- Need: To improve rural residents' oral healthcare.
- Intervention: MORE Care creates interprofessional oral health networks to 1) better integrate oral health into primary healthcare and 2) coordinate oral health between primary and dental healthcare.
- Results: MORE Care has led to increases in fluoride varnish administration, improvement in interprofessional communication, and patients' improved self-management of their daily oral health.
Rural areas face many challenges when it comes to
oral healthcare: They are more likely than urban
areas to be within Dental Health Professional Shortage
Areas, have higher rates of poverty, and have fewer
dental providers accepting Medicaid. Because of these and
other factors, rural residents are more likely to have
missing teeth and more dental caries.
However, the integration and coordination of oral health
between primary and dental care teams can help rural
patients improve their oral and overall health. The
Medical Oral Expanded Care (MORE Care) Initiative
connects Rural Health Clinics (RHCs) with dental care
partners. These interprofessional oral health networks
(IPOHNs) create interdisciplinary care teams that provide
patient-centered oral care. To date, four states have
participated in MORE Care: South Carolina, Pennsylvania,
Colorado, and Oregon.
The initiative in South Carolina includes a partnership
with the Medical University of South Carolina, which
received additional funding from a 2016-2018 Health
Resources & Services Administration (HRSA) Grant to
States to Support Oral Health Workforce Activities.
MORE Care helps primary care providers:
- Develop oral health referral networks
- Integrate oral health preventive measures into their
- Develop oral health self-management goals with their
- Test ways to overcome challenges
in interprofessional practice
MORE Care helps dental providers:
- Develop referral networks with primary care providers
- Adopt medical-dental referral practice
- Encourage risk-based disease
In efforts to improve health information technology (HIT)
among rural partners, the Colorado Rural Health
Center facilitated changes to the Quality Health
Indicators (QHI) informatics system, which is
traditionally used for hospital system metrics and
quality improvement, to add a format that collects oral
health data. This system change allowed MORE Care clinics
to integrate oral health into their current measurement
system so that oral health was integrated into the
established system rather than appearing as an extra
stand-alone effort. The MORE Care program here ended when
The Central Oregon
Health Council provided funding for four clinics to
incorporate oral health into their primary care practices
(such as oral health risk assessments and fluoride
varnish applications) and create a two-way referral
system with dental practices.
Office of Rural Health created the Dental Delivery
Systems Coordinator (DDSC) position. The DDSC, a
registered dental hygienist with public health licensure,
provides oral health training to primary care providers
and serves as liaison between the rural health teams and
the Pennsylvania Office of Rural Health.
The South Carolina Office of
Rural Health added new positions called quality
improvement coaches (QICs). These coaches help rural
practices implement and evaluate quality improvement
measures and visit RHCs to help them identify challenges
MORE Care involves a total of 30 RHCs and 19 dental care
partners in 4 states, resulting in:
- Increases in fluoride varnish administration
- Increases in oral health risk assessment and
evaluation by medical providers
- Improvement in interprofessional communication
between medical and dental care teams
- Improved dental home establishment
- Patients' improved
self-management of their daily oral health
In 2018, MORE Care participants from St. Luke's Miners
Rural Health Clinics in Pennsylvania received the
National Rural Health Association's Outstanding Rural
Health Organization Award:
MORE Care was featured in a 2017 DentaQuest white paper
MORE Care: Narrowing the Rural Interprofessional Oral
Health Care Gap and in a 2017
RAC Monitor article.
In many private insurance and Medicaid plans, it is
difficult for providers to get reimbursed for oral health
services for older children and adults. Care teams will
benefit from training in effective management of coding
and billing as well as an understanding of Prospective
Payment System (PPS) and renegotiation strategies.
Other factors can prevent effective care coordination and
- Breakdown in management or communication
- Differences in providers' education or training
- Lack of HIT interoperability
- Lack of a quality improvement environment
- Time constraints for providers
Program coordinators used a modified version of the
Institute for Healthcare Improvement (IHI) Breakthrough
Qualis Health – Oral Health Delivery Framework, and
"Smiles for Life: A National Oral Health Curriculum"
during training and implementation.
State programs asked colleges of dentistry and existing
oral health programs like Colorado's Cavity Free at
Three and Pennsylvania's Healthy Teeth Healthy
Children to provide personnel for onsite training at the
RHCs. The three State Offices of Rural Health involved
with MORE Care recommend yearly onsite training.
A program like MORE Care can be implemented at the clinic
level, but program coordinators recommend implementing it
at the community or state level to promote more
widespread changes in oral healthcare integration.
Program coordinators also give the following advice:
- Build a leadership team
- Develop a business plan
- Gain buy-in from the community and healthcare leaders
- Gather qualitative and quantitative data for program
- See if your state has an oral
health coalition, which can provide additional support
The Rural Primary Care Practice Guide to Creating
Interprofessional Oral Health Networks was created
based on MORE Care primary care practices' experiences.
For more information on planning and implementing an
IPOHN, please read the "MORE Care: Narrowing the Rural
Interprofessional Oral Health Care Gap" section titled
State Offices of Rural Health and Medical Oral Expanded
Care Initiation (p. 14).
Integrated service delivery
Networking and collaboration
Rural Health Clinics
Colorado, Oregon, Pennsylvania, South Carolina
June 6, 2017
Date updated or reviewed
July 9, 2020
Suggested citation: Rural Health Information Hub,
MORE Care [online]. Rural Health Information Hub. Available at:
[Accessed 5 July 2022]
Please contact the models and innovations contact directly for the most complete and current information
about this program. Summaries of models and innovations are provided by RHIhub for your convenience. The
programs described are not endorsed by RHIhub or by the Federal Office of Rural Health Policy. Each rural
community should consider whether a particular project or approach is a good match for their community’s
needs and capacity. While it is sometimes possible to adapt program components to match your resources, keep
in mind that changes to the program design may impact results.