Enter your email to receive the CareQuest newsletter:
September 26, 2025
As immediate past president of the Ohio Dental Association (ODA) and member of the ODA’s Executive Committee, Hal Jeter, DDS, has had the privilege of participating in several projects that seek to improve access to dental care, especially for underserved populations. One such initiative is Medical Oral Expanded Care (MORE Care®) in Ohio, which he highlighted in a recent letter to ODA members.
MORE Care in Ohio was a two-year collaborative program between CareQuest Institute for Oral Health, Oral Health Ohio, and dental and pediatric primary care practices in the state. This program supported medical-dental integration by increasing preventive oral health services and coordinating dental referrals across several Ohio counties. The program’s alternative payment model (APM) combined pay-for-reporting and pay-for-performance designs to incentivize medical and dental providers to collaborate and achieve shared goals:
- Preventive dental services rose from 30% to 34% of all dental visits, while surgical interventions declined from 16% to 12%, reflecting a shift toward minimally invasive, risk-based care.
- Oral health integration during medical well-child visits increased from less than 1% to an average of 8%, with Medicaid-covered visits reaching 10%, highlighting the growing role of medical providers in preventive oral health.
- Medical practices made 407 dental referrals, with 34% resulting in completed visits and 83% of those referrals successfully closed through coordinated follow-up.
Dr. Jeter’s reflections below on this experience offer valuable insights into the benefits and challenges of implementing APMs in dental practice. He highlights the importance of trust, transparency, and communication in designing APMs that improve medical-dental integration and access to preventive oral health care. Fostering collaboration across disciplines and actively including dental professionals in the design process, he notes, can break down silos and create innovative payment strategies that reflect the full spectrum of care, ultimately improving outcomes for patients and communities alike.
Q: What was your initial reaction to participating in a dental APM?
Honestly, there was some skepticism at first. In Ohio, many providers still carry the sting of a previous APM model, where dentists’ efforts received varying financial outcomes without fully understanding what influenced those differences. The lack of transparency made it difficult for providers to trust the model or adjust their practices with confidence. That experience left a bad taste, and when MORE Care was introduced, some feared it was just another version of capitation. But as the project evolved, it became clear that this was something different — something better.
Q: What made the MORE Care experience stand out from previous APM efforts?
MORE Care was stellar. It emphasized prevention and collaboration, not punishment. There were no negative incentives, and the goal was clear: improve communication between medical and dental providers and reduce surgical dental interventions through preventive dental care. That clarity and focus made a huge difference. I even made changes in my practice because of it, and I’d absolutely do it again.
Q: Can you talk about the changes? What impact did medical-dental integration have on your practice?
It strengthened relationships. I became a resource for pediatricians, and we improved care coordination, even knowing the medical electronic records didn’t talk to each other at all. That's the heart of integration — closing the loop between referral and treatment. When a child comes back caries-free after treatment and preventive care, that’s the value. That’s what we should be measuring.
Q: What challenges did you encounter while participating in the APM?
One challenge was when the program first started, it was a lot of information, and it took me some time to settle in and understand how the main goals of the APM — increasing preventive services and decreasing the need for surgical dental services — were being measured in the model. Additionally, when we had changes in workflows, like losing staff or receiving new referrals for patients with many surgical dental needs, the quality metrics didn’t always reflect that reality. These are things future models need to address.
Q: What advice would you give to other providers considering APM participation?
Communication is key. Providers need to know exactly what’s being measured, how incentives work, and what the contract says. If you can make it clear that the incentive is in addition to regular reimbursement — and not a replacement — that goes a long way. Also, avoid [unnecessary] negative incentives. If providers feel they’re being penalized unfairly, they’ll walk away. Trust and transparency are everything.
Q: What would you say to those designing future APMs?
Keep it simple, fair, and focused on prevention. Make sure providers understand the goals and the data. Build in flexibility for real-world changes. And above all, communicate. If you do that, you’ll get more buy-in and better outcomes.
Editor’s Note: Curious about how the MORE Care Ohio program and APMs transformed dental care in the state? Dive into our impact report and case study. And check out our self-paced courses for more on APMs.