Center for Oral Health

Engagement in Oral Health Work

for Vulnerable Populations

May 4, 2016

About

Center for Oral Health (COH)• Over 30 years of experience in working

to improve the oral health of

vulnerable populations

• Mission: to improve oral health,

especially of vulnerable populations,

through innovation, research,

education, and advocacy

State of the State

?

The Dental Neglect

Centers for Medicare & Medicaid Services (2011). Health Expenditures by State of Residence. Retrieved 04112016

at http://www.cms.gov/NationalHealthExpendData/downloads/resident-state-estimates.zip

Social Determinants of Health

Who Are the Most

Vulnerable Populations?

California’s Children

9.3 million children…that’s 13% of all children in the U.S.

California’s Older Adults

33% of Older Adults Have

Untreated Decay

CA Insurance Coverage 2015

Percentage of Population enrolled in

Medi-Cal by Age Group2:

- All Age Groups: 33.4%

- 0-5: 57.0%

- 0-18: 54.2%

- 19-44: 30.5%

- 45 - 64: 23.7%

- 65+: 20.9%

2. Research and Analytic Studies Division. January 2016. Proportion of California Population Certified Eligible for Medi‐Cal By County and Age Group – September 2015. Medi‐Cal Statistical Brief. California Department of Health Care Services.

So…

What Are We Doing

About It?

SOLUTIONS

• Oral Health Action Coalition of the Inland

Empire (OHAC-IE)

• Early Smiles

• Oral Assessment of Older Adults

OHAC-IE

Systemic:-Highprevalenceoforaldiseases-LowDenti-CalUtilization-Denti-Calishighlycentralized-Underinsured&Uninsured

· OHAC–IEmembers

· DentalSchools· DentalHygiene

Programs

· LocalGovernmentAgencies

· LocalHealthDepartments

· SchoolDistricts· HealthPlans· Professional

societies· IndividualDental

Providers· Business

Community· LocalSocialService

Agencies· Faith-basedOrg

· Funders· Consumerand

healthcareadvocates

· LocalMedia

· SafetyNetclinics/providers

OHAC-IEorganizations:-Advocacyorganizations-Dentalschools-DentalHygieneprogram(Morenovalley)-Privateproviders

FormTaskForce-SubcommitteesofOHAC-IE(3&4)1. Advocacy2. DirectServices3. PublicAwareness/

Communications4.Surveillance,Data,EvaluationConnectwithBoardofEducationstoadoptschooloralhealthpolicies(1,2,3,4,5)PromoteprivatedentistparticipationinDenti-Cal(2)Promoteadentalbenefit“carve-in”forIEHPandothers(3)Createanoralhealthenvironmentalscan(5)Promoteintegrationofhealthcaresystems(1,2,3,4)

IncreaseAwarenessofLoanRepaymentProgramAvailabilityforProvidersinIE(1&2)MaximizeHRSADesignations(1&2)DevelopofRoadMaptoAccessibleCareinIE(1&2)Identifyimportantactivities/issuestoadvocatefor(3)Monitorstateissues,bills,etc(3)IncreasePublicAwareness(all)Baselinereport(5)

Increase#ofaccesspoints(1&2)Increaseaccesstoevidence-baseddentalpreventivemeasures(fluoridatedwater,topicalfluoride,sealants)(1,2,3)IncreaseAvailabilityofDentalProviders(andspecialtyproviders)(1&2)IncreaseprovidersthatparticipateinDenti-Calprogram(1,2,3)IncreaseDentalResidenciesprogram(1&2)

1.Strengthenedtheoralhealthsafetynet2.IncreasedAccesstoCare

· Structural(ex.moreproviders)

· Financial(ex.numberpeoplew/insurancecoverage)

· Cultural3.PublicPoliciesthatfavoraccesstocareforvulnerablepopulationsinplace4.Improvedknowledge,attitudes,andbeliefsrelatedtooralhealth5.Establishedoralhealthsurveillancesystemtomonitorprogress

OralHealthActionCoalitionIE(OHACIE)LogicModel,2015-2020

GoalStatement:ImprovetheoralhealthofvulnerablepopulationsintheInlandEmpire(IE)RegionofSouthernCaliforniaSituation Inputs Outcomes–Impact

-FQHCs-CommunityClinicsAssociation-Funders-CountyAgencies-IEHP

Priorities:-Advocacy-DirectServices-ProviderEducation-PublicAwareness

Outputs

Participation ActivitiesShort-TermOutcomes

IntermediateOutcomes

LongTermOutcomes(5YearGoals)

Providers:-Insufficientprovidergeographicdistribution-LowproviderparticipationinDenti-Cal-Lowprovider:populationratio

Population-Loworalhealthliteracy-Loworalhealthawareness-AccessibilityBarriers

Communities:-Culture-Insufficientaccesspoints

ContextualFactorsImpactingLongTermSuccessVersion4.5.16

Data-Insufficientdatatoinformpoliciesandmeasureoutcomes

OHAC-IE Subcommittees

• AdvocacyState Level

Local Level

• Direct ServicesProviders

Consumers

Prevention Neglect

OHAC-IE Subcommittees

• Public Awareness

Services

Consumers

Providers/Support

• Data & Surveillance

Workforce

Measures & Evaluation

Dental Workforce• Approximately 36,000 Dentists in California

• Reported to be enrolled in DentiCal ≈ 11,400 but only 7,706 active

Ratios:

• All Dentist : General Population ≈ 1:1,050

• DentiCal Dentist : DentiCal Population ≈ 1:2,733

• But only 1 in 6 DentiCal Dentists receive $10,000 or more in Medicaid payment/year

• Therefore, the actual ratio would be ≈ 1:12,000

• 25% of DentiCal dentists serves 80% of all Denti-Cal children

Reference: Dental workforce capacity and California's expanding pediatric Medicaid

population. J Calif Dent Assoc. 2014 .

Keeping in mind that over half of CA kids are on Medi-cal

Purpose of the Program

Create a

seamless

system of care

that…

Purpose of the Program

links resources

throughout the

community (e.g.,

medical, dental,

behavioral health

care, education,

social services,

insurance), and…

Purpose of the Program

removes barriers

to oral health

care (coverage,

transportation etc.)

End Result

to achieve

optimal oral

health for

children 0-5 and

pregnant

women

Education Screening NavigationDental Home

Early Smiles components

✚ ✚ =

What is a Dental Home?Oral health care delivery model that:

• Provides comprehensive,

• Continuous,

• Patient-centered,

oral health care with the goal of

obtaining maximized oral health

outcomes.

Oral Health Education

• Pregnant

women

• Families with

children under

age 6

• Group and/or

one-on-one

Oral Health Education• Evidence-based

curriculum

– 1, 2, 3, 4, 5 First

Smiles and Cavity

Free at Three

• Using principles of

adult learning

• All learning styles

Oral Health Education

• Group education

– General oral

health

knowledge

– Optimal oral

health practices

– Utilization of

dental benefits

Oral Health Education• One-on-One

– Specific oral

health

knowledge

– Optimal oral

health

practices

– Utilization of

dental benefits

Screening and Early Prevention

• Caries risk

assessment

• Dental

Screening

• Fluoride varnish

application

Navigation• Referral to

dental home

• Referral for

coverage (Covered CA,

Medi-Cal etc.)

• Follow-up until

first dental visit

complete

How it Works

Model

• Community-based

capacity building

approach

– Network

partnerships to

implement Early

Smiles

– Provide gap filling

servicesAccessed July 20, 2015 from http://www.partnertool.net

Focus Communities

• Areas identified as need based on

First 5 Healthy Communities and

Cities initiative:– Central Valley

– East Valley

– West Valley

– East Desert

– High Desert

– Rim Mountain

Oral Health Assessment of

Older Adults in California

Center for Oral Health

&

Keeping in mind that…

• Medicare – No Dental Benefits to

speak of

• Affordable Care Act – No adult

provision for adult dental benefits

• Whitehouse Conference on Aging –

Oral Health on the agenda or

ignored again?

Overview

• Phases:

– Phase 1: Vulnerable populations served

by health care facilities licensed by the

CA Department of Public Health (e.g.,

skilled nursing facilities, long-term care

facilities)

Overview

• Phases:

– Phase 2: Community dwelling individuals

(e.g., community living complexes,

congregate/home delivered meal sites)

Objective

• To obtain data that represents all older

Californians in Skilled Nursing Facilities,

Long Term Care Facilities, and

Congregate Health Facilities

Who is this population?

Target Population California

Geriatric (65+) 4,246,514

Old-Old (85+) 600,968

Total Facility Beds 137,778

California’s Older Adults

Characteristic US

% with no natural teeth 25%

% of adults with who did not use

their dentures18%

% of adults with teeth that have untreated decay

~33%

Impact

• Expanded coverage for older adults,

especially preventative services

• Better access to care within facilities

and congregation sites

• Utilization of intermediate level

providers (e.g., RDHAP)

Additional information

Jessica L. Woods, RDHAP, BSDH, RDA

Program Associate

jwoods@tc4oh.org

909-632-7921