Even though teeth are an integral part of the human body, dental care has long stood apart from health care. This is probably because taking care of your teeth can have more of an aesthetic and wellness aspect, compared to taking care of your blood pressure or blood sugar levels, which seem to be an integral part of a long and healthy life.
The reality is that dental emergencies can land you in the emergency room. As increasing efforts are made to link dental health to overall health, the urgency should be keenly felt not only by pregnant women but, more importantly, by their healthcare providers and health insurance companies. Consider that pregnant women with gum disease are 3 to 4 times more likely to develop pre-eclampsia, a dangerous condition involving a sudden increase in blood pressure and signs of damage to other organs such as the kidneys. according to the National Center for Biotechnology Information. This fact was shared by Jourdan Miller, Director of Sales at mySwaddle, who was speaking recently at the annual Transform Summit in Scottsdale, Arizona. My swaddling is a care coordination and support solution for pregnant women, many of whom qualify for Medicaid.
The Transform Summit is hosted annually by Skygen, a leading dental and vision benefits administration company based in Menomonee Falls, Wisconsin, serving 60 million members. (Editorial note: The company paid part of my travel expenses but did not contribute to editorial coverage.)
“We talk a lot about maternal health in our country — prenatal visits, mental health screenings, postpartum depression. Oral health is almost never on that list,” Miller said. “So it’s a big deal, and it’s an important, measurable driver of maternal and child health outcomes that most plans aren’t actively managing.”
She added a statistic about Medicaid women, some of which MySwaddle hopes to serve in the future — while 86% of pregnant women on Medicaid report dental problems, only 35% seek treatment, representing a largely underutilized covered benefit.
“They carry a measurable risk of pregnancy and research clearly shows that periodontal disease in pregnancy is linked to prematurity and low birth weight,” she explained. “So the coverage exists. It’s not a benefit design problem. It’s an engagement and access problem.”
And why is it important to solve this problem? Miller linked it to the high costs of his ignorance.
“So emergency dental visits cost on average about $1,500 per visit,” she said. “It’s a significant expense for something that is actually entirely avoidable through routine care. So when a member avoids seeing a dentist, [visit] and the condition deteriorates and [the member] ends up in the emergency room, it is the most expensive and least appropriate establishment for dental care.
And it’s not just a financial issue related to the mother’s oral health. This can affect newborns throughout their developmental years. She explained that NICU stays for infants born prematurely can on average cost more than 10 times the cost of a full-term delivery and that periodontal disease is a “documented contributor to premature birth.” And it’s not like the problems disappear when the infant leaves the hospital. Indeed, low birth weight could lead to developmental complications, the costs of which could be reflected in better social services, early intervention and educational support for many years, according to Miller.
The problem is that no one tells pregnant women to take care of their oral health.
“Obstetricians don’t do oral health screenings. They don’t go to dentists when they see a woman who has poor oral health and so there’s no safety net here to catch limbs before this problem becomes a serious health risk,” Miller said.
Which means that state-contracted health plans need to address this engagement problem, given that the state funds the benefits, but they remain largely underutilized. This is where health plans can benefit from MySwaddle, they hinted. It is important to note here that mySwaddle is not just a maternal oral health tool. Rather, it aims to support a pregnant mother’s journey from the early stages to a year after giving birth.
In fact, the app’s webpage that provides information to families and members does not mention oral health prominently. Rather, it is associated with another neglected aspect of a pregnant mother’s journey: nutrition. This page lists other, much more important needs: personalized education and guidance, which includes resources on a week-by-week pregnancy journey, trimester-specific information and to-do lists, as well as finding a doctor and connecting with the care team, in person or via virtual visits.
Still, for Transform’s audience, Miller and another MySwaddle executive described oral health as a priority, while emphasizing that that’s not all the app does.
“Even though we start with oral health, that’s really just the entry point,” said Kia Hussain, mySwaddle’s vice president of business development during a presentation at the Summit. “Once you engage with members, you can support the whole journey of maternity diary, care coordination, behavior, health, nutrition, postpartum, and that’s where the big picture and that’s where the impact comes in.”
She added that plans that select MySwaddle for their Medicaid populations will see immediate benefits — avoiding 120 emergency dental visits, “which is essentially funding the pilot program with MySwaddle and that’s before factoring in any NICU avoidance or quality incentives.”
This is exactly the kind of cost savings through health improvement that CMS is looking for when it comes to maternal health. In 2023, CMS announced the Transformation of Maternal Health (TMaH) model to reduce spending while taking a “whole person approach to pregnancy, childbirth, and postpartum care.” The model would support participating state Medicaid agencies that address the physical, mental health and social needs experienced during pregnancy over a 10-year period, targeting not only Medicaid moms but also those enrolled in the CHIP program. Then, at the beginning of January 2025, CMS announced the 15 states that will implement the TMaH model and will receive funding of $17 million.
Although mySwaddle was designed to adhere to the contours of this federal initiative for Medicaid mothers, it can be a digital tool that commercial health plans and managed care organizations can also deploy for their members.
The app, backed by Holista Health, will have no shortage of competition in terms of digital tools aimed at pregnant women if it chooses to try to move into the non-Medicaid maternal health market. This marketplace offers everything from Maven Clinic, a venture-backed women’s health company slated to go public, to LabCorp’s Ovia Health, to much smaller companies like Trellis health, Health Lōvu and more.
Photo: ChatGPT
