MI MOM S MOUTH. Examining a Multifaceted Michigan Initiative and the Critical Role of FQHC s in Delivering Interprofessional Care

Transcription

1 MI MOM S MOUTH Examining a Multifaceted Michigan Initiative and the Critical Role of FQHC s in Delivering Interprofessional Care

2 TODAY S OBJECTIVES Learning Objective 1: Develop an understanding of Michigan s Perinatal Oral Health Initiative and research regarding oral health care during pregnancy, as well as investigate common barriers both providers and patients face within the state. Learning Objective 2: Learn strategies used to support FQHC s with transformation in practice, policies and payment models. Learning Objective 3: Learn current program best practices and examine challenges faced by this initiative, with an emphasis on the application of these practices and lessons learned.

3 WHY ARE WE HERE TODAY? Despite the linkages between poor oral health and preterm birth, the transmission of Strep Mutans and caries acquisition, and the fact that pregnant women and children on Medicaid in Michigan have a dental benefit In Michigan, only a little over half of all pregnant mothers with immediate oral health needs receive treatment during pregnancy. Furthermore, this decreases dramatically when looking at minorities and the socioeconomically disadvantaged. In 2015, only 4.5 percent of Medicaid beneficiaries under the age of 2 had a dental visit. Medicaid Enrollment and Dental Utilization Statistics by County, Calendar Year Michigan department of health and human services

4 WHY SO LOW? COMPLEX ISSUE WITH MULTIPLE CONTRIBUTING FACTORS 59% of women do not receive any counseling regarding oral health in pregnancy Obstetricians 80% do not use oral health screening questions 94% do not routinely refer all patients to a dentist Rare to have training in oral exams Dentists Hesitant to provide care; may have been taught to delay care 92% are private practice and do not participate in Medicaid Medicaid reimbursement rates are very low Mothers May not view oral health as a priority or understand the importance of oral health care May not have access

5 PERINATAL ORAL HEALTH PROGRAM Launched January 2013 Housed under Michigan s Infant Mortality Reduction Plan Goal: Develop Comprehensive Perinatal Oral Health System for State of Michigan Perinatal- Period of time beginning before conception and continuing through the first year of life (March of Dimes, TIOP II, 1993) 5

6 INFANT MORTALITY REDUCTION PLAN 1. Achieve health equity and eliminate racial and ethnic disparities by addressing social determinants of health in all infant mortality goals and strategies. 2. Implement a perinatal care system 3. Reduce premature births and low birth weight 4. Support increasing the number of infants who are born health and continue to thrive 5. Reduce sleep related infant deaths and disparities 6. Expand home-visiting and other support programs to promote healthy women and children 7. Support better health status of women and girls 8. Reduce Unintended Pregnancies 9. Promote behavioral health services and other programs to support vulnerable women and infants

7 7 Historic Infant Mortality Rates Infant mortality rates, by race/ethnicity and year United States, Centers for Disease Control and Prevention (CDC): Public Health Approaches to Reducing U.S Infant Mortality

8 8 Michigan Infant Mortality per 1,000 live births Infant Mortality rate per 1,000 live births United States & Michigan, Source: Michigan Resident Birth and Death files, MDHHS Division for Vital Records & Health Statistics Prepared by: MDHHS Epidemiology Section United States Michigan

9 9 Statewide Infant Mortality Source: Vital Statistics Birth & Linked Infant Death Cohort ( ) Map created by Sue C. Grady, PhD, MPH Geography, Michigan State University

10 A LOOK AT MICHIGAN DATA: PRAMS Prevalence of dental care needed and dental care sought Over a quarter of women reported that they needed dental care during their pregnancy. Of the women who needed care, 58.4% sought dental care during their pregnancy, while 41.6% did not seek dental care Michigan Department of Community Health (MDCH). Michigan Pregnancy Risk Assessment Monitoring System Data. Lansing, MI: MDCH, Lifecourse Epidemiology and Genomics Division, Maternal Child Health Epidemiology Section; [2015].

11 MICHIGAN DATA: PRAMS Michigan Department of Community Health (MDCH). Michigan Pregnancy Risk Assessment Monitoring System Data. Lansing, MI: MDCH, Lifecourse Epidemiology and Genomics Division, Maternal Child Health Epidemiology Section; [2015].

12 MICHIGAN DATA: PRAMS Michigan Department of Community Health (MDCH). Michigan Pregnancy Risk Assessment Monitoring System Data. Lansing, MI: MDCH, Lifecourse Epidemiology and Genomics Division, Maternal Child Health Epidemiology Section; [2015].

13 MICHIGAN DATA: PRAMS A SNEAK PEAK AT NEW PRAMS DATA! In 2013 about 23,000 moms had dental problems during pregnancy that required attention. Only 60% of women sought out care Of the 40% who did not get care 50% had insurance and 50% did not. 60% had their teeth cleaned in the 12 months before they were pregnant. A large number of non-trivial dental problems are going untreated during pregnancy despite dental insurance status and recent prepregnancy dental visits. Michigan Department of Community Health (MDCH). Michigan Pregnancy Risk Assessment Monitoring System Data. Lansing, MI: MDCH, Lifecourse Epidemiology and Genomics Division, Maternal Child Health Epidemiology Section; [2016].

14 AGE ONE DENTAL VISITS 2015 data shows that On average, approximately 4.5 percent of Michigan Medicaid beneficiaries under the age of 2 had a dental visit. Numbers vary greatly by county, with a low of ~1.2 percent ( Delta County in the Upper Peninsula) and a high of ~39.2 percent (Charlevoix, Northern Michigan County). Calhoun county is at 12.5 percent, which is among the highest average in counties with a sizable population. Medicaid Enrollment and Dental Utilization Statistics by County, Calendar Year Michigan department of health and human services

15 PERINATAL ORAL HEALTH ACTION PLAN 5 Objectives I. Develop Evidence-based Perinatal Oral Health Guidelines II. Integrate Oral Health into the Health Home for Women and Infants III. Develop Interdisciplinary Professional Education to Improve Perinatal Oral Health IV. Increase Public Awareness of the Importance of Oral Health to the Overall Health of Pregnant Women and Infants V. Ensure a Financing System to Support Perinatal Oral Health

16 Putting the Plan into Action Michigan Perinatal Guidelines for health professionals released earlier this year Developing educational opportunities for medical, dental, and public health professionals. Michigan selected NPM 13a when applying for Title V funding, resulting in additional focus and support for this initiative within the state.

17 WICHEALTH.ORG: A PERINATAL ORAL HEALTH MODULE Developed in partnership with Dr. Robert Bensley and wichealth.org- available in November! Educational module for WIC clients Contains information for both pregnant women and mother s of young children. Clients develop their own action plan depending on their current belief s and actions. ( responsive design) Available to all states who utilize Wichealth.org for FREE! Provides statistics on users and module completion, to allow for evaluation.

18 Putting the Plan into Action Additional funding has been allocated to increase the adult dental benefit for pregnant women. Supporting and promoting the integration of dental care into the medical setting Partnering with the Michigan Primary Care Association and FQHC s who are Providing innovative models of care Developing incredibly successful programs ( some independently of this initiative) to meet the needs to their clients.

19 CHALLENGES Recognizing that insurance coverage doesn t equal access to care Lack of awareness and prioritization in medical and dental communities as well as within the general public 2017 Priority: how to target private practices, both Dental and OBGYN. Evaluation and a lack of data infrastructure.

20 CONTACT INFORMATION Emily Norrix, MPH Perinatal Oral Health Consultant

21 MICHIGAN S HEALTH CENTERS 40 Health Center organizations 39 Health Center Program Grantees 1 FQHC Look-Alike 1 is both a Health Center Program Grantee & FQHC Look-Alike 260+ service sites Over 650,00 patients served annually

22 MI HEALTH CENTERS LEADERS IN CARE AND QUALITY Transformative yet base on founding mission Cost effective yet expanding Quality care yet serving populations with high needs Innovative yet sharing Learn endlessly, Steal shamelessly

23 HEALTH CENTER DATA - MICHIGAN PRENATAL AND QI INDICATORS Prenatal Patients Trend %Change Prenatal Patients 13,125 13,061 12,696 13,139 12, % Prenatal Patients who Delivered 7,098 7,109 6,948 7,394 7, % Perinatal Health Quality of Care Indicators Access to Prenatal Care (First Prenatal Visit in 1 st Trimester) Trend %Change 67.8% 69.0% 72.1% 71.68% 72.76% 4.96% Low Birth Weight 8.4% 7.9% 8.8% 9.18% 8.73%.33%

24 CENTERING : AN OVERVIEW Group care Improves patient engagement Patient centered Builds on partnerships and community alignment Better health outcomes and birth experience

25 OVERVIEW & BEST PRACTICES TO INCREASE UTILIZATION OF ORAL HEALTH SERVICES Integration of services supported: Co-location Shared records Shared quality measures including health outcomes Standardized referral system Patient navigators Outstanding and committed staff

26 MPCA CENTERING LEARNING COMMUNITY Centering Healthcare Institute Model Implementation Plan (MIP) Education and Resource Center MPCA Centering Model of Care & Learning Community Website Resource and Education Center Notebook MPCA hosted Coordinator and Provider peer to peer meetings Monthly Coordinator peer to peer meetings Quarterly meetings for Provider/Facilitator Educational Conferences Orientation and Launch Meeting Basic Facilitation and Training Advanced Facilitation Training

27 TRAINING AND PEER SUPPORT Resource and Education Center/Notebook Coordinator Network Provider/Facilitator Network Reporting Training Basic Facilitation (two-day) Advanced Facilitation (one-day

28 SUSTAINABILITY OF GROUP MODEL Payment Reform Outcome based payments Quality incentives from HRSA HEDIS incentives Maximizing billing opportunities

29 TRANSFORMATION TO IMPROVE QUALITY & HEALTH OUTCOMES Patient Centered Medical Home Effective models of care e.g. Group visits Meaningful engagement with health care system Health literacy Healthy Moms, Babies and Families One model tested and being replicated Grace Health, Battle Creek Michigan

30 INITIATIVE OVERVIEW Increase access to care Provide education Advocate

31 1 ST VISIT-1 ST TRIMESTER Oral Health Assessment Screening Smoking Cessation Assess needs Schedule follow up with Dental Department

32 2 ND VISIT- 2 ND TRIMESTER Speak with patient in OB exam room Assess needs, schedule appointments accordingly Discuss oral concerns Assist with referrals if indicated Discuss diet and homecare during pregnancy

33 3 RD VISIT-3 RD TRIMESTER Meet with patient in OB exam room Assess needs, schedule appointments accordingly Discuss diet and homecare for infant/children Age 1 visits in coordination with well child checks Educate on transmission of disease Early dental intervention

34 4 TH VISIT- POSTPARTUM Reassess needs, schedule accordingly Dental gift- From Drool to School book, infant finger brush and toothbrush Remind patient of Age 1 visit

35 AGE 1 VISITS Pediatrics calls for hygienist Oral assessment Fluoride varnish Education Appointments as needed

36 WHO GRACE HEALTH HAS REACHED 104 pregnant patients currently in the program 343 patients have finished our program 272 patients have followed up with at least 1 appointment in our Dental Department 2,049 fillings treatment planned 578 extractions treatment planned 31 abscesses identified 41 out of 148 children age 9 months or older that have been born to our patients have already been seen for an age 1

37 CHALLENGES & SUSTAINABILITY Challenges Workforce limiting access to care Lack of awareness in medical and dental communities as well as within the general public of importance and options Continuity of care after pregnancy Health literacy in utilization of benefits and services Sustainability Payment reform including health outcomes QI incentives Scope of services optimization

38 QUESTIONS? tact Lynda Meade, MPA Director of Clinical Services Director of Michigan Quality Improvement (direct) Special thank you to the staff at Grace Health for their innovation, commitment and willingness to share their experience

39 Q & A