Evaluating the effect of a new Medicare dental benefit on the health of older adults

PROJECT SUMMARY This is the Paul B. Beeson Emerging Leaders Career Development Award in Aging submission for Lisa Simon, MD DMD, an internal medicine physician, general dentist, and early-stage investigator whose work focuses on the impact of oral health access on health outcomes for older adults. Through this Career Development Award, she will strengthen her skills in advanced analytic techniques and mixed methods analysis and develop clinical expertise in the medical and dental care of older adults. Although oral health is an important component of overall health for older adults, Medicare has not historically offered a dental benefit. Through a policy change beginning in 2023, traditional Medicare has begun covering dental services for Medicare beneficiaries with certain eligible diagnoses: those undergoing organ transplant, cardiac surgery/valvuloplasty, those with head and neck cancer, and those with cancer receiving chemotherapy, intravenous bisphosphonates, or chimeric antigen receptor T-cell therapy. This policy change represents a novel opportunity to evaluate the effect of dental access on both the dental and medical outcomes of Medicare beneficiaries through the following specific aims, leveraging both advanced methods that support causal inference and qualitative analysis: 1) to determine the change in rates of dental visits and complete tooth loss among Medicare beneficiaries with conditions meeting eligibility for the new dental benefit; 2) to evaluate treatment effect heterogeneity of dental coverage for eligible Medicare beneficiaries by racial and ethnic identity, geography, and availability of dental care; and 3) to identify the barriers and facilitators associated with Medicare enrollment among dentists. In tandem, with the support of an exceptional mentorship team, Dr. Simon will pursue the following career development goals to enrich her research and leadership abilities. These goals are: 1) to develop expertise in geriatric medicine at the interface of medicine and dentistry to better understand the health needs of older adults; 2) to acquire advanced skills in data science methods including causal inference and claims data analysis; and 3) to develop proficiency in qualitative research and its application to aging policy. Brigham and Women's Hospital and Harvard Medical School are the ideal environment for research excellence, with a strong background in Medicare policy evaluation and advocacy for older adults. Upon completion of this Career Development Award, Dr. Simon will be uniquely equipped to achieve independence as a researcher in aging.