WIXLIB

Dental Care Coordination through Systems Approachto Increase Access to Dental Carefor Medi-Cal Beneficiaries:Alameda County’s ExperienceQuamrun Eldridge, Suhaila Khan, Bhavana Ravi,Yilak Fantaye, Kerri Chen, Jared Fine, Arash AslamiAlameda County Office of Dental HealthCOHTAC Lunch & Learn SeriesNovember 19, 2020ALAMEDA DTI - HEALTHY TEETH HEALTHY COMMUNITIES1

Learning Objectives1. To discuss and explain the effectiveness of the Dental Care Coordinationmodel through a systems approach to increase access to dental care forMedi-Cal beneficiaries in Alameda County. WHAT WE DID.2. To discuss and describe the strengths and challenges of implementingobjective 1 in a large county-wide collaboration. HOW WE DID IT.3. To discuss the results based program and policy implications. WHAT ISNEXT.ALAMEDA DTI - HEALTHY TEETH HEALTHY COMMUNITIES2

CONTEXT:Need To Increase Access To Dental CareALAMEDA DTI - HEALTHY TEETH HEALTHY COMMUNITIES3

Alameda County 739 sq. miles By San Francisco Bay Population 1,671,329, 7th largest Race/ethnicityWhite 44.1%, Asian American 34.9%,Latinx 22.3%, African American 12.2%,Native Hawaiian Other Pacific Islander 1.4%,American Indian/Alaska Native 1.5%,Other 12.8%Uninsured: 3.8%Publicly insured: 29%Data Source: US Census Bureau 2019ALAMEDA DTI - HEALTHY TEETH HEALTHY COMMUNITIES4

ALAMEDA DTI - HEALTHY TEETH HEALTHY COMMUNITIES5

Little HooverCommission Report:“Fixing Denti-Cal”April 2016WWW.LHC.CA.GOVALAMEDA DTI - HEALTHY TEETH HEALTHY COMMUNITIES6

Key Findings of Little Hoover Commission Report:why Medi-Cal’s Dental Program was failingDental Provider FactorsLow reimbursementToo few settings – lack of dentists who take Medi-Cal patientsDifficulty finding providers for kids under 5Administrative-financial burdenPatient/Client FactorsLittle outreach or care coordinationHigh no show rateLow oral health literacyLanguage/cultureLong wait for appointmentsLong distancesPsycho-social barriersAdministrative-financial burdenSystem FactorsAdministrative issuesFinancial issuesData collection/utilizationPublic-private collaborationDental-medical-behavioral collaborationALAMEDA DTI - HEALTHY TEETH HEALTHY COMMUNITIES7

Access to torsALAMEDA DTI - HEALTHY TEETH HEALTHY COMMUNITIES8

What is Healthy Teeth Healthy Communities (HTHC)? Alameda County Office of Dental Health funded byDental Transformation Initiative (DTI) from the State. Alameda County’s DTI is called the Healthy TeethHealthy Communities. Project Period: April 2017 – December 2020. 19.7 millionALAMEDA DTI - HEALTHY TEETH HEALTHY COMMUNITIES9

WHAT WE DIDBuilt an effective Dental Care Coordination model throughsystems approach, that led to increased access to (& utilizationof) dental care for Medi-Cal children-youth ages 0-20 years inAlameda County.ALAMEDA DTI - HEALTHY TEETH HEALTHY COMMUNITIES10

HTHC Goal, Objective, Actions, and Sub-actionsGoal: To increase access to preventive dental care servicesfor Medi-Cal children-youth ages 0-20 years in Alameda County.Objective: To create and implement a new model of county-widedental care coordination system in Alameda County.ALAMEDA DTI - HEALTHY TEETH HEALTHY COMMUNITIES11

Actions:1. Create community dental care coordination (CDCC) workforce2. Create network of dentists called Community of Practice (COP)3. Collect, analyze, report & use data Create online databaseSub-actions:1. Continuous quality assurance2. Leadership, disciplined administration, and multi-level communications3. Build & utilize partnerships-collaborations Public-private Medical-dental-behavioralALAMEDA DTI - HEALTHY TEETH HEALTHY COMMUNITIES12

Model: Dental Care Coordination dministration-Communication-PartnershipsALAMEDA DTI - HEALTHY TEETH HEALTHY COMMUNITIES13

Action #1 (bridge connecting patients & providers):Create Community Dental Care Coordination (CDCC)Workforce26 CDCCs - from 14 agencies8 FQHCs2 community health centers2 CBOs2 programs from ACHCSA (ODH,CHSC)Culturally-linguistically sensitiveALAMEDA DTI - HEALTHY TEETH HEALTHY COMMUNITIES14

CDCC Workforce Responsibilities Outreach & in-reach to find families with children who are on Medi-Calor Medi-Cal eligible Educate families about oral health, using Medi-Cal dental services Assist families with dental appointments - scheduling & showing up Accompany clients to 1st appointments, conduct follow-up calls Establish-maintain a good working relationship with dental providers Collect and enter data in the database Attend project trainings-meetings as scheduledALAMEDA DTI - HEALTHY TEETH HEALTHY COMMUNITIES15

Action #2 (address provider factors):Create Network of Dentists: Community of Practice (COP)164 dentists recruited 133 from 8 FQHCs 29 from 23 private practices 2 from 1 community health centerChampion deployedALAMEDA DTI - HEALTHY TEETH HEALTHY COMMUNITIES16

COP Provider Responsibilities Accept Medi-Cal patients (for private dental offices) Coordinate with CDCCs for patient’s dental appointments Complete documents (Dental Encounter Form) Participate in trainings & mentorship program 14 CE courses - 49 units, no cost, by UCSF faculty 17 pediatric dentistry mentors Provide Family Oral Health Education (FOHE) to familieswith children 0-5 years oldALAMEDA DTI - HEALTHY TEETH HEALTHY COMMUNITIES17

Action #3Collect, Analyze, Report & Use DataCreated database that emphasizes dental care coordination Cloud-based, online, live, HIPAA compliant Real time data collection & data entry by 26 CDCCs Real time monitoring & reportingCreated CDCC monthly report with targetsConducted Surveys Client satisfaction (2019 & 2020) – English, Spanish, Cantonese CDCC satisfaction (2017, 2018, 2019) CDCC knowledge-skills-confidence (2018, 2019) COP satisfaction (after every CE, 4x annually, 2017-2020) COP follow-up baseline (2018, 2019, 2020)Conducted Focus Groups 2018 (6 client, 2 CDCC, 4 dental provider) 2020 (dental providers, Zoom)ALAMEDA DTI - HEALTHY TEETH HEALTHY COMMUNITIES18

Sub-action #1:Continuous Quality AssuranceFormed Accountability & Quality Improvement (AQI) Workgroup monthly meeting, partners of ODH-UCSF-Alameda Health Consortium developed the data collection tools conducted all the surveys analyzed & used the dataData quality check monthly error report from database – shared with 26 CDCCs, data corrected Data Audit: 2019, 26 CDCC’s client data checked e.g. signed consent formExample of using data for quality improvement CDCC survey: which refresher training to repeat – HIPAA, Medi-Cal COP CE survey: more case scenarios on how to treat children ages 0-5 years CDCC monthly targets not met – called Project DirectorALAMEDA DTI - HEALTHY TEETH HEALTHY COMMUNITIES19

Sub-action #2:LeadershipHCSAPHDAlamedaCountyVision, Infrastructure, ImplementationHealth Care ServicesAgencyPublic HealthDepartmentCHSODHCommunity Health Services(10 programs)Local OralHealthProgramOffice of Dental HealthHealthySmilesWIC DentalDaysSchool BasedProgramsALAMEDA DTI - HEALTHY TEETH HEALTHY COMMUNITIES20

Sub-action #2Disciplined Administration & Multi-level CommunicationsALAMEDA DTI - HEALTHY TEETH HEALTHY COMMUNITIES, APHA ANNUAL CONFERENCE, 10/5/2021

Sub-action #3Build & Utilize Partnerships-Collaborations County-wide dical-behavioralCounty-UCSFCounty-Alameda Health Consortium 40 partners17 agencies23 private dental offices(including 8 FQHCs, 2 community healthcenters, 2 CBOs)ALAMEDA DTI - HEALTHY TEETH HEALTHY COMMUNITIES22

Our Valued PartnersALAMEDA DTI - HEALTHY TEETH HEALTHY COMMUNITIES23

HOW WE DID ITYear 0 (2016): Pre-grant activitiesYear 1 (2017): PlanningYear 2, 3 & 4 (2018, 2019, 2020): Field workThe strengths and challenges of implementing LearningObjective #1 in a large county-wide collaboration.ALAMEDA DTI - HEALTHY TEETH HEALTHY COMMUNITIES24

Year 0: Pre Grant Activities Alameda County Office of Dental Health provided the leadership to writethe grant Partnership with 17 organizations was built before the grant was written Grant was written in collaboration with 17 partners Job responsibilities of CDCCs were developed with the partners FQHC dentist participation was formulated with FQHC dental directorsALAMEDA DTI - HEALTHY TEETH HEALTHY COMMUNITIES25

Year 1 (project started 2017 April):Planning & Developing Project Implementation ToolsCDCC Workforce curriculum advisory group formed – met weeklyCare coordination advisory group formed – met monthlyCOP Leadership group formed with UCSF – met 2x monthlyCOP & CDCC curriculum development startedQuality Assurance AQI Group formed with UCSF, Alameda Health ConsortiumDatabase design discussions started with vendorImplementation Plan started writing (2018, 2019)Evaluation Plan started writing (finished mid 2018)ALAMEDA DTI - HEALTHY TEETH HEALTHY COMMUNITIES26

ALAMEDA DTI - HEALTHY TEETH HEALTHY COMMUNITIES27

CDCC Workforce Activities (2017 Oct, Nov, Dec) Developed 8-week training curriculum Training curriculum topics: oral health,care coordination, outreach principles,dental terminology, data entry Recruited 26 diverse CDCCs: by partners Trained the CDCCs: ODH organized iPads provided for entering dataALAMEDA DTI - HEALTHY TEETH HEALTHY COMMUNITIES28

Target/Benchmarks for CDCCsType of ServicesEach CDCC/monthEach CDCC/yearContact families with children/youth50600Schedule dental appointment/care coordinate23276Show for dental appointment15179Continuity of care10116ALAMEDA DTI - HEALTHY TEETH HEALTHY COMMUNITIES29

Tools for CDCCsALAMEDA DTI - HEALTHY TEETH HEALTHY COMMUNITIES30

Patient Consent FormAvailable in: English Arabic Farsi Chinese simplified Chinese traditional Spanish Tagalog VietnameseALAMEDA DTI - HEALTHY TEETH HEALTHY COMMUNITIES31

Dental Encounter FormAvailable in: English, Arabic, Farsi, Chinese simplified, Chinesetraditional, Spanish, Tagalog, VietnameseFilled byAssisting CDCCFilled by DentalProvider officestaffALAMEDA DTI - HEALTHY TEETH HEALTHY COMMUNITIES32

Year 2 (2018) CDCC Workforce ActivitiesCDCCs provide dental hygiene supplies, health education, andsupport with making appointments to families.(Lili & Nandita of Alameda County Office of Dental Health)CDCCs provide resources to families at health fairs and otherevents throughout Alameda County.(Chris & Becky of Tiburcio Vasquez Health Center)ALAMEDA DTI - HEALTHY TEETH HEALTHY COMMUNITIES33

CDCC Workforce COP Dentists (challenge #1)Dental Providers (private & FQHC, dentist &front office staff) didn’t know who the CDCCs were.Solution – setup introductory meetingsPrivate dental provider office staff wereuncomfortable working with all 26 CDCCssimultaneously.Solution – have a Lead CDCCProvider anxiety - bus load of Medi-Cal childrenSolution – practice’s select how many children, age, appointment slot timesALAMEDA DTI - HEALTHY TEETH HEALTHY COMMUNITIES34

COP Dentist Network Serving Medi-Cal ChildrenDentists, RDHs, and RDAs at a CE course.Participants complete a worksheet exercise at a CEcourse.ALAMEDA DTI - HEALTHY TEETH HEALTHY COMMUNITIES35

Challenge #2: Online Databasenot ready for 6 months in 20181 page paper data collection form: created by ODH staffManually counted DEFsAccess database: created by ODH staffAppointment calendar: created by ODH staff*Outreach calendar: created by ODH staff*CDCC Monthly Report spreadsheet: created by ODHstaff**features not available on database even by end of projectALAMEDA DTI - HEALTHY TEETH HEALTHY COMMUNITIES36

Appointment Calendar – Tool for CDCCsALAMEDA DTI - HEALTHY TEETH HEALTHY COMMUNITIES, APHA ANNUAL CONFERENCE, 10/5/2037

HTHC Online Calendar for CDCCs: Outreach-Inreach cscheduling@gmail.com38

More Tools for CDCCs – 2018, 2019-ALAMEDA DTI - HEALTHY TEETH HEALTHY COMMUNITIES39

PublicationsALAMEDA DTI - HEALTHY TEETH HEALTHY COMMUNITIES40

AL)VIETNAMESEFARSIARABICALAMEDA DTI - HEALTHY TEETH HEALTHY COMMUNITIES41

ALAMEDA DTI - HEALTHY TEETH HEALTHY COMMUNITIES42

ALAMEDA DTI - HEALTHY TEETH HEALTHY COMMUNITIES43

APHA Annual Conference 2020 – 4 presentationsALAMEDA DTI - HEALTHY TEETH HEALTHY COMMUNITIES44

EVIDENCE OF SUCCESSALAMEDA DTI - HEALTHY TEETH HEALTHY COMMUNITIES45