Photo: Sarrell Dental

Improving Access to Oral Healthcare: A Robust Business Model for a Self-Sustaining Nonprofit

By Kristie Wang, Ashoka Changemakers

Improving Access to Oral Healthcare: A Robust Business Model for a Self-Sustaining Nonprofit

Sarrell Dental is arguably the only highly successful, self-sustaining non-profit dental practice in the nation. It has accomplished what many in the U.S. health industry had thought impossible—providing dental care to children covered by Medicaid, while running a top-notch, growing business and lowering the cost of care to the government.

Sarrell Dental works in the poorest counties in Alabama, but is one of the highest paying dental employers in the state. The organization subsists almost entirely on Medicaid cases, all without donations or volunteers.

A Shortage of Dentists, Few that Accept Medicaid

Only 60 percent of America’s Medicaid-eligible children see a dentist regularly, due to a lack of access to care, according to Sarrell Dental. In Alabama, 66 out of 67 counties have a shortage of dentists, according to federal guidelines.

To compound the problem, many dentists in Alabama and nationwide do not accept Medicaid patients, citing low reimbursement rates, red tape, and difficulty working wi…. However, making dental care accessible to low-income children is key to preventing more severe and costlier problems later on.

Many families may opt to forgo dental care for their children, believing that dental care isn’t necessary for baby teeth. However, the health of baby teeth influences the growth of the face and jaw, as well as speech development. Children with tooth decay may experience pain and difficulty chewing, and their self-esteem may suffer as well.

Patient-Centered Care Combined with Economies of Scale

Sarrell Dental’s innovation combines a non-profit’s social mission with smart business sense. The organization pays top dollar for dental and business talent and separates the business and health sides of the operation so that dentists can focus on delivering truly patient-centered care.

As a result, Sarrell Dental has experienced 31 consecutive quarters of record patient growth. Currently, it has 14 state-of-the-art offices and a mobile dentist bus. By leveraging economies of scale to lower supply and equipment costs, the organization is able to remain completely financially self-sustaining while growing.

Many other dental organizations have struggled to deliver patient-centered care for Medicaid patients. Low-income patients tend to have limited flexibility with regard to appointment hours and may not have reliable transportation to get them to a clinic on time.

To accommodate these challenges, Sarrell Dental is open 10 hours a day and is flexible about missed appointments. “More than 80 percent of our patients are not old enough to drive, so they arrive, in general, via transportation provided by an adult,” according to Sarrell.

“If a patient shows up late for an appointment at 6p.m. (closing time), and the dentist is still present, we turn back on the equipment and treat the child. We have experienced more than 400,000 patient visits without a single patient complaint to the Alabama Board of Dental Examiners.”

The organization also maintains a strong, positive community presence. “We invest in our patients, our people, and our infrastructure,” according to Sarrell Dental. “We have a Community Outreach person in every area we have an office.

“We have am Hispanic outreach team specifically targeted to that segment. They screen children for dental issues in schools, day cares, Head Start programs and at community health fairs, free of charge. We also provide dental education at the aforementioned events.”

Replicating and Expanding Sarrell Dental’s Model

Sarrell Dental is now a model for the nation, with other states like Florida looking to replicate its success. “Our solution is readily expandable to almost any other state in the union,” according to Sarrell Dental.

“The infrastructure upgrades we have made to allow video conferencing, remote digital imaging, and EHR (to name a few) have placed us in a optimal position to expand. The states most favorable to our expansion are those with the greatest need for Medicaid dental care, and with community health providers open to partnership and collaboration.”

However, Sarrell foresees challenges to expansion due to many states’ Dental Practice Acts (DPA), which do not allow non-profit organizations to operate, even though Sarrell uses only fully licensed dentists. In fact, Sarrell had to initiate legislation in Alabama in 2011 to clarify that it was legal to operate a non-profit dental clinic.

“Dentistry is about 20 years behind the medical field, as far as consolidation and the use of alternative providers (i.e., nurse practioners),” according to Sarrell Dental. “DPA’s must change.”

Still, with Sarrell’s successful cost-saving model, it’s no wonder that the organization is receiving so much attention from top dental universities and news organizations like PBS Frontline, which recently featured Sarrell in its program, Dollars and Dentists. Last year, the Kentucky Dental Association invited Sarrell’s CEO, Jeffrey Parker, to write an article detailing the organization’s differentiating factors from other practices.

“To us, the standard of care is the standard of care and it is never compromised,” Parker writes. “We have a Chief Dental Officer who regularly audits every dentist’s work . . . So what differentiates our practice from yours? Clinically, there is little difference. The difference is in the business model.”

Editor’s Note:

This story is part of a series about innovative business models that are solving the systemic health problems of different markets around the world. This initiative was selected as a finalist in the Transforming Health Systems: Gamechanging Business Models competition, launched by Ashoka Changemakers and Boehringer Ingelheim. Visit the competition page to vote for your favorite finalist before June 18.

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