MCO where they're getting some sort of shared upside, you know, kind of dollar amount based on, like, how well they manage the risk of, you know, all the care of the patients within that population. That's awesome, but the dentist probably doesn't have any way to participate in those savings, right?
And so you have this, you know, kind of not only communication gap, but you have then this, you know, kind of financial gap as well that I think, you know, can, could we solve that? We really could drive the kind of care that people want in the places that they already are without having to re-document, re-code, re-do all the things that, you know, we're currently having to do.
Yeah, absolutely. I'll say that definitely is a gap that we have noted, you know, across the 10 years that we've been working in medical dental integration. Because, you know, if the benefit, so to speak, of treating an oral health issue, whether it's a benefit to the patient's health or benefit to cost savings, is on the medical side, well, what's the incentive for dentistry to do that?
And I think that that's something that we started to address. I'm bringing up Ohio again, it was just such a good project, but that we began to address and explore a solution, or what a solution could look like in kind of that payment space. With that particular program, we also operated an alternative payment model on top of, you know, the clinicians that we worked with, you know, communicating, referring, working in oral health services to their medical visits.
We wanted to make sure they were paid in a way that incentivized them to work together and to do, you know, more preventive services, improve access. And the way that it worked was essentially on top of their normal, you know, fee for service reimbursement that they got from the medical provider, that they got from their payers, because our pilot program was outside of, you know, their regular payment. They would have the shared goals for quality measures, is another way that some people use that term.
And based on the quality measures that they worked on together and the increases that they were able to see in the quality measures, whether it was implementing a certain preventive service or a certain number of referrals, they actually got paid essentially an extra fee to do those things as a part of the project. And so, you know, I think that's a fairly common alternative payment arrangement that's happening across the nation, whether it's medicine or some dentistry as well. But I think the unique thing, the innovative thing in our program that CareQuest Institute is trying to test is let's actually give these providers shared goals.
That way they're incentivized to actually work together rather than work in silos.
Totally. That's awesome. Yeah.
I think one of the things that I appreciate right about the work that you all are doing is that these are not easy challenges to solve and it's easier I think sometimes to just sit on the sidelines and watch and not do anything because it's hard, right? And so, you know, I think it's easy sometimes to be like, well, we could have done more, we could have done this or, you know, whatever, but it's also like we took a step, right? And we are trying to figure out the answers and there is an iterative process I feel like to solving these problems that is, you know, not going to solve everything all at once and you know, pilots, pilots, right?
Like are only useful in the way that we want them to become the way that we normally do business and we will never change the way we normally do business if we don't have some structured learnings along the way where we can kind of say, okay, cool, that didn't work like we expected. Let's change. Let's do something different, right?
And I think, you know, I really appreciate that about the approach that you all take.
So, Absolutely. There was plenty of that. Like, oh, we could have done that better or we really learned this hard lesson, but you're right.
It's how we use what we learned to improve the system and to improve business going forward. And I think everything that we learned, whether it was a process of, you know, referring or providers working together to communicate or with the payment piece, we are already using those learnings to start new conversations and new partnerships to help address some of the challenges that we saw that we already spoke about today in the couple of years.
Yeah, totally. I love it. Awesome.
Well, let's learn a little bit more about you. I've enjoyed getting to know you over the years and just kind of like unpeeling the layers right a little bit. So, we always want to give folks that are listening in, like if they see you at a conference or meeting or something like that, like, hey, I never knew that about you.
Like, that was not something I could have ever learned on LinkedIn, right? So, one of the things that I always love to hear from people, and this can be outside of work, totally can be inside of work, whatever might kind of float your boat here, you know, kind of picking on strengths and kind of the bright spots idea, right, of, you know, hey, what are you most proud of? You've accomplished a lot in your life already.
What are you most proud of that you've done?
I think because we have been talking more at like that high level of systems change, maybe I'll bring this answer like down just a little bit and say, something that I'm most proud of is that I, even though I spent a lot of time in the systems change space for work, I've still really prioritized making change in my own community. So, for example, I have worked with for years, several organizations in my community that seek to bring dental care into the community for people who traditionally lack access to oral health care, have issues with social drivers of health, and traditionally, again, don't have a dental office that they can go to. So, over the past few years, I've been able to help set up, for example, a day of free dental care in my community where we actually collaborated with others in the community to bring not only dental care, but other types of health care, fresh produce, medical screening needs to the community, and help them connect to care also in the community based off of what we saw in a particular one day of seeing them.
Hopefully to improve their access, but also to improve their health over time. And so, that's something that I am really proud of and absolutely love to talk about because we do so much at CareQuest Institute, sometimes at like the more bigger picture national level. It sometimes can be more challenging to find time to talk about the things that drive me and my passion in my community and my everyday.
So, it's certainly something that I'd love to talk about if anyone saw me out at a conference or wanted to connect on LinkedIn or whatever it is. It's certainly something that I'm most proud of and able to not only use my foundational dental hygiene training to improve lives at the systems change level, but also at the clinical level and in the community level, something that I'm really proud of.
That's amazing. Yeah, for sure. I mean, the old kind of adage, right, like all politics is local, right?
All health is probably local. And I think there's certainly ways, right, that, yeah, like we need big system changes and whatnot as well. But to accomplish those things, right, I think we also need the encouragement of looking somebody in the face and seeing them and experiencing that human connection, right, which is a perfect segue into our last kind of segment here, which is making health care more human, right?
You're doing that in your community, which is amazing. And so when we think about then kind of making, and we'll just say health care more human, right, because we're talking about integrated care, some here today. What do you, give us your future vision?
We're here right now, we're going somewhere. What is that future vision for how dental care becomes more integrated, human, holistic, et cetera?
Well, I love to talk about that too. So I think we're all very well aware that we work in a health care system that is pretty disjointed. It certainly doesn't mean we haven't made progress over the last few decades.
You know, like CareQuest Institute, many others are working on this issue of medical dental integration and trying to make the health care system more integrated. But there are very unique places and silos that dentistry and medicine just continue to be separated. So we work, again, in a system where it is hard for health care providers to work together efficiently.
Not only work together with themselves, but also work with patients. And patients really feel, and I have this experience myself, the burden and the challenge of navigating their own health care and their health decisions. So the siloed system that we really work in not only affects health care providers, but it affects patients in the ways that we're able to work together and ultimately help.
So from this siloed system, I really want to move to a system where it's easy at the very end of the day for health, or excuse me, for patients to manage their own health and to navigate care in a way that is efficient, affordable, and not frustrating, where care can be paid for in a way that truly incentivizes providers to collaborate and not continue to work in their own silos. And, ultimately, I think this system would prevent the chronic disease endemic that we're seeing in our country, and, of course, manage health issues as they come up. We don't want to ignore that fact.
And I think managing disease, focusing on prevention, in a way that really prioritizes patients' needs is kind of the vision that I'd hope to have for the future, and certainly I'm working towards my own community, but it's also the vision that CareQuest Institute has. So I am lucky I get to merge those together and get to talk about them today.
I love it. Well, to that end, right, like you do continue to see patients, right? You continue to know what that feels like to actually provide that type of care that meets patients where they're at and does those things.
So a lot of clinicians probably listening to this podcast, right? And what is one kind of small thing like to close this up here? Like what's one small thing that you feel like should be happening in every dental visit, but maybe it's not happening now or something that you've learned, maybe even from the systems level, kind of like analysis that you've been able to kind of bring down to, hey, here's what it looks like to sit with somebody and provide care with them.
Absolutely. I hope there's a lot of clinicians listening because I certainly am one myself that loves this podcast and have shared with other clinicians. So I think what we have seen in our research at CareQuest Institute is that patients or people that come to a health care visit, a dental visit, they traditionally just want to know that you're listening to them in the process of care and what that can look like in a dental visit and how I implement it in every dental visit that I have with patients is by starting the visit out by asking the patient a question.
So instead of coming in to say, here's what we're gonna do today because I've got half an hour to do yada, yada, yada, the patient doesn't necessarily care about that, is by starting off by asking them a question. Typically, the question I ask is what matters most to you today? So instead of sharing my own priorities for the visit, I want to know what priorities they have for the visit and typically, they're pretty open to then having me share the priorities that typically we have for a dental hygiene visit.
And what I know based off looking at your history and your chart, here's what we can prioritize together. But asking them that question and listening and then working their answers into how you approach the rest of the visit is something that I'd encourage everyone to do. And it starts with one simple question.
It's not gonna take you a lot of time.
Love it. And yeah, I mean, even just the small thing that you said there, too, right, of together, right, like you start adding that word into that conversation as well.
Right.
And it feels different for folks. It feels less like this is what I'm going to do to you. And this is what we're gonna accomplish as a team.
And that certainly changes, I think, the perception from the patient to, hey, I'm a passenger in this care to I'm an active participant in it. So I love that idea. I love that question.
And thank you for sharing it. If people want to learn more about what you're working on, how you're doing it, what you're thinking about the next projects that you have, whatever it might be, they want to connect with you, they want to learn more about CareQuest. Where should they go?
Tell us a little bit more about that so that folks can reach out if they're interested.
Sure. So you can go to carequest.org to find out. All the CareQuest Institute is doing the programs just like I was talking about, the Medical Dental Integration Program, all of our research is housed on our website.
So certainly a great resource. And then if you're interested in connecting with me, I do have a LinkedIn page, just Caroline McLeod. It'll pop up as employee of CareQuest Institute.
That's how you know it's me. And I'll also be speaking, the pleasure of speaking with some participants from one of our pilot programs at the upcoming NOAA Conference in San Antonio in November. So I'll be there if you want to connect with me.
I'm sure you can find my information through the conference.
Awesome. Well, I'm not sure if I'm going to make it to that meeting yet, but if I do, I will look forward to, you know, pouring one out with you there together. If not, I hope it's a great meeting.
And thank you so much for taking the time today, Caroline. It's really just a pleasure to get to unpack more of what you're doing, get to understand it more from your perspective, and certainly appreciate the kind of holistic way that you approach care, that you approach the problems that we experience as a big system, and the kind of humble and, I would say, incremental quality improvement approach to solving those big problems. So thank you for all the work that you do.
Well, thank you so much for having me today and for giving so many of us a platform to share solutions and things that we're working towards together. So, appreciate you too.
Of course, yeah. Have a good one.