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 1

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3 Purpose and Charge Develop a vision for the characteristics of the desired oral health care system in 2023 Consider how the tools of quality and accountability can move the current system to the desired system Make recommendations for actions to apply the strategies developed in this process to move the current system toward the desired vision for

4 Committee Membership 4

5 Action Steps 5

6 Preamble 5 Principles Vision for The U.S. oral health care system has entered the Era of Accountability and the tools of quality improvement and accountability will be instrumental in making progress toward the committee s vision. 2. Increased integration with the overall health care system and with the education and social service systems is essential. 6

7 5 Principles Vision for The major drivers of a rapidly changing overall health system all apply to and will have profound impact on the oral health system. 4. It will be increasingly important for the oral health care system to demonstrate the Value produced by the nation s oral health expenditures. 5. There must be an increased emphasis on prevention and disease management if the segments of the population with the greatest oral health disparities are to achieve and maintain good oral health. 7

8 Vision for Characteristics of the oral health system The oral heath system for 2023 will: 1. Improve population health while increasing the value of health care expenditures. 2. Be focused on health outcomes. 3. Assure equity and eliminate disparities in oral health. 4. Promote basic oral health for All including freedom from active disease. 5. Be integrated with the overall health care system. 8

9 Vision for Characteristics of the oral health system The oral heath system for 2023 will: 6. Prioritize prevention and disease management in the context of comprehensive care. 7. Permit multiple options for the delivery of services. 8. Develop and use evidence to improve consistency and reduce unwarranted variability in the delivery and outcomes of oral health care. 9. Engage people as active partners in care. 9

10 Impact 10

11 Recommended Strategies I. Coverage Goal: Secure public and private coverage for oral health services across the age and income spectrum through established government supported or government regulated approaches. Objectives Activities 11

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13 Recommended Strategies II. Disease Management Goal: Promote adoption of chronic disease management approaches for the prevention and management of common oral diseases. Objectives Activities 13

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15 Recommended Strategies III. Health Promotion Goal: Advance family- and community-level oral health promotion initiatives. Objectives Activities 15

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17 Recommended Strategies IV. Community-based Oral Health Delivery Goal: Advance low-cost community-based, prevention-oriented interventions. Objectives Activities 17

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19 Recommended Strategies V. Move Payment from Volume to Value Goal: Develop payment and incentive arrangements based on intermediate health outcomes and health outcomes. Objectives Activities 19

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21 Recommended Strategies VI. Consumer Empowerment Goal: Increase public understanding and appreciation for oral health, with the goal of making oral health as important and valuable to people as other health concerns. Objectives Activities 21

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23 Recommended Strategies VII.Accountable Care Goal: Develop and reward networks of care providers cooperating to improve oral health outcomes as in Accountable Care Organizations. Objectives Activities 23

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25 Future Work Dissemination Influence funding priorities Entities begin or expand work in these areas 25

26 Paul Glassman DDS, MA, MBA Professor and Director of Community Oral Health University of the Pacific School of Dentistry San Francisco, CA 26

27 Pacific Center for Special Care University of the Pacific School Arthur A. Dugoni School of Dentistry Paul Glassman DDS, MA, MBA Director Maureen Harrington MPH Director of Operations and Community Education Maysa Namakian MPH Program Manager Jesse Harrison-Noonan Hilda Anderson Pacific Center for Special Assistant Care Program at the Manager University of the Pacific Arthur Contracts A. Manager Dugoni School of Dentistry 27

28 Moving from Concept to Legislation to Value-Based Incentives Goal Concept Design Funding Demonstration Lessons Legislation Spread Sustainability 28

29 Goal Improve oral health of underserved populations 29

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31 The Surgeon General s Report Although there have been gains in oral health status for the population as a whole, they have not been evenly distributed across subpopulations. Profound health disparities exist among populations including: Racial and ethnic minorities Individuals with disabilities Elderly individuals Individuals with complicated medical and social conditions and situations Low income populations and those living in rural areas 31

32 Concept Design and implement using broad coalition Bring care to where people are Integrate oral health services and actions with educational, social, and general health systems Use technology to connect geographically distributed personnel into telehealth connected teams Emphasize prevention and early intervention 32

33 The 2011 IOM Reports on Oral Health 33

34 Themes from the 2011 IOM Reports on Oral Health Improve access to services and oral health through: Chronic disease management Delivery Systems Telehealth Payment incentives Workforce expansion Drive change and accountability through Quality measures and improvement 34

35 Design Design and implement using broad coalition Dental school California Dental Association California Dental Hygiene Association The Children s Partnership Children Now Head Start associations and agencies School health associations and agencies CA Department of Health Care Services (DHCS) CA Department of Public Health (DPH) more. 35

36 Design Bring care to where people are Head Start, elementary schools, residential facilities for people with disabilities, nursing homes Integrate oral health services and actions with educational, social, and general health systems Develop agreements, customized protocols Enlist and work with staff on: raising awareness, consent, education, scheduling, referral follow-up 36

37 Design Use technology to connect geographically distributed personnel into telehealth connected teams Choose and customize cloud-based software Design information flow and practice integration Emphasize prevention and early intervention Science of minimally invasive dentistry Preventive procedures Behavior change strategies Interim Therapeutic Restorations 37

38 Interim Therapeutic Restoration (ITR) AAPD Policy on Interim Therapeutic Restorations (ITR) 38

39 The CA Health Workforce Pilot Project 39

40 The CA Health Workforce Pilot Project RDAs, RDHs, and RDHAPs will make the decision about which radiographs to take, if any, to facilitate an initial oral evaluation by a dentist. RDAs, RDHs, and RDHAPs will place Interim Therapeutic Restorations (ITR) 40

41 The CA Health Workforce Pilot Project 41

42 Funding American Dental Hygienists' Association California Dental Association Foundation California Consumer Protection Fund The California Department of Developmental Services The California Emerging Technology Fund The California Health Care Foundation The Verizon Foundation Paradise Valley Community Health Fund/ The San Diego Foundation University of the Pacific, Arthur A. Dugoni School of Dentistry First 5 Los Angeles and San Mateo County Health Resources and Services Administration through the California Department of Public Health DentaQuest Foundation The California Endowment more 42

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44 EHR: Radiographs 44

45 EHR: Photographs 45

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51 Community-based Prevention and Early Intervention Procedures 51

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54 Oral Health Systems for Underserved Populations 54

55 Patients and Visits Population Type # of Patients Seen Total Visits Head Start Elementary Long Term Care Multifunction Community Center Regional Center Total Data Current as of 6/30/14 55

56 Referrals to Dental Offices Type of Site % Needing Referral to Dental Office Head Start Preschool 37% Elementary School 37% Long Term Care 34% Data Current as of 6/30/14 56

57 Procedures Performed Population Type X-ray sets ITRs Head Start Elementary Long Term Care Multifunction Community Center Regional Center Total Data Current as of 6/30/14 57

58 Hub and Spoke System 58

59 Demonstration Project: Conclusions Telehealth connected teams can reach populations who do not normally get care in the traditional system Most underserved people (~2/3) can be kept healthy on-site in community locations Allied dental personnel can safely decide what diagnostic records to collect and perform ITRs (however only allowed to do so in HWPP) Payment mechanisms do not support telehealth connected teams and telehealth-enabled procedures 59

60 Legislation Goal Include duties tested in HWPP in scope of practice Clarify and require payment for telehealth-enabled services Process Coalition Sponsor (principle supporter): The Children s Partnership Funding: The Pew Charitable Trusts Author Legislative process 60

61 Legislative Process Design legislation and introduce AB1174 Assembly Senate Introduction Policy committees (B&P, Health) Appropriations Policy committees (B&P, Health) Appropriations Administration Governor 61

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66 New Duties AB 1174 Provisions RDAEFs, RDHs, and RDHAPs can make the decision about which radiographs to take, if any, to facilitate an initial oral evaluation by a dentist. RDAEFs, RDHs, and RDHAPs can place Interim Therapeutic Restorations (ITR) Payment Expansion California Medicaid Program is required to pay for services performed using store and forward telehealth systems 66

67 AB1174 Implementation Timeline AB 1174 takes effect January 1, 2015 Regulations 2015 January -??? Educational programs Telehealth billing Training 2015 and beyond New duties Working in telehealth-connected teams Establishing community-based Virtual Dental Home models Develop and disseminate resources 67

68 AB1174 Implementation Resources Intermittent Clinics Dental Hygiene Billing Dentist Contracting 68

69 Spread and Sustainability Training Courses Consultation Technical assistance and support Incentives to create a population with good oral health 69

70 The Era of Accountability 70

71 The Triple Aim improving the experience of care improving the health of populations reducing per capita costs of health care 71

72 The Era of Accountability The Urban Institute 72

73 Value-Based Incentives for Oral Health A California Pilot Project 73

74 Plan Goals Dental plan agreements that include incentives based on the oral health of the entire eligible population A community surveillance system to monitor the oral health of the target community separately from provider records Technical assistance to help dental plans and providers understand and use community-based prevention, early intervention and integration methods to achieve the goals of improving the oral health of the target population and lowering costs of care delivery. 74

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76 Plan Development/Process Advisory Committee Scan of National Landscape Develop Measures Incentive system Organization/operation system Evaluation plan 76

77 Measures Oral health status measures (modified Basic Screening Survey measures) Access to care measures (modified Dental Quality Alliance (DQA) measures) Cost measures (DHCS data) 77

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79 Incentive System Incentives to participate Learning Expertise Pay for reporting/participation Learning community Gradual introduction of risk 79

80 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 80

81 Lessons Coalitions Long time horizon Benefit to partners Common ground Flexibility Incremental progress Improving oral health of underserved people is the goal 81

82 Paul Glassman DDS, MA, MBA Professor and Director of Community Oral Health University of the Pacific School of Dentistry San Francisco, CA 82