Economics of Clinical Data Integration

  • Stephen ForemanEmail author
  • Joseph Kilsdonk
  • Kelly Boggs
Part of the Health Informatics book series (HI)


This chapter discusses dental insurance, its coverage and its relationship to overall health status of the population in the United States (US). Limited coverage can have impacts beyond oral health. An emphasis has been placed on how the management of chronic and oral conditions can lead to improvements in cost management. Private insurers have taken note of this. Further, the chapter includes examples of tangible financial gains of integrated management of care in health settings. Potential pathways including health economics perspective to improve both oral and systemic health have been discussed. Subsequently the authors delve directly into the economics of integration.


Insurance Integrated health care systems Health expenditures Health care economics Managed care programs Financial management 


  1. Acharya A. Marshfield Clinic Health System: integrated care case study. J California Dent Assoc. 2016;44(3):177–81. Scholar
  2. ADA News. Study: dental benefits can help employers improve workforce, their bottom line. 2018. Accessed 16 Jun 2018.
  3. ADEAFGIES Foundation. William J. Gies and the Gies Report. 1926. Accessed 16 Jun 2018.
  4. Aetna. Aetna’s dental medical integration program may help lower costs and result in better health – the health section. 2013. Accessed 17 Jun 2018.
  5. Aetna. Dental-Medical Integration Program. Aetna Dental. 2018. Accessed 16 Jun 2018.
  6. Allen J. Diabetes: half of U.S. adults at risk by 2020, says United Health Group – ABC News. 2010. Accessed 16 Jun 2018.
  7. Amadeo K. Rising health care costs: causes, by year. 2016. Accessed 16 Jun 2018.
  8. American College of Physicians. Nation’s top primary care physician organizations release guidelines for patient-centered medical home recognition programs. ACP Newsroom. ACP. 2007. Accessed 17 Jun 2018.
  9. American Diabetes Association. The cost of diabetes: American Diabetes Association®. 2018. Accessed 16 Jun 2018.
  10. Anderson G. Chronic care: making the case for ongoing care – RWJF. 2010.
  11. Bokhari S, Khan A, Leung W, Wajid G. Association of periodontal and cardiovascular diseases: South-Asian studies 2001-2012. J Ind Soc Periodontol. 2015;19(5):495–500. Scholar
  12. Bott D, Kapp M, Johnson L, Magno L. Disease management for chronically ill beneficiaries in traditional medicare. Health Aff. 2009;28(1):86–98. Scholar
  13. Carroll L. Mother’s gum disease linked to infant’s death – health – oral health. NBC News. 2010. Accessed 17 Jun 2018.
  14. Casanova L, Hughes F, Preshaw P. Diabetes and periodontal disease: a two-way relationship. BDJ. 2014;217(8):433–7. Scholar
  15. CDC. Chronic disease overview. Publications. Chronic disease prevention and health promotion. CDC. 2018. Accessed 16 Jun 2018.
  16. Chalmers N, Wislar J, Boynes S, Doherty M, Nový B. Improving health in the United States: oral health is key to overall health. J Am Dent Assoc. 2017;148(7):477–80. Scholar
  17. Chazin S. Supporting efforts to advance adult dental coverage and access in medicaid - CHCS blog. 2015. Accessed 16 Jun 2018.
  18. Medicaid incentives for prevention of chronic diseases grants. 2013. Accessed 17 Jun 2018.
  19. Consortia-pedia. Care connectivity consortium (CCC) – consortiapedia. 2012. Accessed 17 Jun 2018.
  20. Council on Foundations. Grantmakers in health. 2018. Accessed 16 Jun 2018.
  21. Dad T, Weiner D. Stroke and chronic kidney disease: epidemiology, pathogenesis, and management across kidney disease stages. Semin Nephrol. 2015;35(4):311–22. Scholar
  22. Dark Daily. VA uses integrated health informatics to produce $3 billion in savings. 2011.
  23. Delta Dental of Wisconsin. Medical conditions. Delta Dental of Wisconsin. 2018. Accessed 17 Jun 2018.
  24. Dental Care News. U and M study links good oral care to lower diabetes cost. 2009. Accessed 17 Jun 2018.
  25. Dental Economics. The convergence of dental and medical care – Dental Economics. 2011. Accessed 15 Jun 2018.
  26. Dye B, Thornton-Evans G, Iafolla T. Dental caries and tooth loss in adults in the United States, 2011-2012. NCHS Data Brief. 2015;197:197. Scholar
  27. Eke P, Dye B, Wei L, Slade G, Thornton-Evans G, Borgnakke W, et al. Update on prevalence of periodontitis in adults in the United States: NHANES 2009 to 2012. J Periodontol. 2015;86(5):611–22. Scholar
  28. Elangovan S, Hertzman-Miller R, Karimbux N, Giddon D. A framework for physician-dentist collaboration in diabetes and periodontitis. Clin Diabet. 2014;32(4):188–92. Scholar
  29. Errante. Institute for Oral Health – DentistryIQ. 2010. Accessed 16 Jun 2018.
  30. Federal Reserve System. The fed – economic preparedness and emergency savings. 2017. Accessed 16 Jun 2018.
  31. Firestein G. Evolving concepts of rheumatoid arthritis. Nature. 2003;423(6937):356–61. Scholar
  32. Frieden J. CMS Projects focus on chronic illnesses. Caring Ages. 2006;7(8):22–3. Scholar
  33. Giraldo. Annual European congress of rheumatology – PDF. 2016. Accessed 16 Jun 2018.
  34. Glurich I, Nycz G, Acharya A. Status update on translation of integrated primary dental-medical care delivery for management of diabetic patients. Clin Med Res. 2017;15(1–2):21–32. Scholar
  35. Greene S, Tuzzio L, Cherkin D. A framework for making patient-centered care front and center. Permanente J. 2012;16(3):49–53. Scholar
  36. Dental coverage in the health insurance marketplace. 2018. Accessed 16 Jun 2018.
  37. Ide R, Hoshuyama T, Takahashi K. The effect of periodontal disease on medical and dental costs in a middle-aged Japanese population: a longitudinal worksite study. J Periodontol. 2007;78(11):2120–6. Scholar
  38. Inside Dentistry. Dentistry at large: CIGNA launches oral health maternity program. 2006. Accessed 15 Jun 2018.
  39. Jha A, DesRoches C, Campbell E, Donelan K, Rao S, Ferris T, et al. Use of electronic health records in U.S. hospitals. N Engl J Med. 2009;360(16):1628–38. Scholar
  40. Kautter J, Pope G, Trisolini M, Grund S. Medicare physician group practice demonstration design: quality and efficiency pay-for-performance. Health Care Fin Rev. 2007;29(1):15–29. Scholar
  41. López N, Da Silva I, Ipinza J, Gutiérrez J. Periodontal therapy reduces the rate of preterm low birth weight in women with pregnancy-associated gingivitis. J Periodontol. 2005;76(11s):2144–53. Scholar
  42. Madalli R, Kheur S, Reddy M, Kheur M, Mahalle A. Assessment of role of Porphyromonas gingivalis as an aggravating factor for chronic obstructive pulmonary disease patients with periodontitis. Dent Hypotheses. 2016;7(3):100. Scholar
  43. Manski R, Hoffmann D, Rowthorn V. Increasing access to dental and medical care by allowing greater flexibility in scope of practice. Am J Public Health. 2015;105(9):1755–62. Scholar
  44. March of Dimes. Premature babies cost employers $12.7 billion annually. 2014. Accessed 17 Jun 2018.
  45. Martin-Cabezas R, Seelam N, Petit C, Agossa K, Gaertner S, Tenenbaum H, et al. Association between periodontitis and arterial hypertension: a systematic review and meta-analysis. Am Heart J. 2016;180:98–112. Scholar
  46. Martin J, Hamilton B, Osterman M, Driscol A, Drake P. Births: final data for 2016. Nat Vital Stat Rep. 2018;67:53. Scholar
  47. Masterson, L. Skyrocketing chronic diseases will cause major healthcare spending spike. Healthcare Dive. 2017. Accessed 16 Jun 2018.
  48. Mealey B, Oates T. Diabetes mellitus and periodontal diseases. J Periodontol. 2006;77(8):1289–303. Scholar
  49. National Institute of Dental and Craniofacial Research, Oral health in America: report of the surgeon general (2010).
  50. NADP Dental Plans. NADP – National Association of Dental Plans. 2018. Accessed 16 Jun 2018.
  51. Oberlander J. The political history of medicare. american society on aging. J Am Soc Aging. 2015.
  52. Ricardo A, Athavale A, Chen J, Hampole H, Garside D, Marucha P, Lash J. Periodontal disease, chronic kidney disease and mortality: results from the third National Health and Nutrition Examination Survey. BMC Nephrol. 2015;16:97. Scholar
  53. Roniger L. Kaiser Permanente premiers integrated medical-dental clinic. 2017. Accessed 16 Jun 2018.
  54. Rosenblum R. Oral hygiene can reduce the incidence of and death resulting from pneumonia and respiratory tract infection. J Am Dent Assoc (1939). 2010;141(9):1117–8. Scholar
  55. Rubinstein H. Access to oral health care for elders: mere words or action? J Dent Educ. 2005;69(9):1051–7.PubMedGoogle Scholar
  56. Sambamoorthi U, Tan X, Deb A. Multiple chronic conditions and healthcare costs among adults. Expert Rev Pharmacoecon Outcomes Res. 2015;15(5):823–32. Scholar
  57. Sato M, Iwasaki M, Yoshihara A, Miyazaki H. Association between periodontitis and medical expenditure in older adults: a 33-month follow-up study. Geriatr Gerontol Int. 2016;16(7):856–64. Scholar
  58. Scannapieco F. Pneumonia in nonambulatory patients. The role of oral bacteria and oral hygiene. J Am Dent Assoc (1939). 2006;137(Suppl):21S–5S. Scholar
  59. Shimpi N, Schwei K, Cooper S, Chyou P, Acharya A. Understanding patients’ oral health information needs. Findings of a survey on use of patient portals in dentistry. J Am Dent Assoc. 2018;
  60. Sommers B, Gawande A, Baicker K. Health insurance coverage and health — what the recent evidence tells us. N Engl J Med. 2017;377(6):586–93. Scholar
  61. Song Z. Accountable care organizations in the U.S. Health Care System. J Clin Outcomes Manag. 2014;21(8):364–71. Scholar
  62. The Office of Disease Prevention and Health Promotion. About healthy people. Healthy people 2020. n.d. Accessed 19 Mar 2018.
  63. U.S. Department of Health and Human Services Oral Health Coordinating Committee. U.S. Department of Health and Human Services Oral Health Strategic Framework, 2014–2017. Public health reports (Washington, D.C.: 1974), vol. 131. Thousand Oaks, CA: SAGE Publications; 2016. Scholar
  64. U.S. Department of Veterans Affairs. Veterans Health Administration 2010 facility quality and safety report - patient satisfaction. 2010. Accessed 17 Jun 2018.
  65. UnitedHealthCare. Medical dental integration study. 2013. Accessed 16 Jun 2018.
  66. USDHHS. Oral health in America: a report of the surgeon general. NIH publication no 00-4713. 2000.
  67. USDHHS. OIG 2015 work plan. Medicare (United States). Medicaid. 2016. Accessed 16 Jun 2018.
  68. Vistnes J, Davis K, Miller G. STATISTICAL BRIEF #477: results from the 2014 MEPS-IC private-sector national tables. 2015. Accessed 16 Jun 2018.
  69. Willink A, Schoen C, Davis K. Dental care and medicare beneficiaries: access gaps, cost burdens, and policy options. Health Aff. 2016;35(12):2241–8. Scholar
  70. Xu S, Song M, Xiong Y, Liu X, He Y, Qin Z. The association between periodontal disease and the risk of myocardial infarction: a pooled analysis of observational studies. BMC Cardiovasc Disord. 2017;17(1):50. Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Health EconomicsRobert Morris UniversityPittsburghUSA
  2. 2.Office of Medical EducationAspirus Healthcare SystemsWausauUSA
  3. 3.Network EngagementAspirus Network Inc.WausauUSA

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