DENTAL ACCESS PROGRAM 1. Program Abstract In 1998 Multnomah County Health Department Dental Program began a unique public private partnership with the purpose to improve access to urgent dental care services for uninsured low-income residents in the Tri-County area around Portland, Oregon. The Dental Access Program, DAP, has as it s outcome: 1) a successful public/private partnership 2) a single point of entry for patient needs and available area resources 3) a formal dental referral program that addresses community needs and involves community resources DAP s features include: 1) one access telephone number dedicated to uninsured low-income residents with urgent dental needs 2) computerized comprehensive list of dental resources 3) recruitment and promotion of public and private sector dental access resources 4) coordination of patients and providers to assure access 2. Program Summary Community Responsiveness The Dental Access Program grew out of a local community action collaboration with public and private sector providers, institutions and stakeholders. The coalition formed was a result of a Healthy Communities Kellogg Foundation grant focusing on a broad goal to transform the way public and private groups in the Portland Metro area address and share responsibility for community improvement. As a result of early work by this initiative, a Healthy Communities Dental Access Action Team was formed. In keeping with this mandate, the Healthy Communities Dental Access Action Team sought to help individuals and organizations work together in a neutral, nonterritorial manner to improve dental access for residents of the tri-county area. This approach recognized that many factors contribute in a interconnected way to the lack of dental access in the community. The Dental Access Action Team was characterized as being: Multi-disciplinary: addressing the multiple factors that affect the oral health of communities Multi-sectorial: involving people and organizations (public and private) with varying purposes, resources, and points of view Action-oriented: moving foreword to implement specific strategies and projects
Funding for the project was unclear, however, Multnomah County Health Department Dental Division set aside funds to support start-up and implementation of the project for one year. While the Action team recognized the tremendous unmet dental needs of the under served, limited resources were available for meeting those needs. Given that reality, it was decided that the project be limited to access for urgent, episodic treatment only. It was the hope of the Action Team that in the future, if this model proved successful and sustainable, that more comprehensive dental services could be provided. This model addresses access for acute dental infection, pain and trauma. Innovation/Collaboration/Integration The Dental Access Team developed the protocols and policies for the DAP program by identifying barriers to access shared by private dentists. The Dental Access Program has the following features: * A single point of entry one telephone number available during business hours for clients and providers. Coordinator * A coordinator to work with patients and providers to: - maintain a computerized updated list of access providers and clinics (including information of available number of referrals, times and provider restrictions) - track referrals and services delivered by providers - screen and quality clients - refer qualified clients to willing providers for appointments (referral to include client financial information, dental problem and brief medical history) - recruit and work with public and private sector providers, including clinics, organizations and private practitioners - coordinate project marketing efforts to form a broad based network of providers and resources (promotion and marketing efforts for this project will include the help of PR staff or agency) - educate patients and providers about the guidelines, policies and protocols of the project, including the value of the services provided - insure adherence to project policies and guidelines * The coordinator is the contact person for both the patient, provider and provider staff, including questions, concerns and problems.
DAP has the following patient responsibilities: * Patients will be required to pay for a portion of the services that they receive. It was recommended that a flat fee of $25 be implemented by all providers. * Patients are required to attend scheduled appointments. Missed appointments would result in the patients losing eligibility for future appointments under this program. * Patients are required to arrive at their appointments on time. Late arrival for appointments may result in the patient losing eligibility for future appointments under this program. * Patients must not have dental insurance coverage, including Medicaid to be eligible for this program. * Patients must live in households that are below 200% of the poverty level to be eligible for this program. DAP employs the following provider responsibilities and incentives: Provider participation is key to the success of this program. Broad based participation insures that no one provider be inundated with requests for delivering care. The project is designed to address many of the issues raised by providers who volunteer to treat low income patients and to recruit large numbers of volunteer dentists and hygienists for participation. Providers will be given a number of options for voluntary participation in this program, including seeing clients in their offices or volunteering to work with several non-profits who deliver dental services to this population. Incentives will be built into the project, to help expand the provider list to include those who have not previously volunteered. It is recommended that those dentist s who choose to participate by seeing referrals in their own offices, accept one patient per month. Additionally, volunteer opportunities are made available for dental providers for evening clinics in Multnomah County Health Department Dental sites. * Providers will be responsible for delivering episodic urgent services only, to the patient. Routine care for the patient is not a requirement, however dentists interested in delivering routine care to clients, in addition to their presenting urgent need, may elect to do so. * Providers will be responsible for delivering post-op care for the services they deliver under this program only. * Providers will predetermine the number of patients they are willing to access under this program.
* Providers will be able to predetermine the services that they are willing to provide patients under this program. * Providers will be able to refer back to the program, patients who need procedures that the provider is not comfortable performing. * Providers will be able refer difficult patients back to the program. * Non-English speaking patients referred to providers will include an on-site interpreter provided by the program. * Providers will receive $25, from the program, for each patient who does not arrive for a scheduled appointment. * Providers will be able to attend continuing education sessions and receive a credit free of charge. * Providers will provide the program encounter information after delivery of services. The program has the following responsibilities: * The program is promoted through component dental societies, private and public sector dental organizations, including managed care and group practices. Provider s are given several options from which they may choose to participate. These would include volunteering in one of several non-profit clinics or accepting patients in their own offices. * The program is evaluated by tracking the number of successful referrals, including specific data on services delivered (this is important to justify current and future funding opportunities). * The program promotes the project to the media, insuring positive acknowledgment of the cooperative efforts of organized dentistry, private sector providers, government, and other non-profit organizations. * The program provides volunteer dentists with ongoing information about the program, including education and tips on delivery of urgency care to low income uninsured patients. Please see attachments DAP AT-A-GLANCE, PATIENT GUIDELINES, DENTIST RESPONSIBILITIES and TRI-COUNTY DENTAL ACCESS PROJECT.
The Health Communities Dental Access Action Team faced a number of obstacles in planning for implementation of DAP. They included: 1) promoting DAP to potential volunteers 2) endorsement from local dental societies 3) funding the project 4) legal issues with abandonment of care 5) lack of understanding of the need and general community awareness These obstacles were addressed using an action plan that included marketing strategies and other tactics. See attachment HURDLES/CHALLENGES. Community data and needs assessments information were used as well. See attachments DENTAL CALLS and VISITS, URGENT DENTAL CARE SERVICES FOR THE UNINSURED and RESOURCES FOR URGENT CARE FOR LOW INCOME UNINSURED. Outcomes Prior to implementation of DAP, 23% of calls to the Tri-County SafeNet program were for dental needs. A survey showed that local dental programs were turning away nearly 100 low income uninsured patient calls per day who were in need of urgent care services. After implementation of DAP all dental calls were referred to the DAP hot line. Currently the hot line receives an average of 950 total per month which include requests for all categories of dental services. About 300 per month of those calls are for urgent needs. Appointments are found for all about 250 of those calling and 50 are turned away. About 40 of these appointments are with private practitioners. See attachment DAP MONTHLY REPORT FROM 01/02 09/02. DAP estimates that about $75,000 of dental services are delivered per year to patients. DAP receives many responses from patients who use DAP. Two examples are attached, SOME CLIENT FEEDBACK... Replication/Sustainability/Administrative Effectiveness DAP is replicable in communities large and small. Collaboration with the private sector and area agencies and advocacy groups is key. Good needs data is to document the problem is essential. Buy-in from the private sector is crucial. As mentioned earlier the barriers include: 1) lack of understanding of need in the community 2) attitudes of dentists 3) perception of the project
4) legal issues around abandonment of care if the program limits services to urgent needs 5) general community awareness The DAP program began with 1 full time coordinator who was responsible for all aspects of the program, from recruiting to appointment making. Cuts in funds have reduced that person to 4 days per week. The need for staffing of a DAP program would depend on the size of the community. In a small community a clinic dental receptionists could most likely accomplish the tasks with no need for additional staffing.