THE DENTAL DILEMMA AMY MARTIN, DRPH DIRECTOR & ASSOCIATE - - PowerPoint PPT Presentation

THE DENTAL DILEMMA

AMY MARTIN, DRPH DIRECTOR & ASSOCIATE PROFESSOR

Introduction: Rural First!

— 20 years in rural health — Bamberg County Hospital & Nursing Center — SC Office of Rural Health — SC Rural Health Research Center — Appalachian Rural Commission, Health Policy

Council

— White House Rural Council Public Private

Partnership Initiative with Grantmakers in Health

— National Rural Health Association Oral Health

Advisory Group

Overview

— Established in 2014 in

Department of Stomatology

— Focus on oral health equity

for underserved populations

— $4.2 million in extramural

funding

Responsibilities

1.

Enhance public health learning for dental students

2.

Conduct health services and population health research

3.

Develop service/outreach programs for vulnerable populations

4.

Translate clinical research for safety net practice

Overview

• 1. Scope of the Problem
• 2. Policy Levers for Addressing Unmet Dental Need
• 3. Business Case for Integrated Care Models &

Interprofessional Practice

• 4. The Path Forward

Unmet Oral Health Burden for Hospitals

ER Visits for Unmet Needs 600+ saliva depleting Rx Memory disorders Substance Abuse Uncontrolled A1c Preterm labor HIV

Another Deamonte Driver

— Middle-aged woman in

Pee Dee Region

— Presented with fasciitis

and sepsis due to untreated abscess

— Admitted to inpatient

bed in September 2016

— Death due to sepsis

ADA Health Policy Institute

Where Have All the Dental Visits Gone?

Scope of the Problem:

How We Rank for Pediatric Access

Source: CMS/DentaQuest Institute, 2015 Medicaid

Dental HPSAs

Dental access challenges exist Too few DMDs or poor distribution?

Dental Safety Net Capacity Considerations

Estimates of Need

• Pop. Numbers

National estimate of underserved 82 million Number that see a dentist annual (27.8%) 22.8 million Current Estimates of Capacity

• Pop. Numbers

Existing capacity at CHCs, hospitals, public schools & dental schools 7 to 8 million Estimates of Capacity Expansion Options

• Pop. Numbers

Expand CHCs & their efficiencies Require dental school grads to receive 1 year of residency training, and senior dental students and residents to work 60 days in community clinics and practices. 2.5 million Bulk of additional capacity needs to come through private practice settings but how do we pay for this?

Source: Bailit H et al, 2006

(Limited) Federal Policy Levers

— Safety Net Investments

NC FQHC Oral Health Expansion Grants

SC FQHC Oral Health Expansion Grants

FQHC Capacity Optimization

— 80% vs. 20%,

medical/dental

— Understanding

partnership

• pportunities &

limitations

— Need for

productivity-based practice culture

The Case for State Policy Levers

What are costly diagnoses to your states’ Medicaid programs?

¡ Those who come early…Preemies

Huck O, Tenenbaum H, Davideau JL. Relationship between periodontal diseases and preterm birth: recent epidemiological and biological data. Journal of Pregnancy, 2011, Article ID 164654.

¡ Those who live long…Dementia/Alzheimer’s

Manczak M, Reddy, PH. Abnormal interaction of oliomeric amyloid-beta with phosphorylated tau: Implications to synaptic disyfunction and neuronal damage. Journal

• f Alzheimer's Disease 36(2), 2013, DOI:10.3233/JAD-130275.

¡ Those who with chronic disease…Diabetes & Cardiovascular Disease

Leite RS, Marlow NM, Fernandes JK. Oral health and type 2 diabetes. American Journal

• f Medical Science. 2013 Apr;245(4):271-3.

Policy Lever 1: Expansion of Professional Practice Acts

— Alternative dental hygiene models (e.g. dental

hygiene therapists)

— Safety net practice/supervision for dental hygienists* — Non-direct supervision models for dental auxiliaries

for preventive services*

*Described in , “State Policy Levers for Addressing Preventive Dental Care Disparities for Rural Children,” included in CD and available at http://rhr.sph.sc.edu/report/ State%20Policy%20Levers%20and%20Dental%20Care%20Disparities%20Executive%20Summary.pdf (State-specific data available.)

Beyond RDH General Supervision

Practice Act Impact on Sealants

Policy Lever 2: Medicaid Reimbursement & Administration

Competitive dental reimbursement rates Easy to navigate provider enrollment & billing infrastructure Non-dental clinician reimbursement policy for preventive services, e.g. fluoride varnish*

÷ Special considerations for safety net providers such as community

health centers and rural health clinics

*Described in, “State Policy Levers for Addressing Preventive Dental Care Disparities for Rural Children,” included in CD and available at http://rhr.sph.sc.edu/report/ State%20Policy%20Levers%20and%20Dental%20Care%20Disparities%20Executive%20Summary.pdf (State-specific data available.)

Medicaid Reimbursement & DMD Participation

Policy Lever 3: Recruitment & Retention Programs

— National Health Service Corp

¡ Encourage FQHC dental expansions & site eligibility ¡ Support outreach & education of students ¡ Connect with State Offices of Rural Health, Primary Care

Offices, & Primary Care Associations, State Divisions of Oral Health

— State-supported loan repayment programs & other

incentive packages

The Business Care for Integrated Care

— Emerging in outpatient settings — Best studies (n=3) examine oral health/diabetes

management, although limited to privately insured patients.

¡ Savings is actualized from inpatient reductions

— Reduce rural health disparities

for children & high-risk adults with diabetes

— Community medical-dental

integration

— Working in 3 rural markets:

York, Fairfield, & Orangeburg Counties

— Enhance oral health

interprofessional education for primary care & dental graduates

— Improved competencies, business

acumen, & willingness for rural safety net practice

Rural Oral Health Equity Portfolio

The Path Forward

— South Carolina demonstration projects — Emerging model with rural hospital system — Partnership mobilization

ROADS Partners

Translating Practice to Pipeline

ROADTRIP’s purpose is to transform

interprofessional education at the MUSC so that more dental and primary care graduates have the prerequisite clinical and interprofessional competencies, business acumen, and willingness for rural safety net

• ral health practice.

¡ Graduate-level certificate in safety net

dental practice

¡ Integration of oral health competencies

campus-wide in health professions programs

Thou shall…

• 1. Risk assessment
• 2. Patient education
• 3. Preventive clinical care
• 4. Referral management

ER Frequent Flyer: An Opportunity Realized

— 5 ER trips in two weeks for

fever of unknown origin

— Family Medicine Resident

inspects the mouth

— Prior training on oral

health risk assessment

— Appropriate care and

referral

New Oral Health Partnership with TDE

— Focus areas

¡ School-based oral health solutions ¡ Safety net capacity ¡ Integrated care models

— Research Consortium

¡ Dental schools & Rural Health Research Centers

Thank you!

Amy Martin, DrPH Director & Associate Professor martinamy@musc.edu 843-792-8270