The Integration of Oral Health with Primary Care Services and the Use of Innovative Oral Health Workforce in Federally Qualified Health Centers

Transcription

1 The Integratin f Oral Health with Primary Care Services and the Use f Innvative Oral Health Wrkfrce in Federally Qualified Health Centers Presented by: Margaret Langelier, MSHSA Center fr Health Wrkfrce Studies Schl f Public Health University at Albany, SUNY April 30, 2015 American Assciatin f Medical Clleges Health Wrkfrce Research Cnference Alexandria, Virginia

2 Study Backgrund The Center fr Health Wrkfrce Studies, University at Albany Schl f Public Health Designated as the Natinal Oral Health Wrkfrce Research Center (OHWRC) under a cperative agreement with HRSA s Natinal Center fr Health Wrkfrce Analysis This is ne f five studies cnducted in 2015 by the OHWRC Access t ral health services is limited, especially fr underserved ppulatins wh receive primary health care services thrugh safety net prviders including Federally Qualified Health Centers (FQHCs) ralhealthwrkfrce.rg

3 FQHCs are Uniquely Structured fr Service Integratin FQHCs are ideally rganized t prmte ral health and integrate ral health service delivery with primary care Primary care, ral health, and behaviral health services are generally delivered under the same rganizatinal umbrella FQHCs required t prvide all pediatric dental services mandated in the EPSDT benefit and preventive dental services fr adults In 2013, FQHCs prvided nsite dental services t 4.4 millin peple, 1.3 millin f whm received restrative services and mre than a millin f whm received emergency r ral surgery services HRSA has invested $55 millin in ral health expansin grants since 2001 ralhealthwrkfrce.rg

4 The Study Objective: T Describe Innvatin in Oral Health Service Delivery Qualitative study with several bjectives 1. T understand effrts t integrate primary care and ral health service delivery in FQHCs 2. T describe Deplyment f innvative ral health wrkfrce mdels The cnfiguratins f ral health care teams 3. T understand the use f technlgy t enable service integratin using Electrnic dental and medical recrds Telehealth mdalities Mbile and prtable equipment ralhealthwrkfrce.rg

5 The Research Study was Qualitative Case study methdlgy Site visits at FQHCs in nine states with differing scpe f practice legislatin fr dental therapists (DTs), dental hygienists (DHs) and dental assistants (DAs) NH, RI, CT, NY, CA, ME, PA, MN, WI Individual and grup interviews Administratrs Medical Prfessinals Oral Health Prfessinals IT Staff, Pharmacy, Behaviral Health Prviders ralhealthwrkfrce.rg

6 The Three Majr Findings frm This Research FQHCs are uniquely psitined t prvide integrated health care services that are patient centered FQHCs experience cmmn prblems with the ral health literacy f patients and with building sufficient capacity t meet high demand fr services FQHCs have exceptinal pprtunities t engage with innvatin, especially nvel lcal wrkfrce slutins that increase access t ral health services fr underserved ppulatins Ability t Utilize Innvative Wrkfrce Mdels Linkages t Cmmunity Prviders Team Based Service Delivery Integrated Care - Primary Health, Oral Health and Behaviral Health Patient Centered Care in FQHCs Patient Supprt Services Including Transprtatin Cmmunity Educatin Prgrams Cultural Cmpetence Electrnic Health Recrds Telehealth Technlgy Financial Optins

7 The Opprtunities fr Innvatin in Oral Health Service Delivery Vary by State Many cmmn difficulties with delivering ral health services amng FQHCs The strategies selected t imprve access are unique because they are determined by lcal cnditins and available resurces The success f lcal innvatin depends n Apprpriately tailring the services t the specific needs and attributes f the ppulatin served Accurately identifying deficits in the lcal ral health delivery system (cn t) ralhealthwrkfrce.rg

8 The Opprtunities fr Innvatin in Oral Health Service Delivery Vary by State (cn t) The pprtunity t use innvative wrkfrce mdels Scpes f practice fr allied dental persnnel t engage in expanded r innvative wrkfrce mdels The availability f a cmpetent prfessinal wrkfrce t prvide services State and federal lan repayment prgrams Dental residencies and student externships Finding state and federal funding t supprt the cst f delivering care Infrastructure imprvements - ACA Technlgy including equipment and infrmatin systems interfaces Reimbursement sufficient t cver recurring csts f prviding dental services Gd wrking knwledge f reimbursement structures ralhealthwrkfrce.rg

9 FQHCs Emply Varius Strategies t Integrate Oral Health and Primary Care Strategic effrts t integrate primary care and ral health care services acrss the delivery system include Requiring all patients in the dental practice t als be primary care patients (RI) Using new patient health infrmatin frms that cntain questins abut ral disease and dental access (NH) Using the electrnic health recrd bi-directinally (NH, RI, MN) ralhealthwrkfrce.rg - T mnitr patient health cnditins, medicatins, and allergies and t mine the health recrd t find patients in need f services (cn t)

10 FQHCs Emply Varius Strategies t Integrate Oral Health and Primary Care (cn t) Taking bld pressures and health histries at dental visits (e.g. diabetes screening study in RI) Placing DHs in satellite primary care clinics r in pediatric clinics t prvide ral health screening and assessment services and t refer t the dental team fr mre extensive services (PA and CT) Scheduling DH assessments as part f all annual pediatric well visits up t three years f age (CT) Using primary care prviders (NPs, physicians) at satellite lcatins t prvide ral health assessment and screening exams and expedite patient referrals fr dental services at the FQHC (NH) ralhealthwrkfrce.rg

11 Strategies (cnt.) Using mbile vans r prtable dental equipment in schl based r schl linked prgrams in cperatin with schl nurses t better enable access t ral health services fr children (CT, MN) Using telehealth technlgies t prvide preventive services and remte dental diagnsis t help children in Head Start prgrams t establish a dental hme (CA) Engaging all primary care and ral health clinicians t achieve ral health clinical gals ralhealthwrkfrce.rg

12 FQHCs Use a Team Based Apprach t Oral Health Care Delivery Wrkfrce in FQHCs are ften missin driven and building effective teams t deliver care is necessary t maximize capacity Openness t using the verlapping cmpetencies f wrkers t meet high demand fr services Willingness t innvate t achieve imprved utcmes Understanding f ral health literacy challenges f the underserved Delivering care in an accepting, nn-judgmental way Assuring cultural cmpetency (cn t) ralhealthwrkfrce.rg

13 FQHCs Use a Team Based Apprach t Oral Health Care Delivery (cn t) The traditinal dental team is the base Dentists, DHs, DAs Others extend the team Primary care prviders Student externs and dental residents Innvatins n the Dental Team Public Health Dental Hygienists Cmmunity Dental Health Crdinatrs Dental Therapists Expanded Functin Dental Assistants Patient Navigatrs, Scial Service Staff ralhealthwrkfrce.rg

14 Characteristics f Dental Teams in FQHCs Clinical prviders and ther staff in FQHCs wrk tgether Different teams at different levels (e.g. clinical teams, administrative teams, discipline specific teams) Matrix f respnsibility Recgnitin f the imprtance f team identity sme decentralizatin small teams wrking tward shared gals helps with patient identificatin and with building a dental hme builds team chesiveness imprves cntinuity f care fr patients engenders familiarity with the capabilities f team members ralhealthwrkfrce.rg

15 Characteristics f Dental Teams in FQHCs (cn t) Desire t fully emply the cmpetencies f all ral health team members t maximize capacity and create efficiencies Expanded functin dental assistants t carve and place amalgam DHs with training t initiate lcal anesthesia ralhealthwrkfrce.rg

16 Dental Residents And Student Externs Cntribute t Staffing FQHCs benefit frm precepting dental residents and students Prvides FQHC patients with better access t sme specialty services Is an imprtant tl fr recruitment f new ral health prfessinals state and natinal lan repayment prgrams Enhances capacity t meet demand fr ral health services at the FQHC especially fr walk-in/ emergency patients Student externs (dentists, DHs, and DAs) and dental residents prfit frm rtatins in FQHCS ralhealthwrkfrce.rg Prvides students with greater levels f experience with dental surgery and extractins Instructs new prfessinals in the ral health needs f different cmmunities

17 FQHCs Have Embraced Innvative Oral Health Wrkfrce Mdels T Enhance Access Expanded Functin DAs and DHs Permitted in many states Restrative functins, rthdntic functins, etc. Increase efficiencies in the clinic Enhance capacity t meet demand Use requires infrastructure t allw dentists t wrk with multiple patients - side by side peratries (WI) Cmmunity Dental Health Crdinatr Mdel prpsed by the ADA 34 CDHCs Wrking in 8 states - AZ, CA, MT, MN, OK, PA, TX, WI Cmmunity educatin Case finding and navigatin Mtivatinal interviewing t engage patients In cmbinatin with ther qualificatins, can prvide clinical services

18 Wrkfrce Innvatins (cnt.) Public Health Dental Hygienists Enabled in the majrity f states but definitins vary WIC, schl based prgrams, satellite primary care practices Able t wrk in the cmmunity with lwer levels f required supervisin r unsupervised Reach patients in the cmmunity and link them t a dental hme Prvide a range f preventive services including atraumatic restratins and prtective sealants Dental Therapist/ Dental Hygienist Therapist Allwed nly in Maine, Minnesta, and Alaska Basic restrative services Allws dentist t cncentrate n high needs patients Substitutes and supplements care by a dentist

19 Summary Patients health utcmes benefit when care is integrated and delivery is patient centered Rates f cmpleted referrals are imprved when referring prviders wrk under the same rganizatinal umbrella The likelihd f establishing a health/medical/dental hme increases when health and ral health services and electrnic health recrds are integrated FQHCs benefit frm the pprtunities t use innvative wrkfrce t reach lcal ppulatins that are underserved fr ral health Wrkfrce innvatin allws fr a variety f service delivery cnfiguratins and als permits existing wrkfrce t gain new cmpetencies. There are multiple pprtunities fr cmbining skill sets t better address the needs f patients (e.g. CDHC and PHDH, DT and DH)