Slides: Breaking Down Silos: Dental Integration
COMING SOON! Presentation for the 2026 Annual Conference of the Florida Association of Free and Charitable Clinics.
How Can Free and Charitable Clinics Build a Seamless Experience for Patients?
In 2013, the SAMHSA-HRSA Center for Integrated Health Solutions created a six-level framework for integrating behavioral health into primary care. Levels 1 and 2 are classified as “Coordinated,” Levels 3 and 4 are “Co-Located,” and Levels 5 and 6 are “Integrated.” These ideas can be useful to Free and Charitable Clinics and Charitable Pharmacies as they seek to streamline their operations.
I have adapted the framework with dental and primary care integration in mind. It works for other services, too. In my adaptation, I call the six stages "phases" rather than "levels." "Levels" suggest a ladder, where higher is better. "Phases" reflect that organizations move through them over time, and that the right target depends on a clinic’s mission and capacity. The six phases fall into three groupings: coordination, collaboration, and integration.
My framework also differs in one important way: Services do not have to be co-located to be integrated. Co-location can ease the burden on patients and help providers communicate. Free and Charitable Clinics, however, sometimes deliver care through mobile units or at multiple sites, where co-locating every service is not realistic. Integration should still be within reach for them.
Finally, I am always learning. This framework will be updated based on feedback and new information. Check back for the latest!
Phase 1
Partnership
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Dental and primary care providers are not part of the same organization.
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Communication may occur at the executive level or provider level.
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Referrals comprise the majority of communications.
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Relationship between provider offices is highly dependent on personnel.
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No formal agreements, payment arrangments, or MOUs are in place.
Phase 2
Coordination
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Dental and primary care may or may not be under the same organization.
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Dental and primary care programs operate as partners, separately and on separate systems.
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Providers view each other as resources and communicate periodically about patients.
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If separate organizations, executives facilitate coordination.
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A formal agreement, referral process, payment arrangement, MOU, or shared governance institutionalizes the relationship.
Phase 3
Basic Collaboration
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Dental and primary care are housed within the same organization.
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Dental and primary care services may be co-located.
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Providers use separate systems but develop workarounds to share patient information and coordinate care, particularly for complex patients.
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Movement of patients between service areas is most often through a referral process.
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Most decisions about patient care are made independently by individual providers.
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Organizational leadership and key providers discuss reducing silos
Phase 4
Advanced Collaboration
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Patient-facing systems are shared (patient intake, eligibility, scheduling, reminders, etc.)
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A process or system allows providers to consistently exchange information about patients across primary care, dental, or other services.
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Complex patients drive the need for consultation, which is done through personal communication.
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Some processes and workflows supporting collaboration are formalized in policies and information systems.
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Organizational leadership and key providers have focused meetings on reducing silos and streamlining the patient experience
Phase 5
Basic Integration
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Dental, primary care and/or other providers begin to function as one team.
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Team dedicates time to systematic solutions, polices, processes or workflows to reduce barriers to integration for a broad range of patients.
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Providers understand the different roles team members play and have started to change their practice and structure of care to better achieve patient goals.
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Organizational leadership, key providers, and staff work together to establish policies, processes, and workflows that advance the collaboration.
Phase 6
Advanced Integration
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Patients and providers view the operation as a single organization.
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Team communicates consistently across disciplines.
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A tracking or feedback system allows providers to verify that patients have received services across other disciplines.
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Receiving services across disciplines (e.g., dental, primary care, pharmacy, etc.) requires minimal effort for the patient.
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Supporting patients receiving services across disciplines requires minimal effort for providers.
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Integration workflows and efficiencies are sustained through infrastructure. Integration is independent of the personnel in key positions.