Center for Oral Health. Engagement in Oral Health Work for Vulnerable Populations May 4, 2016

Transcription

1 Center for Oral Health Engagement in Oral Health Work for Vulnerable Populations May 4, 2016

2 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

3 State of the State?

4 The Dental Neglect Centers for Medicare & Medicaid Services (2011). Health Expenditures by State of Residence. Retrieved at

5 Social Determinants of Health

6 Who Are the Most Vulnerable Populations?

7 California s Children 9.3 million children that s 13% of all children in the U.S.

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9 California s Older Adults 33% of Older Adults Have Untreated Decay

10 CA Insurance Coverage 2015 Percentage of Population enrolled in Medi-Cal by Age Group 2 : - All Age Groups: 33.4% - 0-5: 57.0% : 54.2% : 30.5% : 23.7% - 65+: 20.9% 2. Research and Analytic Studies Division. January Proportion of California Population Certified Eligible for Medi Cal By County and Age Group September Medi Cal Statistical Brief. California Department of Health Care Services.

11 So What Are We Doing About It?

12 SOLUTIONS Oral Health Action Coalition of the Inland Empire (OHAC-IE) Early Smiles Oral Assessment of Older Adults

13 OHAC-IE Oral Health Action Coalition IE (OHAC IE) Logic Model, Goal Statement: Improve the oral health of vulnerable populations in the Inland Empire (IE) Region of Southern California Outputs Situation Inputs Outcomes Impact Systemic: OHAC-IE organizations: Participation Activities Short-Term Intermediate Outcomes Outcomes - High prevalence of oral diseases - Advocacy organizations - Low Denti-Cal Utilization - Dental schools - Denti-Cal is highly centralized -Underinsured & Uninsured - Dental Hygiene program OHAC IE Providers: - Insufficient provider geographic distribution - Low provider participation in Denti-Cal - Low provider: population ratio Population - Low oral health literacy - Low oral health awareness - Accessibility Barriers Data - Insufficient data to inform policies and measure outcomes Communities: - Culture - Insufficient access points (Moreno valley) - Private providers Priorities: - Advocacy - Direct Services - Provider Education - Public Awareness - FQHCs - Community Clinics Association - Funders - County Agencies - IEHP members Dental Schools Dental Hygiene Programs Local Government Agencies Local Health Departments School Districts Health Plans Professional societies Individual Dental Providers Business Community Local Social Service Agencies Faith-based Org Funders Consumer and healthcare advocates Local Media Safety Net clinics/providers Form Task Force - Subcommittees of OHAC-IE (3&4) 1. Advocacy 2. Direct Services 3. Public Awareness/ Communications 4. Surveillance, Data, Evaluation Connect with Board of Educations to adopt school oral health policies (1,2,3,4,5) Promote private dentist participation in Denti- Cal (2) Promote a dental benefit carve-in for IEHP and others (3) Create an oral health environmental scan (5) Promote integration of health care systems (1,2,3,4) Increase Awareness of Loan Repayment Program Availability for Providers in IE (1&2) Maximize HRSA Designations (1&2) Develop of Road Map to Accessible Care in IE (1&2) Identify important activities/issues to advocate for (3) Monitor state issues, bills, etc (3) Increase Public Awareness (all) Baseline report (5) Increase # of access points (1&2) Increase access to evidence-based dental preventive measures (fluoridated water, topical fluoride, sealants) (1, 2, 3) Increase Availability of Dental Providers (and specialty providers) (1&2) Increase providers that participate in Denti-Cal program (1,2,3) Increase Dental Residencies program (1&2) Long Term Outcomes (5 Year Goals) 1. Strengthened the oral health safety net 2. Increased Access to Care Structural (ex. more providers) Financial (ex. number people w/insurance coverage) Cultural 3. Public Policies that favor access to care for vulnerable populations in place 4. Improved knowledge, attitudes, and beliefs related to oral health 5. Established oral health surveillance system to monitor progress Contextual Factors Impacting Long Term Success Version

14 OHAC-IE Subcommittees Advocacy State Level Local Level Direct Services Providers Consumers

15 Prevention Neglect

16 OHAC-IE Subcommittees Public Awareness Services Consumers Providers/Support Data & Surveillance Workforce Measures & Evaluation

17 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

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

20 Purpose of the Program Create a seamless system of care that

21 Purpose of the Program links resources throughout the community (e.g., medical, dental, behavioral health care, education, social services, insurance), and

22 Purpose of the Program removes barriers to oral health care (coverage, transportation etc.)

23 End Result to achieve optimal oral health for children 0-5 and pregnant women

24 Early Smiles components Education Screening Navigation = Dental Home

25 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.

26 Oral Health Education Pregnant women Families with children under age 6 Group and/or one-on-one

27 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

28 Oral Health Education Group education General oral health knowledge Optimal oral health practices Utilization of dental benefits

29 Oral Health Education One-on-One Specific oral health knowledge Optimal oral health practices Utilization of dental benefits

30 Screening and Early Prevention Caries risk assessment Dental Screening Fluoride varnish application

31 Referral to dental home Referral for coverage (Covered CA, Medi-Cal etc.) Follow-up until first dental visit complete Navigation

32 How it Works

33 Accessed July 20, 2015 from Model Community-based capacity building approach Network partnerships to implement Early Smiles Provide gap filling services

34 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

35 Oral Health Assessment of Older Adults in California Center for Oral Health &

36 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?

37 Phases: Overview 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)

38 Phases: Overview Phase 2: Community dwelling individuals (e.g., community living complexes, congregate/home delivered meal sites)

39 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

40 California s Older Adults Characteristic US % with no natural teeth 25% % of adults with who did not use their dentures % of adults with teeth that have untreated decay 18% ~33%

41 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)

42 Additional information Jessica L. Woods, RDHAP, BSDH, RDA Program Associate