People with intellectual and developmental disabilities (IDD) face some of the deepest oral health disparities in the healthcare system, and the consequences are costly. Higher rates of cavities, gum disease, and tooth loss are due to limited access to care, gaps in provider training, and sensory and mobility challenges that make routine dental care difficult. Poor oral health doesn’t stay in the mouth either: it contributes to chronic diseases like heart disease, which increases long-term healthcare costs.
As payers look for smarter ways to improve outcomes and manage spending, one emerging tool deserves close attention: salivary diagnostics. This non-invasive, real-time diagnosis offers a preventive solution for high-risk populations. It also presents a low-risk opportunity for insurers to assess their impact.
Why Oral Health Innovation Matters for DDY Care and Payers
Traditional approaches to dental care are often insufficient for people with IDD. Routine cleanings can be stressful or inaccessible due to anxiety, sensory sensitivity, mobility issues, or communication barriers. Many dental providers are not trained to care for this population and specialty offices are often out of reach. The result? Preventable dental problems become medical problems, leading to avoidable emergency visits, worsening chronic diseases, and increasing costs, especially for Medicaid plans.
This is where in-office saliva testing has incredible potential. It is fast, non-invasive, and adaptable to various care settings including group homes, community clinics, primary care, etc. The test analyzes saliva for markers such as pH and MMP-8 to identify early signs of dental disease or systemic inflammation. It provides providers with real-time data and helps caregivers tailor interventions before problems become emergencies.
Saliva testing is also gaining traction nationally. The American Dental Association recently approved a new CDT code for saliva at the point of care diagnostics: paving the way for broader adoption in clinical settings and strengthening their role in preventive care.
Early evidence of promise
Pilot studies are valuable tools to demonstrate how saliva testing can work in practice. Early pilot efforts have shown encouraging signs, such as improvements in key biomarkers related to cavity risk and gum health, as well as improved preventive behaviors among participants. While more research is needed, these early trends highlight the potential for salivary diagnostics to help providers intervene earlier and support populations with the highest needs more effectively.
For payers, the important takeaway is that saliva testing shows promise as a scalable and accessible tool for generating insights and outcomes. Pilots allow insurers to collect real-world data, refine strategies and evaluate long-term value, without needing to overhaul existing benefit models.
A low-risk way to test a high-potential solution
For health insurers, the appeal is not just clinical; It’s financial. Emergency dental visits alone cost the US healthcare system more than $2 billion a year, with Medicaid covers more than 40% of those costs.. Preventive tools that detect risks early and reduce avoidable interventions are the next logical step in flattening the cost curve, especially for high-needs populations.
In-office saliva testing is also notable for its low-barrier implementation. It does not require advanced equipment or clinical infrastructure and can be administered by support staff in non-traditional care settings. This makes it scalable and suitable for reaching underserved IDD populations.
That’s why pilot programs are a smart entry point. Payers can explore the impact of saliva testing on a defined population, track clinical and financial outcomes, and collect real-world data, without the need to make major policy changes. Partnering with experienced fringe benefit providers can ensure efficient implementation, data collection, and analysis with minimal internal push.
Building an intelligent and scalable pilot
For payers ready to explore saliva testing, the path forward doesn’t require a massive investment: just clear goals, the right partners, and a plan to measure the right metrics. Here are four components necessary to launch a focused, high-impact pilot:
Define the scope of your program. Consider starting with high-risk IDD populations: people with a history of dental problems or inconsistent access to preventive care. These members will benefit greatly from early intervention and generate clear data on impact.
Lean on external experts. Partner with supplemental benefits administrators who understand the operational demands of specialty care and can ensure smooth execution. They can manage implementation, optimize logistics, and ensure the pilot runs smoothly from day one.
Measure what matters. A successful pilot offers more than anecdotes: it generates actionable data. Key metrics may include changes in biomarkers, fewer emergency visits, better preventative habits, and additional outcomes, but the focus should always be on meaningful impact.
Scale the program based on results.. If the data shows better results and lower costs, build from there. Use that knowledge to integrate saliva testing into your benefits strategy, whether as a targeted adjunct, a care coordination tool, or a broader preventative offering.
The time to act is now
The oral health needs of people with IDD have not been addressed for too long and the subsequent costs are piling up. Salivary testing represents more than a new tool; is a scalable strategy to shift care upstream, reduce preventable emergencies, and provide equity to a population too often left behind.
Pilot programs offer health plans a rare combination of low risk and high benefits. With early results and real-world implementations already underway, the question is not whether this technology has potential, but whether payers are ready to explore it. For those committed to smarter, more inclusive care delivery, it’s time to lead the way.
Image: Nastasic, Getty Images
Brian Jones He is the growth director of Avesisa provider of specialty dental and vision benefits. Brian leads initiatives that improve health care access and outcomes for Medicaid, Medicare, and other populations with special health care needs.
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