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Filling The Gaps Left By Business And Government To Ensure Healthcare Delivery

Contributed By: Ashoka

Medicaid was created to help bring essential healthcare services to the poor, but millions of children and youth who are enrolled in this government program still do not receive dental care. The system is in place, but from the perspective of many dental practices, treating Medicaid patients does not appear to be a sound business practice. As a result, these practices simply do not see such patients.

Newly elected Ashoka Fellow Jeff Parker sought to fill the gaps left by business and government through a unique social enterprise model that seeks to revolutionize the way the business of dentistry is handled. In this interview with Ashoka, he argues that treating Medicaid patients is a financially viable practice.

What is your big idea?

To provide access to quality dental and eye care for our country’s most neglected and vulnerable children. We have proven it can be done, and have done it in a non-profit setting that does not rely on grants or cash donations. At Sarrell Dental we have seen over 550,000 patient visits without a single patient complaint to the dental board. We have implemented a business model that proves that treating Medicaid patients can be a sustainable endeavor, despite what most dentists have traditionally believed. In addition, we have lowered the cost of care to our government and taxpayers because of the efficiency measures we’ve implemented—among them, a culture of caring which leads to high chair utilization rates; high-quality talent who conduct high-quality procedures; and world-class equipment which allows us to provide exceptional treatment. These measures, combined with dental education, prevent more expensive procedures in the long run, reducing the cost per visit and reimbursements from Medicaid.

Bottom line, we have proven through our new model of care that we can eliminate cavities among some of our poorest children, in some of our nation’s poorest counties, in one of our nation’s poorest states. If it can be done here, why can’t it be done everywhere?

It sounds like you really had to swim against the current in a lot of ways to make this program a reality. Tell us how you pushed back against the status quo.

Many in dentistry just don’t get it. Many dentists have an under-utilized fixed asset (their office), and they are thus in a position to treat anyone, regardless of whether they are on Medicaid or not. However, less than half of the Medicaid eligible children in our country receive dental care, even though dentists with empty chairs could easily treat them. Not only is it the right thing for the people, getting extra usage from the fixed asset to contribute to their overhead is the smart thing for their businesses. Traditional dentistry’s mantra of pleading for higher Medicaid reimbursements is not the solution, especially in this economy. If nothing else, they should do what any for-profit business does: maximize capacity, then replace it with higher margin opportunities as they become available.

Do you think that other industries have the same opportunities to upend “business as usual” by innovating to provide essential products and services? What are your suggestions for people who aspire to do this?

Absolutely. If any new business listens to industry leaders—from any industry—who say “this is how our industry operates,” then it is destined to be average. Those leaders have established the rules and do not want change. If you play the game established by those who control the game, you are destined to be mediocre. Understand the rules, play within the rules, but change the game to give you a competitive advantage.

When did you realize you had to pursue this mission?

It was easy for me to think I understood the issues facing those citizens most in need. I supported many charities with donations, attended their events and felt I was doing my part. However, like with any issue, when you get down to the grass roots level, you get a much different perspective. I was looking into the eyes of our patients and their families. Looking into the eyes of good people, with economic misfortune. I heard their stories of not being able to find a dentist who would see new Medicaid patients or who even took Medicaid at all. It made me see the issue differently. Whether rich, middle class, or poor, all parents love their children and want them to have a chance to succeed.

Who has had the most influence on your work?

On the non-profit side, Dr. Warren Sarrell, a retired cardiologist, who first started the Calhoun County (AL) Dental Clinic. After I took the job in 2005, we had it renamed in his honor. Dr. Sarrell was a veteran of two wars, a physician who truly worked seven days a week for his patients. Dr. Sarrell taught me what the practice of healthcare used to be. His vision to solve the oral health crisis in this part of Alabama gave me the insight to realize this is not just an Alabama problem.

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