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Alameda County Healthy TeethHealthy Communities UpdateB A H AR A MANZADEH , D D S , M P HJ A N 8 TH, 2 0 1 8D E N TAL H E A LTH A D M I NIST RATO RA LA ME DA C O U N TY D E P A RT M ENT O F P U B LI C H E A LTH1
Alameda County Denti-Cal UtilizationOf 156,342 children (0-20) eligible for Denti-Cal Services: Only 43,932 (28%) were seen by a dentist in 2014. Of these, only 21,634 (49%) saw a dentist in the following year.Healthy Teeth, Healthy Communities (HTHC)2
Alameda County Oral Health Strategic plan 2012-20173
ACCESS to DENTAL CARE for CHILDREN coveredby Factors4
Local Dental Pilot Project GoalsPreventionIncrease the utilization of children ages 1-20 enrolled in Medi-Cal who receive anypreventive dental service, by at least ten (10) percentage points over a 4-year period.Access to CareIncrease the number of actively participating providers in each county who providepreventive services.Continuity of CareIncrease utilization of children continuously enrolled in the Medi-Cal Dental Programwho receive services performed by the same provider in 2-, 3-, 4- consecutive yearperiods.5
HTHC Strategy 1: Increase Dental CareCoordination Create a cross-agency workforce of Community Dental CareCoordinators (CDCC) who are linguistically and culturally responsiveto community Leverage existing infrastructures for outreach and carecoordination Develop a web-based Care Coordination Management System(CCMS) to link families to dental appointments and supportcontinuity of careHealthy Teeth, Healthy Communities (HTHC)6
HTHC Strategy 2: Increase Safety Net DentalNetwork and Capacity Expand provider network through recruiting private dentists intoDenti-Cal and enhancing FQHC participation Offer additional local educational and financial incentives toparticipating dentists Develop a Dental Community of Practice (COP) to connect dentalproviders to additional training and technical assistanceHealthy Teeth, Healthy Communities (HTHC)7
TrainDental CareCoordinatorsRethinkPlacesCreateConnected CareCredit to Gobee’s GroupHealthy Teeth, Healthy Communities (HTHC)8
Path of Establishing “Dental Home” as Illustratedby Community Dental Care Coordinators (CDCCs)9
Dental Care Coordination Convening10
HTHC Governance StructureSteering CommitteeImplementation WorkgroupSustainability WorkgroupAnalysis, Accountability Quality Improvement WorkgroupCare CoordinationForumDental Communityof Practice11
Steering Committee MembersNameOrganization & TitleDr. Baharak AmanzadehACPHD/ODH / Dental Health DirectorAngela BallACPHD / Public Health Nursing DirectorJanis BurgerFirst 5 Alameda County / Chief Executive OfficerDr. Muntu DavisACPHD / Chief Health OfficerQuamrun EldridgeACPHD/CHS Community Health Services Division DirectorEileen EspejoChildren Now / Senior Managing Director, Media & Health PolicyDr. Jared FineColleen Chawla /orDanice CookOscar GomezACPHD/ODH / Dental AmbassadorDr. David HoffmanAlameda Health System / MD, Highland HospitalDr. Huong LeAsian Health Services / Chief Dental OfficerLiz MakerTracey Schear/ orKimi SakashitaRalph SilberACPHD/CAPE - Evaluation Unit / Program Specialist/Lead EvaluatorRhodora UrsuaAlameda Health Consortium / Director of ProgramsKimi Watkins-TarttACPHD / Deputy DirectorACPHD / HCSA DirectorHOP - Health Outreach Partners / CEOHCSA/Center for Healthy Schools and / Communities (CHSC) DirectorAlameda Health Consortium / Executive Director
HTHC Timeline Hiring internal staffEvaluation Work GroupformedCare CoordinationLeadership Team formed April 2017MayJunDental ProvidersFirst Trainingand enrollmentNov 4Develop Trainingcurriculum andprotocols forCommunity DentalCare CoordinationJul-NovJulAug ProjectStarted SteeringCommittee andCommunity ofPractice formedFinancial systemset upContracts, MOUs,SSAs in placeProjectAccomplishedInitial Training forCare CoordinatorsOct 10-Nov 30 SepOctFinalize the Development ofinterim Web-based CareCoordination ManagementSystemInitiate enrolling Medi-CalDentists into programNov Dec20182019 Dec 2020Begin carecoordination13
Countywide diverse workforce of 27 Community DentalCare Coordinators (CDCCs) from 14 agencies hired An initial 8 week interactive training curriculum wasdesigned and implemented CDCCs have started their outreach efforts14
Language Abilities of CDCCs(Speaking, Reading, Writing, Translation)Number of ameseHindiBengali15
Collective Assets: Prior Work Experience of CDCCsCommunity Health/Outreach Worker/Promotora14Other*12Case Manager/Patient Navigator10Receptionist/Front Desk Staff10Administrator or Manager5Dental Assistant5Health Insurance Application Assistant5* Other Includes Experience in Business/Customer Service, Research, Tutoring, Mobile Dental Clinics16
CDCCs’ Training17
Power of CDCCs18
Dental Community of Practice Network Aims tobuild a sufficient network of dentists whoare collectively and individually motivatedand proficient to improve access to dentalcare for Medi-Cal children.19
Dental Community of Practice Goals1. Identify barriers, find solutions and support for dentists who wish to expand capacityto serve the target population.2. Support dentists in connecting with peers in the community who are serving thetarget population by creating formal avenues for sharing experiences and learningtogether.3. Engage motivate more dentists to better serve children from low income families inour community.4. Offer training and education to help increase dentists clinical and culturalcompetency to serve the target population through a care coordination model.5. Develop a shared sense of responsibility for the dental health of our communities.20
Kicked off Continuing Education Program on November 4th for over 60dentists (private and FQHCs dentists) 21 in the process of signing contract, followed by in-office meetings Developed Incentive Model and 3 year Continuing Education Curriculum Partnered with 3 Dental Societies for Promotion Initiated a mentorship collaboration with Pediatric Dental Specialists21
Colleague to colleague 22
District 1District 2District 3District 4District 5Total# of CDCCs23105724# of providers3372519**Providers Counted twice: TV is in 2 & 3, WO is in 3 & 523
Metrics finalized for the Web-based Care CoordinationManagement System to outreach, link families to dentalappointments and support continuity of care Design of Ecchange as the interim solution and goingonline by February24
Evaluation Plan Overview Outcome Evaluation Process Evaluation Metrics development Surveys of dentists and CDCCs Training Evaluation25
Performance Metrics: Preventive Dental VisitAverage PerCDCC(Annually)Children on Denti-Cal:Receive Initial Contact600through OutreachReceive Care Coordination276Receive Dental Care179AnnualCountBeginsJanuary2017(65% Show Rate)All CDCCs(Annually)Project Total(Over 3.5Years)15,00052,5006,90024,1504,47515,66315,663 10% increase from baseline26
Performance Metrics: Continuity of CareServices ReceivedAn exam from the same servicelocation with no gaps in services for2 continuous periodsAn exam from the same servicelocation with no gaps in services for3, 4, 5 or 6 continuous periodsYear 1Year 2Year 3Year -3%10% IncreaseIncrease (49% to seBaselinesUnknownThere is currently no Alameda County baseline for the percentage of children receiving an exam for 3 or morecontinuous periods.27
HTHC Performance MetricsHow Much Did We Do?How Well Did We Do It? # of CDCCs Trained and Deployed (25) Client Satisfaction with CDCC and Dental Care Number of Families Receiving: Outreach (52,500) Appointment Scheduling and Client Tracking Through WebBased System (CCMS) Care Coordination (24,150) % of Children Receiving Preventive and Restorative Services Preventive Care (15,633) % of Children Receiving Dental Care for 2 or MoreConsecutive Years (Dental Home) Number of Dental Service Locations that Serve Medi-CalChildren (FQHC or Private Dentist – 35)Is Anyone Better Off? Reduced Dental-Related Emergency Department Visits Improved Dental Health Outcomes28
Plans for ongoing sustainability analysis through the projectSteering Committee and Sustainability Workgroup to build on theinfrastructure and to leverage other funding. Plans for partnerships with UCSF School of Dentistry andDentaQuest Foundation to identify and document lessons learnedand best practices in order to support potential scaling orreplication in other jurisdictions. Results to inform policy changes through DHCS on increasingreimbursement rates and incentives.29
Challenges and Successes Fast ramp-up Ground Collaborative nature Innovative County-wide coordination Multi-faceted New workforce Aims for system change Multiple county policies andprocedures Robust evaluation planbreaking Hiring30
Our Assets and Accomplishments The amazing workforce of Community Dental Care Coordinators! The presence and momentum of our partnerships County leadership Our community trust A well-designed program Positive response from the dental communityHealthy Teeth, Healthy Communities (HTHC)31
Vision for Alameda County:All children are cavity freeAll adults can access the needed dentalservices32
Healthy Teeth, Healthy Communities (HTHC)33
DENTAL HEALTH ADMINISTRATOR ALAMEDA COUNTY DEPARTMENT OF PUBLIC HEALTH 1. Alameda County Denti -Cal Utilization Of 156,342 children (0-20) eligible for Denti-Cal Services: Only 43,932 (28%) were seen by a dentist in 2014. Of these, only 21,634 (49%) saw a dentist in the following year.
