�� From the dental insurer��s perspective, the division between selleck kinase inhibitor medical and dental insurance product lines has created a disincentive to expand dentists�� scope of service to include tobacco use treatment. Viewed in the context of the Patient-Centered Medical Home movement with its emphasis on coordinated and cost-effective care, as well as the growing literature linking oral and systemic health, continued exclusion of oral health professionals in new models of care delivery represents a missed opportunity for improving preventive health care delivery and improved patient outcomes (Glick, 2009). Insurers also described a lack of integration of clinical information systems, even among the dual insurers, as another barrier to studying the benefits associated with preventive care in dental settings.

However, a recent study demonstrated the feasibility of linking dental and medical health care records between a large dental carrier and an integrated health plan to assess the impact of oral disease on overall health (Theis et al., 2010). Additional research is needed to inform policy changes related to tobacco use treatment, and preventive care more generally, in dental settings. It may be possible to use similar large insurance company databases to gain a greater understanding of the intersection of medical and dental services and the potentially bidirectional relationship between dental and medical health treatment and cost and outcomes (Theis et al., 2010). Statewide Medicaid programs have started to break down disciplinary and scope of practice-related barriers to improving health outcomes.

For example, Medicaid programs are reimbursing pediatricians and family physicians to provide preventive dental services (Rozier et al., 2003). There are a few pioneer programs serving Medicaid patients that offer reimbursement to dental for tobacco cessation counseling services. In Pennsylvania, dentists are reimbursed $15 for each 15-min counseling sessions they provide and can provide up to 70 sessions per person each year (Pennsylvania Department of Public Welfare, 2008). In Oregon, contracted dental care organizations are required to offer cessation services in line with the 2As and an R model (Ask, Advise, and Refer); however, reimbursement for this service is included in capitated fee. Both programs affirm the importance of dental visits as an opportunity for preventive care (Oregon Dental Service, 2011).

There is a need to study impact of these novel preventive care and reimbursement models in dental settings, as well as the effect of interdisciplinary care processes and integrated clinical information technology systems to improve health outcomes (Glick, 2009). There were several limitations. First, the small Batimastat sample and qualitative approach did not allow for adequate descriptions of how stand-alone dental insurers differed from integrated companies.