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Building and Maintaining aFinancially Sustainable OralHealth ProgramAllen Patterson, CPA, FACMPE, MHAChief Executive OfficerCommunity Healthcare CenterWichita Falls, TexasScott Wolpin, DMDChief Dental OfficerEastern Shore Rural Health System, Inc., Onancock, VA2017 National Healthcare for the HomelessConference & Policy SymposiumJune 23, 2017
Objectives of Today’s Session To understand the need for oral health care in healthcenters serving the underserved and especially thehomeless To describe six strategies for increasing (beginning orexpanding) access to oral health services for theunderserved and homeless To share strategies regarding staffing, productivity, andintegrating oral health with the care provided by thehealth center’s medical program
What is NNOHA Founded 1991 by health centerDental Directors who identified aneed for networking and peer-topeer support National organization of oral healthproviders & supporters working incommunity health centers andother safety net providers Has cooperative agreement withHRSA to provide training &technical assistance to healthcenter grantees
The Need for Oral Health Care“ . You cannot be healthy without oral health”Oral Health in America: A Report of the SurgeonGeneral, 2000
Toothache Leads to Boy's Death
Early Childhood Caries DisparitiesPercentage 3-5 y/o Untreated DecayCDC/NCHS, National Health and Nutrition Examination Survey, 2009–2010.
Homelessness and Oral Health Each year an estimated 2 million people in the UnitedStates lack access to a conventional dwelling or residence Children account for almost 25% of homeless population Homeless persons are 12 times more likely thanindividuals with stable housing to have dental problems.Persons living in unstable housing, such as a hotel or theresidence of a friend or relative, are 6 times more likelyto have dental problems Among homeless children ages 5 to 9 years, 96 percentrequire dental care and 44 percent experience pain orinfection.
Periodontal Disease Prevalence byRace/Ethnicity%Eke PI, Dye BA, Wei L, Thornton-Evans GO, Genco RJ; CDC Periodontal Disease Surveillanceworkgroup. Prevalence of periodontitis in adults in the United States: 2009 and 2010. J Dent Res. 2012Oct;91(10):914-20.
Edentulism in Adults 65-74 & Poverty LevelCDC/NCHS, National Health and Nutrition Examination Survey, 2009–2010.
Oral Cancer Disparities 5-year Survival RatesSurveillance, Epidemiology, and End Results (SEER) Program, National Cancer Institute
HRSA Health Center Grantee Facts 2015 Number Health Center programs receiving 330-grantfunding: 1,375 Number HC programs with a dental program: 1,067(78%) Total health center users: 24,295,946 Number medical users: 20.6 million Number dental users: 5.2 million (21%!)
Who do we see?
Health Center Demographics: Age & Ethnicity 0-17 18-64 65 & up31.2%60.9%7.9% 62.4% identify as racial and/or ethnic minorities Hispanic/Latino35.2% African-American23.0%
Health Centers: Income as % of Poverty Level
Six Strategies for IncreasingAccess to Oral Health Care
Six Strategies for Increasing Access to OralHealth Care1. Brick & mortar - “build it and they will come!”2. Contracting for dental services3. Integrating Oral Health into Primary Care Practice(IOHPCP)4. Workforce innovation5. Tele-dentistry6. Redesign
HRSA Commitment to IncreasingAccess - Oral Health Expansion Grant(s) June 2016 announcement 156 million for dental expansions420 health centers- almost one third of all grantees120 days to hire dental providers & start seeing clients850,000 new patientsGrant is for up to 350,000 with 150,000 available forcapital (equipment) costsThis year with new administration will there be newopportunity?
If dental is a “new” program for our healthcenter how can we “build it”? Health Center Oral Health Start-Up Tool Kit NNOHA resources for organizations starting an oral -program-management/startup-and-expansion/# Safety Net Dental Clinic Manual Helps safety net dental clinics with all aspects of clinicdevelopment and ongoing operations.http://dentalclinicmanual.com/
Lot’s of equipment is needed to providedental care!
Other Capital Expenses include EHR Health Information ogrammanagement/health-information-technology/ “Its All in the Numbers: Planning and Financing yourDental ding/522368775637304166522
Build it and they will come Providers An Analysis of 2013 Health Center Oral Health ProviderRecruitment, Retention, and Job Satisfaction SurveyResults (includes salary survey) 84% of dentists & 94% of dental hygienists intended to remainemployed at health centers 40% of dental directors had salary 140,000/year 52% of the dentists had rotated through a health 014/09/SalarySurvey-Report 2014-09-08 final.pdf
Health Center Dental Providers Dental Recruitment Tips for Human Resources and DentalDirectors Characteristics of Providers who are Likely to Stay Feel a mission to serve dentally underserved population 5-10 years experience in dentistry – not necessary but es-and-DentalDirectors.pdf
School-based Dental Programs Survey of School-BasedOral Health ProgramsOperated by HealthCenters: nt/uploads/2014/07/SBHC-Report-FINAL 201407-28.pdf
MobileversusPortable
2. Contracting for Dental Services Health Centers with and/or without dental programs maycontract for dental services outside the "four walls” Contact with private dental offices, dental schools, othernon-profit dental clinics May contract for emergency care, comprehensive care,specialty care or any combination
Contracting Primary resource includingsample ic-privatepartnerships 013/09/Contracting-with-Private-PracticeDentists Partnerships-forAccess.pdf
3. 2014 HRSA Integration of Oral Health andPrimary Care Practice (IOHPCP) Initiative Translate oral healthcore clinicalcompetencies intoprimary care practice insafety net settings Improve access to earlydetection andpreventiveinterventions leading toimproved oral health
Integration of Oral Health and Primary CarePractice Initiative Primary Care Providers MD/DO Certified NurseMidwives Nurse Practitioners Physician Assistants Oral Health Core ClinicalCompetency Domains1.2.3.4.5.Risk assessmentOral health evaluationPreventive interventionsCommunication &educationInterprofessionalcollaborative oralhealth/primarycare/integrationoforalhealth.pdf
NNOHA IOHPCP Resources Integrated ence/integratecare/ A User’s Guide for Implementation of Interprofessional Oral HealthCore Clinical Competencies: Results of a Pilot Project Oral Health and the Patient-Centered Health Home: Action Guide
A User’s Guide for Implementation of InterprofessionalOral Health Core Clinical Competencies Step-by-step guide Develop systems forPCPs to learn andimplement oral healthcompetencies Health center and othersafety-net practices
ESRHS Combined Baby Well Check/FirstDental Exam
4. Workforce Innovation- Expand Scope ofPractice Existing Dental Team Members Registered Dental Hygienist- Remote Supervision State practice act dependent Ability to take care outside traditional dental office School-based, WIC, Head Start, geriatric, public healthprograms without direct dentist supervision Allows more patients to be reached
Workforce Innovation- Expand Scope of PracticeExisting Dental Team Members Dental Assistants State practice act dependent Allows more productivity in all practice settings
Workforce Innovation- New Team Members Midlevel Dental Providers: One Approach to Expanding Accessto Care Explains four midlevel provider models being used to expandaccess to care. Updates legislative interest from other 15/06/Midlevel-Dental-Providers063015 final.pdf Workforce Innovation to Increase Access to Dental Care Describes Community Dental Health Coordinators and DentalTherapists/Advanced Dental Therapists and how these teammembers are utilized in health orce-innovationto-increase-access-to-dental-care/
Workforce Innovation- New Team Members Dental Therapists Currently 2 states Webinar: The Impact of DentalTherapists on Health ploads/2014/08/Impact-of-dentaltherapists combined final.pdf Community Dental HealthCoordinators Currently 8 states Webinar: Community DentalHealth Coordinator- NewMember of the Dental Accessto Care r-NewMember-of-the.pdf
ESRHS-VDA CDHC Pilot ProjectThis collaborative effort was to arrange to study how acommunity dental health coordinator might benefitpatients needing dental care. CDHCs can help health centerdental programs; Decrease no-shows Increase the understanding of the importance of oral health to overallhealth Improve in-reach, outreach and scheduling of patients Increase completion of patient’s dental treatment plans and dental sealantutilization.
5. Tele-dentistry/ Virtual Dental Home Developed at the ArthurA. Dugoni School ofDentistry, University ofthe Pacific Utilizes technology tolink practitioners in thecommunity withdentists at remoteoffice sites
Tele-dentistry Webinar: Improving Oral Health Through Telehealth This webinar will assist health centers who wish to be a part oftelehealth connected dental teams.NNOHA webinar ams
6. System Redesign Workflow redesign can impact: Patient access to appointments In-appointment cycle time Increase practice efficiency and capacity QI/systems approach
Redesign Variables Standardization of process, protocols, equipment etc. Right room and support staff ratios Team members working at top of scope of practice
Redesign Resources Shows how to assessescurrent system and makechanges that improvequality Includes tools, pdf
Redesign Resources Redesigning the Dental Clinic for Maximum Efficiency Presentation developed by DentaQuest Institute’s Safety NetSolutions reviews methods for determining correct level ofdental clinic staffing, most efficient use of staff and moreWebinar on Clinic Efficiency 3.13.17
Schedule a DentaQuest Institute Safety NetSolutions Expert Advisor Site VisitLed by the Expert Advisor, a practicingdentist with the experience and knowledgeof safety net dental, and supported bypractice management consultants anddata analysts, the team provides leadership,sophisticated data analytics expertise andproven action plans for enhancing programfinances and sustainability.
NNOHA Technical Assistance Programs Website www.nnoha.orgDental Clinic Operations Manual/publicationsWebinarsPromising PracticesAnnual ConferenceNational Oral Health Learning InstituteListservSpeaker’s BureauConsultation/referral
www.nnoha.org
et-solutions
ContactScott Wolpin, DMDChief Dental OfficerEastern Shore Rural Health System, Inc.Onancock, VASwolpin@esrh.orgAllen Patterson, CPA, FACMPE, MHAChief Executive OfficerCommunity Healthcare CenterWichita Falls, Texasapatterson@chcwf.cominfo@nnoha.org
Six Strategies for Increasing Access to Oral Health Care 1. Brick & mortar - "build it and they will come!" 2. Contracting for dental services 3. Integrating Oral Health into Primary Care Practice (IOHPCP) 4. Workforce innovation 5. Tele-dentistry 6. Redesign HRSA Commitment to Increasing Access - Oral Health Expansion Grant(s)
