Payers have a key role to play in closing oral health disparities
People with intellectual and developmental disabilities (IDD) face some of the most severe oral health disparities in the health care system, with costly consequences. Higher rates of tooth decay, gum disease, and tooth loss occur 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 your mouth, either—it can lead to chronic diseases like heart disease and increase long-term medical costs.
As payers look for smarter ways to improve outcomes and manage spending, one emerging tool deserves serious attention: salivary diagnostics. This non-invasive, real-time diagnostic provides preventive solutions for at-risk populations. It also provides insurance companies with a low-risk opportunity to assess the impact.
Why oral health innovation matters to IDD care and payers
Traditional dental care methods often fail to meet the needs of people with IDD. Routine cleaning tasks can be stressful or difficult to perform due to anxiety, sensory sensitivities, mobility issues, or communication difficulties. Many dental providers are not trained to care for this population, and professional practices are often out of reach. The result? Preventable dental problems escalate into medical problems, resulting in avoidable emergency room visits, exacerbation of chronic conditions, and increased costs—especially to Medicaid.
This is where chairside saliva testing has incredible potential. It is fast, non-invasive and suitable for use in a variety of care settings, including group homes, community clinics, primary care and more. The test analyzes markers such as pH and MMP-8 in saliva to identify early signs of dental disease or systemic inflammation. It provides providers with real-time data and helps caregivers tailor interventions before a problem becomes an emergency.
Saliva testing is also gaining traction across the country. The American Dental Association recently approved new CDT codes for point-of-care saliva diagnostics, clearing the way for wider adoption in clinical settings and strengthening its role in preventive care.
early evidence of commitment
Pilot studies are valuable tools for showing how saliva testing works in practice. Early pilot work has shown encouraging signals, such as improvements in key biomarkers related to tooth decay risk and gum health, as well as better preventive behaviors among participants. While more research is needed, these preliminary trends highlight the potential of salivary diagnostics to help providers intervene earlier and support high-need populations more effectively.
The important takeaway for payers is that saliva testing shows promise as a scalable, easy-to-use tool that can generate insights and results. The pilot allows insurers to collect real data, refine strategies and assess long-term value without overhauling existing benefit models.
A low-risk way to test high-potential solutions
For health insurance companies, the appeal isn’t just clinical; This is financial. Emergency dental visits alone cost the U.S. health care system more than $2 billion annually, with Medicaid covering more than 40% of these costs. Prevention tools that flag risks early and reduce avoidable interventions are logical next steps in bending the cost curve, especially for high-need populations.
Chairside saliva testing also stands out for its low-barrier implementation. It does not require advanced equipment or clinical infrastructure and can be delivered by support staff in non-traditional care settings. This makes it scalable and ideal for reaching underserved IDD populations.
That’s why a pilot program is a smart entry point. Payers can explore the impact of saliva testing on specific populations, track clinical and financial outcomes, and collect real-world data without making broad policy changes. Partnering with an experienced supplemental benefits provider ensures efficient rollout, data collection, and analysis while minimizing in-house promotions.
Build smart, scalable pilots
For payers ready to explore saliva testing, the path forward does not require significant investment—just clear goals, the right partners, and a plan to measure the right metrics. Launching a targeted, high-impact pilot program requires four components:
Define the scope of your plan. Consider starting with people who are at high risk for IDD—people with a history of dental problems or who don't have access to preventive care. These members will benefit greatly from early intervention and generate clear impact data.
Rely on external expertise. Work with a supplemental benefits administrator who understands the operational needs of specialty care and can ensure smooth execution. They can manage implementation, streamline logistics, and ensure the pilot runs smoothly from day one.
Measure what matters. Successful pilots go beyond anecdotes and generate actionable data. Key metrics can include changes in biomarkers, fewer emergency visits, better prevention habits, and additional outcomes—but the focus should always be on meaningful impact.
Expand plans based on results. If the data shows better results and lower costs, build from there. Use these insights to integrate saliva testing into your benefits strategy – whether as a targeted add-on product, a care coordination tool or a broader prevention offering.
Now is the time to take action
The oral health needs of people with IDD are chronically unaddressed and have increasing downstream costs. Saliva testing is more than a new tool; it is a scalable strategy that can move care upstream, reduce preventable emergencies, and bring equity to populations that are often left behind.
Pilot programs offer health plans a rare combination of low risk and high benefit. With early results and real-world implementation already underway, the question is not whether the technology has potential, but whether payers are ready to explore it. For those working to deliver smarter, more inclusive care, it’s time to lead the way.
Image: Nastasik, Getty Images
Brian Jones is chief growth officer at Avēsis, a provider of dental and vision specialty benefits. Brian has led a range of initiatives designed to enhance health care access and outcomes for Medicaid, Medicare, and other populations with special health care needs.
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