Oral Health Workforce: Options and Opportunities

Transcription

1 Oral Health Workforce: Options and Opportunities Burton L. Edelstein DDS MPH Senior Fellow in Public Policy, Children s Dental Health Project, Washington DC Professor of Dental Medicine and Health Policy & Management Columbia University ble22@columbia.edu

2 CHARGE 1. Discuss the dental workforce needed to meet the needs of the population? 2. Discuss potential hot dental careers that can drive employment to jump start the economy?

3 The mouth: Orphaned by Government 1. Medicare 1965 No 2. Medicaid 1965 State Option 3. Medicaid 1967 Sort of for children via EPSDT 4. S CHIP 1997 State Option 5. CHIPRA 2010 Mandate 6. ACA 2010 Essential but not mandatory for children only

4 So what? An organ of Digestion Respiration Communication Protection Sensation Home to unique structures Teeth Gums Tongue TMJ Salivary glands Oral systemic health connection through contiguous and distant linkages (circulatory, neurologic, lymphatic etc)

5 The problems 1 We dentists persist in treating chronic oral diseases as acute surgical problems at high expense and are disappointed (in our patients) with high recurrence rates. 2

6 ORAL v DENTAL HEALTH CARE Dental

7 Can ORAL healthcare improve ORAL health? (or only correct problems)

8 Opportunity: We re now at the forefront of merging clinical care and public health to meet the Triple Aim Population Personal Health Health

9 Oral Health Dental Care DDS Dental Therapist Preventive Dental Preventive Dental Helping Professions Community Health Workers

10 Oral Health Preventive Dental Helping Professionals Community Health Workers Expanded roles, deployments, & independence New options to address social, environmental & behavioral disease etiologies (with technology assistance for dental science integrity)

11 Dental Care Expanding numbers Basic dental repair (MN, ME) Expanded roles, deployments, & independence DDS Dental Therapist Preventive Dental

12 Adult Medicaid (2009 ADA) Pediatric Medicaid Performance (2011, CMS 416 Any visit) Expanded Duties (ADHA 2013) Dental Therapist* (2014,Pew) ACA/ Medicaid expansion (KFF 3/26/14) Grants Workforce/ SIM/CDC (Columbia U) CO None 47.6% expansive No State/yes Y/N/Y KY Limited 44.3% restricted No State/yes N/N/N IN Limited 29.2% prohibited No FFE/? Y/N/N OK Emerg cy 42.5% constrained No FFE/no N/N/N MN Limited 38.1% restricted Yes State/yes Y/N/N NC Limited 43.6% restricted No FFE/no Y/N/N WI Full 24.8% restricted No FFE/no Y/N/Y * DT Legislation: VT, OH, KS, NM, WA, MA, NH study: ND considering: OR CT MI

13 State To do list 1. Maximize existing dental workforce & training Expand allied oral health professionals duties through practice acts & regulation Use licensure to assess dental FTEs serving Medicaid/CHIP beneficiaries Expand loan repayment programs Grow dental faculty with focus on public health & team care Expand training in FQHCs and community sites Use Medicaid, Medicare, and Pediatric Hospital GME 2. Grow new dental workforce Empower Community Health Workers and Community Dental Health Coordinators Allow involvement and delegation to helping professionals Consider Dental Therapy 3. Leverage medical workforce Engage primary care medicine

14 4. Utilize Federal grants SIM grants (CMS) State Oral Health Leadership Cooperative Agreements (CDC) Oral Health Workforce Grants (HRSA) Health profession training grants (HRSA) Title V block grants (HRSA) FQHC and School based health care expansions (HRSA) 5. Expand access points Provide adult Medicaid coverage Consider the virtual dental home (teledentistry authorization) Include dental in ACO/PCMH development Leverage your own state employee dental program Designate more dental shortage areas (D HPSAs)

15 Resources Children s Dental Health Project (Oral Health Policy) Patrice Pasqual ED, th Street NW, Suite 400, Washington DC 10032; ppascual@cdhp.org, Burton Edelstein, Senior Policy Fellow, ble22@columbia.edu, American Dental Education Association (Dental, Hygiene, and Dental Therapy Education) Richard Valachovic ED, 1400 K Street NW, Suite 1100 Washington DC 20005; valachovicr@adea.org American Dental Hygienists Association Anne Battrell ED, 444 North Michigan Avenue, Suite 3400 Chicago, IL annb@adha.net, American Dental Association Kathy O Loughlin ED, 601 East Chicago Avenue, Chicago, IL oloughlink@ada.org, Community Catalysts & Pew (Dental Therapy) David Jordan, Project Director Community Catalyst, djordan@communitycatalyst.org, Shelly Gehshan, Director Children s Dental Campaign, 901 E Street NW, Washington DC 20004, sgehshan@pewtrusts.org, National Academy for State Health Policy Andy Snyder, Program Manager, (Medicaid/CHIP), th St NW, Suite 303, Washington, DC asnyder@nashp.org,

16

17