Paul Glassman DDS, MA, MBA Professor and Director of Community Oral Health University of the Pacific School of Dentistry San Francisco, CA

Transcription

1 Paul Glassman DDS, MA, MBA Professor and Director of Community Oral Health University of the Pacific School of Dentistry San Francisco, CA

2 The Era of Accountability

3 Health Care and Social Spending as a Percent of GDP 2013 The Commonwealth Fund U.S. Health Care from a Global Perspective: Spending, Use of Services, Prices, and Health in 13 Countries

4 Social Determinants of Health Let s Get Healthy California. Social Determinants of Health.

5 The Quadruple Aim

6 National Oral Health Expenses $250 U.S. National Dental Expenditures ($ Billions) 350% $ % $150 $ % 200% 150% Dental Services (DS) DS % of 2000 Level (321%) $50 100% 50% $0 0% Source: CMS National Health Expenditure NHE Historical and projections,

7 (Millions) Health Spending by Condition $110,000 $100,000 $90,000 $80,000 $70,000 $60,000 $50,000 $40,000 $30,000 $20,000 $10,000 $0 Medical Expenditure Panel Survey - Top 25, 2013 General Health: MEPS: Expenditures by Medical Condition 2013, Table 3 Dental Health: MEPS: Expenditures per Person by Health Care Service 2012, Table 3 VAR2=SEX&VAR3=RACETH5C&VAR4=INSURCOV&VAR5=POVCAT13&VAR6=REGION&VAR7=HEALTH&VARO1= &VARO2=1&VARO3=1&VARO4=1&VARO5=1&VARO6=1&VARO7=1&_Debug=

8 Oral Health Expenses 300% Consumer Price Index (CPI) and CPI for Dental Services (% of 1990 dollars) 280% 260% 240% 220% 200% 180% CPI % of 1990 Level (177%) CPI-DS % of 1990 Level (285%) 160% 140% 120% 100% Source: Bureau of Labor Statistics: Consumer Price Index

9 Oral Health Expenses 300% Consumer Price Index (CPI) and CPI for Dental Services (% of 1990 dollars) 280% 260% 240% 220% 200% 180% CPI % of 1990 Level (177%) CPI-DS % of 1990 Level (285%) CPI_PS % of 1990 Level (224%) 160% 140% 120% 100% Source: Bureau of Labor Statistics: Consumer Price Index

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13 Dental Care Utilization in US Age Group Total Population % Utilization Utilizers ,916, % 33,909, ,794, % 70,486, ,760, % 20,871,492 Total Utilizers 313,472, % 125,267,147 Total Non-Utilizers 60.0% 188,205,071 Most non-utilizers are low income and have significantly more disease than utilizers! Population Data: US Fact Finder:

14 Medicaid and CHIP Payment and Access Commission (MACPAC) June 2015 Report to Congress on Medicaid and CHIP. Chapter 2. Coverage of Medicaid Dental Benefits for Adults.

15 Impact of Health Center System US Population Compared to Health Center Patients (in millions) US Population Patients served by health centers U.S. Census. U.S. and World Population Clock.

16 Impact of Health Center System Number of Health Center Patients (in millions) total patients # have medical services # have dental services HRSA National Program Grantee Data.

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18 Disruptive Innovation

19 U.S. Automobiles 1960s -> Luxury, Sophistication Cadillac Buick Pontiac

20 Japanese Automobiles 1960s -> Basic Transportation Toyota

21 Disruptive Innovation Disruptive innovation, describes a process by which a product or service takes root initially in simple applications at the bottom of a market and then relentlessly moves up market, eventually displacing established competitors.

22 Disruptive Innovation Companies tend to innovate faster than their customers needs evolve Their products or services become too sophisticated, too expensive, and too complicated for many customers in their market. Historically the greatest profitability has been achieved by charging the highest prices to their most demanding and sophisticated customers at the top of the market.

23 Disruptive Innovation However, by doing so, companies unwittingly open the door to disruptive innovations at the bottom of the market. An innovation that is disruptive allows a whole new population of consumers at the bottom of a market access to a product or service that was historically only accessible to consumers with a lot of money or a lot of skill.

24 The Oral Health Industry

25 The Oral Health Industry

26 Delivery Systems Measurement and Payment Systems Prevention and Behavior Science

27 Measurement and Payment Systems

28 Measurement DQA Payers Dental Benefit Companies Public Payers HRSA: Health Center system Group Practices

29 Prevention and Behavior Support Science

30 The Declining Role for the Dental Drill

31 Fluoride Varnish Silver Diamine Fluoride

32 Sealing Caries

33 Care for Chronic Oral Diseases Acute Care/ Surgical Intervention Chronic Disease Management

34 Delivery Systems

35 Gov. Doug Ducey signs bill allowing 'dental therapists' to practice in Arizona

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37 Space and Equipment

38 Space and Equipment

39 EHR: Radiographs

40 Space and Equipment

41 EHR: Photographs

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44 Community-based Prevention and Early Intervention Procedures

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47 The Virtual Dental Home Sites

48 Oral Health Systems for Underserved Populations

49 Reach people, emphasize prevention, and lower costs Majority of people kept and verified healthy on-site About 2/3 of children had all needed services completed by dental hygienist Continuous presence Community organization integration Dentist integration

50 The Virtual Dental Home Current Trainees 8- DentalQuest Learning Collaborative 19- DHCS Dental Transformation Initiative 1- Delta Dental 5- HRSA 1 CA Wellness 2 Regional Centers 2 Hawaii 3 Oregon 5 - Colorado Total = 46 entities

51 The Virtual Dental Home Current Trainees 8- DentalQuest Learning Collaborative 19- DHCS Dental Transformation Initiative 1- Delta Dental 5- HRSA 1 CA Wellness 2 Regional Centers 2 Hawaii 3 Oregon 5 - Colorado Total = 46 entities

52 San Mateo County site in VDH Demonstration Partner IHSD Head Start Agency 1 part time community team East Palo Alto 52

53 Ravenswood Family Health Center

54 Ravenswood Family Health Center

55 Ravenswood Family Health Center

56 Ravenswood Family Health Center

57 Ravenswood Family Health Center

58 Ravenswood Family Health Center

59 Ravenswood Family Health Center

60 San Mateo County v sites Multiple agencies and schools 2 full time community teams Across San Mateo County 60

61 Community Engaged Dental Care System

62 What is a dental practice? High cost surgical suite Low cost community site

63 What is a dental practice? Linked Community/Clinic System High cost surgical suite Low cost community site

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66 Legal and Regulatory Environment Ability to use telehealth Scope of practice laws, regulation, interpretation Ability of allied personnel to collect diagnostic records prior to a patient being seen by a dentist Ability of allied personnel to perform procedures in locations separate from dentists Understanding that dentists can develop a diagnosis and treatment plan without an in-person visit with the patient

67 Legal and Regulatory Environment Ability to be paid for services performed using telehealth technologies Principle: consider telehealth technologies as communication tools, distinct from the health services that are being provided. Require payors to pay for covered services whether performed in-person or with the use of telehealth technologies Include store-and-forward as well as real time

68 Legal and Regulatory Environment Ability to be paid for services performed using telehealth technologies Suggested language: face-to-face contact between a health care provider and a patient is not required for services performed using real time or store-andforward teledentistry.

69 Dental Practice = Dental Care in the Future Geographically distributed Telehealth enabled Oral health teams Chronic disease management using biological, medical, behavioral, and social tools Integrated with general health, educational, and social service systems Interacting with the majority of the population Focused on oral health outcomes in the Era of Accountability

70 Paul Glassman DDS, MA, MBA Professor and Director of Community Oral Health University of the Pacific School of Dentistry San Francisco, CA