Oral Health Stakeholder Work Group: Welcome Meeting Thursday, June 5, :00 am 12:00 pm B-TWAN/Conference Call

Transcription

1 Oral Health Stakeholder Work Group: Welcome Meeting Thursday, June 5, :00 am 12:00 pm B-TWAN/Conference Call Attendance: Shawnda Schroeder, Gary Hart, Brad Gibbens, Kristin Schuller, Bill Krivarchka, Liz DiLauro, Bate Myszka, John Grant, Andy Peterson, Brittney Odberg, Mary Hofman, Donene feist, Jan Anderson, Janis Cheney, Jim Podrebarac, Julie Schwab, Brad Hawk, Shelly Peterson, Rita Ozbun, Shelly Arnold, Kimberlie Yineman 1. Welcome (Dr. Shawnda Schroeder) a. Center for Rural Health Introductions Shawnda gave welcome and brief introduction. Shawnda Schroeder is Research Specialist at UND Center for Rural Health (CRH). She is the point of contact for this project and the stakeholder meetings and can answer any questions. Contact her at or Other CRH staff included: Dr. Gary Hart, Director of the CRH; Brad Gibbens, Deputy Director; Dr. Kristin Schuller, faculty in the Masters of Public Health program; and Bill Krivarchka, Director of Eastern Area Health Education Center and former practicing rural dentist. b. Project Description (Dr. Gary Hart) The CRH was contacted by Pew Charitable Trusts to do an assessment of the oral health landscape in North Dakota. They have been charged with reviewing all secondary data around oral health in North Dakota while also exploring what primary data is available. In addition, stakeholder and input groups have been developed to help the CRH staff identify the needs and access issues around oral health while also working to identify and describe various models or best practices to address any identified problems. The CRH is a neutral party in this assessment and will produce two products: (1) a report on the current oral health needs in North Dakota due at the end of June 2014; and (2) a report on multiple models that may be implemented to address the identified needs, along with a list of evidenced-based pros and cons related to each model. The stakeholder group will be included in each step of this process. This initial meeting is designed to help identify needs and areas for improvement in oral health. The stakeholder group will also be asked to review the needs report and help identify models for the CRH to research and explore further. Thank you to those that have agreed to be stakeholders what you say is very important and will guide our future work in this area.

2 c. Pew Charitable Trusts Introductions (Elizabeth DiLauro) Thank you so much for participation. Liz shared that they are located in D.C. and had visited Fargo a month ago and were very excited to see the passion and commitment our various stakeholders and others in the state have for addressing oral health needs. Reiterated that the CRH has been contacted to identify issues and possible solutions and that the CRH is independent and neutral. In the future, Shelly Gehshan, Director of Pew Charitable Trusts, will speak to this group. 2. Stakeholder Member Introductions Andy Peterson, Chamber of Commerce, Statewide Vision and Strategy Committee Represents businesses in North Dakota Brittney Odberg, Third Street Clinic Work with low income, generally adults Assist uninsured and low income receive timely access to care Mary Hofman, Community Healthcare Association of the Dakotas Providing health to underserved populations Donene Feist, Family Voices of North Dakota Assist families that have children with special health needs Help family navigate services Jan Anderson, Fargo Public Schools Homeless liaison Janis Cheney, North Dakota American Association of Retired Persons Assist with quality of life as we age Julie Schwab, Medicaid Provide services to help vulnerable populations obtain services they need Close to home services are important Brad Hawk, North Dakota Indian Affairs Commission Tribal liason Make connections with state agencies to obtain assistance and services Work with Ronald McDonald mobile dental van Work with ND Dental Association on reservation access issues Reservations are rural times two when it comes to barriers to care Shelly Peterson, Long Term Care Association of North Dakota Works with all LTC and lobbies for members Rita Ozbun, Developmental Homes Works with children/adults with disabilities Help clients gain independence and access services

3 Shelly Arnold, Sanford Bismarck Emergency and Trauma Center Experience in emergency room presentation of oral health issues Kimberlie Yineman, North Dakota Department of Health, Oral Health Program (off and on call no introduction) Mark Schaefer (Not on the call), North Dakota Head Start Association Jim Podrebarac, Family HealthCare (off and on call no introduction) 3. Stakeholder Discussion Access/Concerns (Shawnda) a. From your perspective, what are the oral health access issues in North Dakota, if any? Andy Peterson: Not personally aware of access issues tribal would be though and those extremely rural. Brittney Odberg: Medicaid expansion is not covering dental. Bigger concern is the larger cost treatments bridges, dentures, oral surgery, etc. CHC can clean, do some extractions but cannot meet more severe demands which are frequent. Homeless population also a large population in need. Shared story of new American needing eight teeth extracted and the barriers to having needs met (dentures and cost). Mary Hofman: Recruitment and retention of dental providers. Donene Feist: One serious barrier is not enough providers for families even in urban centers. Also those providers that have openings do not accept new patients with Medicaid. Cost. Access. Need new dental providers and need more availability for Medicaid patients. Jan Anderson: Families in poverty do not have needs met. Also, huge lack of preventative care. Emergency issues only. Do not seek care until they need care NOW. Only reactive. Would like to see more prevention. Also reiterated the lack of providers accepting Medicaid patients even in urban centers. Patients have also reached the point where they do not want to go to dentist because they know the tooth will just be pulled and teens would rather have the pain than the gap in their mouth. Transportation to care is also an issue. Janis Cheney: Her conclusions are anecdotal does see issues to access. Also knows that Medicare does not cover much. Bill Krivarchka added that many baby boomers do not realize that they do not have oral health expenses covered. Julie Schwab: Dental is covered up to age 21 for Medicaid does not cover adults. Brad Hawk: Several barriers to care. Number of providers on the HIS system there is high turnover. People are not comfortable with dentists. AS soon as they have built rapport, their dentist leaves. They may be hesitant to see new DDS. IHS also makes it hard to get providers to come. Loan repayment programs do not allow some providers to apply based on certification rules. Need this to be easier process. Very little prevention on the reservations. A lot of reactive care. Need more prevention/education need to work to make the population more proactive about care.

4 Shelly Peterson: Hard to get residence in with a dentist. LTC is required to provide services. Bridging the Dental Gap is a welcome service and Shelly wishes it would expand statewide. Bridging the Dental Gap charges private and Medicaid for the care assessment. There is a Fargo nonprofit that is a similar model, however they have a per resident charge that insurers will not cover which makes their (otherwise excellent) services cost prohibitive to many facilities. That, or the facility has to absorb the per-patient fee. Mentioned Smiles for Life an education program for LTC nurses (at many levels) that trains others on how to do preventative dental care/assessments in a LTC facility specialized geriatric training. Web based. Rita Ozbun: Not a lot of dentists are willing to work with or have the time for special need clients. No prevention just pull the tooth. Example 25 year old with a cracked front tooth. Instead of treating and saving tooth it is pulled. Also concern that there are no services in the case of an emergency. Patient must be taken to the ED. Especially not enough providers willing to work with population with special needs they take more time, more understanding, and some need to be sedated/put under in order to have their care provided. This care requires travel to Bismarck which is a long travel, expensive travel, straining on the patient with special needs, and has a long wait list. Shelly Arnold: Have patients that present at the ED with dental concerns. There are no dentists on call or on staff to meet these needs. Have to treat the patients and make them wait to see a dentist. Pain meds or antibiotics can be given. Some ED docs will make calls to dentists on behalf of the patients but patient cannot always be seen. b. What are some of your concerns around oral health in North Dakota, if any? Many concerns were already mentioned in previous conversations. What are others of the group? Money up front is a concern. Hard to have $1400 up front for care needed now that was unplanned. Can be this high of a cost even with some private insurance. Each dentist is different and some will work on payment plans or request on half up front. Number of dentists though that are willing to see patients with little or no insurance is low. Children s Dental Services out of Minneapolis is meeting the need for prevention in schools. That is a big concern. Need to more from reactive to preventive care. This program was in ND before, and needs to be reinstated. Sarah Wovcha is contact. Information shared with Shawnda. Also see dental pain being used for drug seeking. This is a concern in the ED because it diminishes the true need and pain of patients with a real dental emergency. 4. Current North Dakota Oral Health Statistics (Dr. Kristin Schuller) See attached document for highlights from previous published reports reviewed by CRH staff. This information, and other statistics and areas of need will be presented in the report developed by the CRH the end of this month. This product will be shared with the Stakeholder group and the Stakeholder group will be asked to review and provide feedback.

5 5. Stakeholder Discussion Oral Health Models (Shawnda) Brad Question: What have been policy barriers around oral health? Answers: Jan Anderson: Someone has to be 18 to access care on their own. Cannot get Medicaid help for a child without their parents consent. Some youth need care and need it now and do not have time or ability to have consent to have care. Cannot help a patient without parent present/signature. Shelly Peterson: Policy change in Fargo area where a nonprofit charge is an unallowable cost for LTC facilities. This is a huge policy concern and keeps facilities from accessing otherwise excellent nonprofit services. Need DHS to recognize the non-profit fee as an allowable expense. Not sure if this needs to be federal or state level change. Julie at Medicaid shared that they are reviewing this now. Andy Peterson: State policy makers feel they need to say no to things. Needs a narrative of something that has gone right. A success story where progress was made. In a story format. Data is great but they are not necessarily data driven in decision making. a. Based on earlier discussions of oral health concerns, what are the policy issues in North Dakota around oral health? b. What are some proposed solutions or models for oral health? Because of earlier policy discussion, lets discuss A and B together Andy Peterson: No additions Brittney Odberg: Expanding or opening Medicaid expansion is just a piece. Even if Medicaid began to cover oral health, you would still need dentists to accept Medicaid patients. A solution may be something like at Valley Health where patients pay on a sliding scale. We need ideas for large scale needs and expenses. A funding solution. Third Street is working on an idea where clients apply for assistance with their large fees and third street would help to pay those costs. Still looking into a funding source for this idea. Or expand the idea of Bridging the Dental Gap. Also could have mobile equipment then ask dentists to use the equipment at central rural locations. LTC is exploring this through DentaQuest and in partner with the Oral Health Coalition. Mary Hofman: No additions Donene Feist: Increase education on prevention. Increase education on the problems. Some are not even aware of the state of oral health in North Dakota. Jan Anderson: I would like to know what has worked in other states and see if it works here. Getting in to the DDS is a huge problem. Need to push prevention. Have someone come into the schools and do preventative care and education. Schools could do sealants, fluoride treatment, etc. Roosevelt in Fargo had this program for some time but it is not across all schools. Look into this idea and see if it is still functioning.

6 Janis Cheney: No additions Julie Schwab: Expansion. No dental over 21 in the RFP from Sanford insurance. Need to review a new reprocurement. Brad Hawk: Need state funding for prevention both on and off the tribes for ALL tribal members. Need to figure out how we fix access issues on reservations and need to find available funding. For IHS, funding is at 50% of the need across the nation. If funding runs out, care may be delayed a year until there is additional funding to provide the oral health care needed for some patients. Public Law 638 also allows a tribe to take over their dental health and the tribe would then oversee certification, etc. Tribes may try this and see if they can manage their own oral health system. We also are pushing the ACA to generate additional revenue and use money to focus on prevention. Question: How are orthodontic needs met on the reservation? Answer: They are not well met. It is a long wait and the focus of dental care is on emergency care. Orthodontics would be out of pocket. Some are waiting more than a year for this service because of funding issues. Shelly Peterson: No additions. Rita Ozbun: No additions. Shelly Arnold: City wide dental call list for ED patients would be excellent. We see three to five dental issues a day in the ED. Not all require an immediate dental visit, or even a dental follow up if we can treat with antibiotic, but for those emergent need, a call list would be excellent. Kimberlie Yineman: Need to find access to care and prevention Bill Krivarchka: Need prevention as a model in schools. Need oral health as an all health component in total patient care. Would be beneficial to have primary care involved in prevention. Nurse practitioners for example providing preventative oral health. c. Are you working on, or aware of any oral health initiatives in North Dakota? Andy Peterson: No additions Brittney Odberg: Grand Forks community as an example. Serves the uninsured and mostly adult population. The dental director identified dentists that are on a rotating list to provide in-kind services to third street clients. Clients go to dentists clinic, dentist does in-kind examination and/or extraction then can refer to an oral surgeon. The oral surgeons also provide in-kind services. Good program, but not a lot of prevention and there is a lot of

7 tooth extraction. Only takes one to two weeks to receive the care needed. We see about 100 clients a year and have about 27 dental offices in Grand Forks on the list so they provide one to three in-kind services a year. Group input: this is a good model for meeting the needs of the uninsured, however, we cannot rely on dentists donating their time and money and care to meet all of the oral health needs in the state. Mary Hofman: No additions Donene Feist: No additions Jan Anderson: No additions Janis Cheney: No additions Julie Schwab: No Additions Brad Hawk: Ronald McDonald Units. They go out for a week and provides services. Dental Days event last year for tribes. Many kids gain services through the mobile units. Need to work with community health centers on tribes oral health prevention. Prevention in community health visits would be beneficial. They prevention would be directed to the visited patient, but the family would participate as well. Good health TV Network could be utilized for prevention as well in Tribal colleges and high schools, to show public health/oral health messages. We are looking for foundations and private funders to help these efforts. Shelly Peterson: No additions Rita Ozbun: No additions Shelly Arnold: No additions Bill Krivarchka: Clinical rotations to bring oral health students into ND to practice and do their clinicals especially in rural. Turtle Lake doing this and happy to have a student on board. Working hard to place and recruit into North Dakota. 6. Stakeholder Discussion Additional Questions/Comments Andy: In CA kids are required to see a dentist before they can start school should look more into this. Jan: MN state Moorhead is doing something in oral health. Roosevelt should have data to review as well. 7. Adjourn Future Meeting Dates Wednesday, June 25, :00 AM 2:30 PM In-Person; Bismarck, North Dakota Thursday, July 10, :00 AM 12:00 PM Remote Access (BTWAN, webinar, or phone) Monday, July 21, :00 PM 4:00PM Remote Access (BTWAN, webinar, or phone) Thursday, July 31, :00 AM 2:30 PM In-Person; TBD