meeting the demand: strategies to improve access … the demand: strategies to improve access to...
TRANSCRIPT
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Meeting the Demand: Strategies to Improve Access to Oral Health Services Julie Stitzel, MPA Campaign Manager, The Pew Children’s Dental Campaign The Pew Charitable Trusts [email protected]
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NH
MA
ME
NJ
CT RI
DE
VT
NY
MD
NC
PA
VA WV
FL
GA
SC
KY
IN OH
MI
TN
MS AL
MO
IL
IA
MN
WI
LA
AR OK
TX
KS
NE
ND
SD
HI
MT
WY
UT
CO
AK
AZ
NM
ID OR
WA
NV
CA
A Dental Workforce Shortage
Less than 10%
10-14.9%
15-19.9%
20% or more
• 45 Million people living in Dental HPSAs nationwide
• 6,000 additional dentists needed to eliminate shortage areas
% of State Population living in Dental Health Professional Shortage Area (HPSA)
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7 Source: American Dental Association. (2011) Distribution of Dentists In the United States By Region and State, 2009.
An Aging Dental Workforce
≥45 %
40-44.9%
35-39.9%
<35%
42.6 (NH)
36.2 (MA)
48.4
36 (NJ)
42.8 (CT) 41.7 (RI)
39.2 (DE)
48.7 (VT)
37.1
46.4 (DC) 39.2(MD)
35.9
42.6
38.1 42.3
37
33.8
39.9
38.4
38.1 42.2
39.6
43.3
37.3 37.1
45.8
36.9
40.4
38.7
44.8
41.5
39.7 40.1
36.2
41.1
40.3
43.1
40.4
36.5
44.4
47.6
32.9
36.4
40.7
31.9
45.5
32.2 37.1
37.5
27.4
32.6
Percentage of Dentists over age 55 (2009)
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The Affordable Care Act
Requirement (unless stand alone
dental plan exists) that a pediatric
dental benefit be included in the
essential health benefits package in
the new state exchanges (Title I, Secs.
1302, 1311)
Option that states set Medicaid
eligibility cap no lower than 138
percent of Federal Poverty Level and
cover all individuals meeting the
eligibility standard (Title II, Section
2001)
Extension of funding for the Children’s
Health Insurance Program (CHIP)
through FY 2015 and authorization of
program through 2019 (Titles II, X)
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The Affordable Care Act
Provisions authorized but not appropriated:
Demonstrations and evaluation of
alternative dental care providers (Title
V, Section 5304) (current block on
funding)
Expanded dental training programs
(Title V, Section 5303)
New or expanded primary care
residency programs, including dental
programs (Title V, Section 5508)
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Challenges
• Shortage/Maldistribution of
dentists
• Emergency room utilization
costs
• Too few providers accepting
Medicaid patients
• Fiscal reality of states
• Lack of adult dental
coverage
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Raising Medicaid Reimbursement Rates
Increases in reimbursement rates have been shown
to increase dentist participation in Medicaid and the
number of patients treated,1 but studies have also
shown that rate increases on their own are not
sufficient to improve access to dental care. 2
Source 1: Institute of Medicine (2011) Improving Access to Oral Health Care for Vulnerable and Underserved Populations. Source 2: Alison Borchgrevink, Andrew Snyder, Shelly Gehshan, The Effects of Medicaid Reimbursement Rates on Access to Dental Care, March 2008, National Academy of State Health Policy, http://www.nashp.org/sites/default/files/CHCF_dental_rates.pdf
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Improving Medicaid Participation
More Steps Needed to Increase
Dentist Participation in Medicaid:
• Easing administrative processes
• Involving state dental societies
and individual dentists as active
partners in program improvement
• Working with patients and their
families about how to use dental
services
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Free clinic in Cape Girardeau, Missouri on May 3, 2013. People
camped out in line for two days to receive free dental care.
Desperate for Care
http://www.columbiamissourian.com/a/161623/mission-of-mercy-clinic-serves-patients-who-have-gone-without-dental-
care/
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Expanding the reach of the dental team with additional providers
Dental Health Aide Therapists (AK)
Dental Therapists (MN)
Advanced Dental Therapists (MN)
Community Dental Health Coordinators (new model piloted by the ADA)
Other state solutions similar to a physician’s assistant on a medical team
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NH
MA
ME
NJ
CT RI
DE
VT
NY
MD
NC
PA
VA WV
FL
GA
SC
KY
IN OH
MI
TN
MS AL
MO
IL
IA
MN
WI
LA
AR OK
TX
KS
NE
ND
SD
HI
MT
WY
UT
CO
AK
AZ
NM
ID OR
WA
NV
CA
2003 Dental Workforce Map
Dental Health
Aide
Therapists
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Expanding the reach of the dental team
Alaska
Dental Health Aide Therapists
(DHAT)
40,000 people in rural AK
now have direct access to
care.
DHATs see an average of
830 individual patients per
year.
700 of those visits are for
prevention.
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NH
MA
ME
NJ
CT RI
DE
VT
NY
MD
NC
PA
VA WV
FL
GA
SC
KY
IN OH
MI
TN
MS AL
MO
IL
IA
MN
WI
LA
AR OK
TX
KS
NE
ND
SD
HI
MT
WY
UT
CO
AK
AZ
NM
ID OR
WA
NV
CA
2009 Dental Workforce Map
Dental Health
Aide
Therapists
Dental Therapists/
Advanced Dental
Therapists
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Expanding the reach of the dental team
Minnesota: Children’s Dental Services
Dental Therapists (2)
367 patients seen in 2013
334 on state insurance
20 private insurance
11 full pay
2 sliding scale
Advanced Dental Therapist (1)
922 patients seen in 2013
826 on state insurance
41 private insurance
32 full pay
18 free care
5 sliding scale
Source: email from Sarah Wovcha, executive director of Children’s Dental Services, August 5, 2013
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Total Revenue Generated by Advanced Dental Therapists and Dental Therapists in Minnesota (in blue) and Dental
Health Aide Therapists in Alaska (in green)
According to a May, 2013 study on the economic viability of dental therapists in Alaska and Minnesota, dental therapists cost their employers less than 30 cents for every dollar of revenue they generate.
Source: Community Catalyst, Economic Viability of Dental Therapists, available at: http://www.communitycatalyst.org/doc_store/publications/economic-viability-dental-therapists.pdfReport conducted by Dr. Frances M. Kim, May 2013
Financial Impact of Expanding the Dental Team
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NH
MA
ME
NJ
CT RI
DE
VT
NY
MD
NC
PA
VA WV
FL
GA
SC
KY
IN OH
MI
TN
MS AL
MO
IL
IA
MN
WI
LA
AR OK
TX
KS
NE
ND
SD
HI
MT
WY
UT
CO
AK
AZ
NM
ID OR
WA
NV
CA
2013 Dental Workforce Map
States considering
additional dental
providers
States with
additional dental
providers
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Conclusions
• We are experiencing a dental crisis in the United States
• State budgets are being punished as a result of lack of access to
dental care
• It is a complex problem that requires multiple solutions
• The data show that expanding the reach of the dental team with
additional providers, similar to physician’s assistant on a medical
team, improves access to care for vulnerable populations in a
financially sustainable way
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