Care Convergence: Mindset Shift for the Future of Care Delivery

Our current state of healthcare delivery is plagued by siloed care and misaligned incentives. Patients often find themselves navigating a complex system where their medical, dental and mental health providers operate in silos. This disjointed care increases the likelihood of redundant procedures, miscommunication and suboptimal treatment plans, driving up utilization and healthcare costs.

Care convergence represents a mindset shift. It brings together different care disciplines, technologies and innovative payment models to deliver better patient care at lower costs.

Convergence Across Care Disciplines

True care convergence connects medical, dental and mental health services with lifestyle factors such as nutrition and social determinants of health.

For instance, a diabetic patient would need the care of multiple specialties to prevent long-term complications, including kidney damage, nerve damage, blindness, Alzheimer’s disease, depression and cardiovascular disease (CVD), as well as access to dental care and nutrition counseling to manage their condition.

A 2022 study shows periodontal (gum) disease increases the risk of diabetes as well as colon cancer, pre-term labor, dementia and cardiovascular disease, among others. According to the American Diabetes Association, the cost of diabetes in the U.S. in 2022 was over $400 billion, mostly on hospital inpatient care, medications and diabetes management supplies.

In addition to poorer patient outcomes, the lack of collaboration across care disciplines causes communication breakdowns, limited information sharing between departments and duplication of efforts, all leading to increased denial rates and delayed or inaccurate reimbursement, directly impacting hospitals’ bottom line.

Technology As An Enabler

Advances in technology are pivotal to care convergence. Automating clinical workflows, billing and administrative tasks can significantly reduce the burden on healthcare providers, allowing them to focus more on cross-disciplinary patient care. A 2023 Medical Group Management Association survey found that only 30% of appointments are scheduled online via self-booking.

Despite the proliferation of electronic health records (EHRs), cross-disciplinary sharing and integrated treatment plans remain scarce. A May 2024 ONC brief found that while 71% of hospitals reported having electronic access to necessary clinical information at the point of care, only 42% of clinicians routinely used this information in patient care. Only 17% of hospitals would send a summary of care records to behavioral health providers—and even fewer to long-term/post-acute care providers.

In oral health, the disconnect is even starker. According to an August 2023 CareQuest report, the vast majority (88%) of medical and dental providers, even at co-located facilities, cannot revise their mutual patients’ treatment plans. Additionally, on average, 37% of new patients are asked to bring physical copies of their medical records to their dentist appointments—and only 34% of patients do so.

Technology and more time with the patient will take us only so far. It would take a mindset shift to overcome the prevailing culture of siloed thinking, training and billing.

Payment Innovation

Operationalizing care convergence requires different payment models. Traditional fee-for-service models instill a volume-over-value mindset, resulting in duplicative services and avoidable readmissions costing billions to the healthcare system.

We continue to underinvest in prevention, even though the CDC estimated that 90% of total healthcare costs go toward mental health and chronic conditions. There’s no shortage of preventative interventions with proven health and economic benefits that reduce the risk of developing these costly diseases, from oral diseases to cancer. What’s missing is a scalable way to pay for them.

New technology-enabled business models focused on improved outcomes are emerging. These models aim to realign incentives, fostering collaboration among care teams and involving patients actively in care with an increased focus on prevention and behavior change. Companies like Dyntl are engaging employers in intelligent benefit design, making it easier for employees to access dental care at or near employer campuses. Since the majority of employees are covered by employers in self-funded plans, employers are key to scaling convergent care models.

One example of convergent solutions that could thrive in an outcomes-based payment model is the use of AI to detect early caries (via companies like VideaHealth) and then applying noninvasive, brush-on treatments like Curodont Repair Fluoride Plus to stop the progression of the caries and remineralize the tooth, avoiding the need for a filling.

Venture Capital: A Vehicle For Transformation

Venture capital plays a critical role in accelerating the transition toward care convergence. By investing in convergent solutions, venture investors can drive the development and adoption of integrated care solutions that might lack the proof points just yet for other types of funding.

Venture capital operates on a power law distribution, where a small number of investments generate the majority of returns. While many startups in a traditional venture portfolio may fail or provide modest returns, a few can achieve exponential growth and deliver outsized returns—and this is a good thing.

This high-risk, high-reward nature of venture capital is well-suited for funding transformative healthcare innovations deemed too new or unproven. Without the pressure of trying to get every investment right, venture investors can look for bolder, bigger bets over extended investment horizons. With a select few, convergent solutions would also gain access to experienced operators and potential go-to-market partners in addition to capital.

Building And Sustaining A Care Convergence Mindset

Access to capital is critical to accelerating the development and adoption of convergent models and care solutions. Building and sustaining a culture of care convergence, however, begins with evolving medical training and care delivery workflows.

We are seeing some bright spots. Leading dental programs like Harvard School of Dental Medicine are incorporating medical education into dental training—ensuring dental students are well-versed in general medicine, which facilitates collaboration with other healthcare professionals. High Point University’s CARE Curriculum incorporates technology literacy and entrepreneurship to prepare future oral health physicians. Promising models at PDS Health integrate dentists, nurse practitioners and primary care doctors into care teams.

The mindset of care convergence allows us to finally treat the patient rather than the condition. As we continue to invest in and champion care convergence, we move closer to a healthcare system that is more coordinated, efficient and effective for all.