In 2022, FHLI’s program, the North Carolina Oral Health Collaborative (NCOHC) launched the Community Oral Health Transformation (COrHT) Initiative to advance value-based, prevention-focused oral health care. Supported by the Blue Cross and Blue Shield of North Carolina Foundation and the CareQuest Institute for Oral Health, the initiative engaged stakeholders from across North Carolina to promote whole-person health.
The recently published report, “The Collaborative Effect: Transforming Oral Health in North Carolina,” evaluates the impact of COrHT. Learn more about the results and implications for transforming oral health in our state!
What Was the Initiative?
From 2022 to 2024, 14 safety-net dental practices spanning 47 North Carolina counties formed a learning community focused on person-centered, integrated, and preventive oral health models grounded in CareQuest Institute’s “Three Domain Framework,” emphasizing:
- Tele-prevention
- Minimally invasive care
- Integration of oral and overall health
With support such as funding, coaching, and an alternative payment structure, the initiative reached over 87,000 unique patients across the lifespan. In addition to achieving positive outcomes for patients, the initiative laid the groundwork for long-term policy changes that support value-based care.
Key Outcomes
The results were nothing short of transformative, ranging from care delivery to patient experience:
| Focus Area | Outcome Achieved |
| Teledentistry | Increased by 635% (from 402 to 2,953 visits) |
| Silver Diamine Fluoride (SDF) | Grew by 423% (1,112 → 5,819 applications) |
| Self-Management Goals | Jumped by 285% |
| Chronic Disease Screenings | Up by 434% |
| Care Coordination / Referrals | Soared by 563% |
| Pay-for-Reporting Incentive | Practices earned 97.2% of available funds |
These metrics underscore a shift toward preventive, minimally invasive, and integrated care models, laying the groundwork for equitable and sustainable oral health delivery.
Comparing to Non-Participant Practices
When benchmarked against a non-participating Federally Qualified Health Center (FQHC), participating clinics delivered significantly better preventive care:
- Higher rates of prophylaxis, fluoride varnish, and self-management goal application.
- Increased use of SDF.
- A 1.3 percentage point reduction in surgical services (from 11.1% to 9.8%).
This suggests that value-based approaches, enriched with support infrastructure, can enhance preventive services and reduce the need for invasive treatments.
A Roadmap for Structural Change
The report emphasizes that lasting oral health equity demands structural shifts, including:
- Robust Infrastructure & Workforce: Preparing clinics with tools and training to deliver complex, integrated care.
- Data-Driven Practice: Building capacity for reporting and using insights to drive improvement.
- Patient-Centered Models: Tailoring care to be inclusive, accessible, and preventive.
- Integrated Systems: Bridging clinical silos to promote coordinated, whole-person care.
It also includes recommendations for how to move forward, including:
- Integrating dental providers into the state’s health information exchange system (HealthConnex).
- Sharing value-based care best practices across safety-net providers.
- Expanding teledentistry reimbursement and support.
- Continuing training programs on dental practice management and operational improvement.
Why This Matters
North Carolina faces significant oral health disparities. In 2019, nearly 76,000 residents sought emergency department care for dental issues, and 93 of 100 counties are designated as Dental Health Professional Shortage Areas. COrHT demonstrates a viable, scalable model to make dental care more integrated, preventive, and equitable. The findings serve as a blueprint not just for North Carolina, but for any state seeking to elevate oral health through collaboration, data, and value-based investment.
The COrHT initiative stands as a landmark example of transforming oral health care through partnerships, innovation, and systemic change. By aligning stakeholders, focusing on patients, and committing to prevention, we can enhance the overall health and well-being of all North Carolinians by ensuring everyone has access to quality oral health care.
NCOHC, a Foundation for Health Leadership & Innovation program, works to advance systems-level changes, improving the overall health and well-being of all North Carolinians by increasing access to care. Sign up for our monthly newsletter to join the network and get involved!