Oral Health Plan Update 4/13/01 Raymond Lala, DDS
We envision a South Carolina where every child enjoys optimal oral health as part of total well-being and: <ul><li>Prevent...
National Governors’ Association <ul><li>Education and Advocacy </li></ul><ul><ul><li>Public </li></ul></ul><ul><ul><li>Non...
Education <ul><li>Children’s Oral Health Coalition </li></ul><ul><ul><li>School survey 1999-2000 </li></ul></ul><ul><ul><u...
Oral Health Promotion <ul><li>Create and disseminate OH Information </li></ul><ul><li>“Seals on wheels” education program ...
Public Awareness <ul><li>Oral Health Campaign </li></ul><ul><ul><li>Funding </li></ul></ul><ul><ul><li>Partnership </li></...
Prevention Programs <ul><li>Dental Sealants </li></ul><ul><li>Fluoride Varnish </li></ul><ul><li>Tobacco Use </li></ul><ul...
Water Fluoridation <ul><li>Presently only monitor MCL (EPA) </li></ul><ul><li>CDC monitoring system (WFRS) </li></ul><ul><...
Education of  Non-Dental Providers <ul><li>Collaboration with AHEC and MUSC </li></ul><ul><li>Regional School Nurse Confer...
Political Will <ul><li>Budget major concern </li></ul><ul><ul><li>Delayed increase in SCHIP poverty threshold </li></ul></...
Dental Provider Education <ul><li>874 of 1561 DMD’s Medicaid enrolled (56%) </li></ul><ul><li>Medicaid Provider education ...
National Governors’ Association <ul><li>Education and Advocacy </li></ul><ul><ul><li>Public </li></ul></ul><ul><ul><li>Non...
Public Health Dentistry <ul><li>Prevent and Control dental disease </li></ul><ul><li>Community as patient </li></ul><ul><l...
Dental Public Health Infrastructure <ul><li>1982-83 statewide needs assessment </li></ul><ul><li>Children receiving a prev...
Needs Assessment <ul><li>Dental disease burden </li></ul><ul><ul><li>Update 1982 assessment in fall 2001  </li></ul></ul><...
Advisory Group <ul><li>Provide community specific consultation </li></ul><ul><li>Blue Ribbon Task Force </li></ul><ul><li>...
Special Needs <ul><li>270,000 children </li></ul><ul><li>Funding – Medicaid and CSHCN </li></ul><ul><li>CSHCN </li></ul><u...
Community and Rural Health <ul><li>Community Health Center safety net </li></ul><ul><li>Only 4 CHC sites with active denta...
Partnerships <ul><li>Existing models </li></ul><ul><ul><li>Pediatric partnership model </li></ul></ul><ul><ul><li>Voluntee...
National Governors’ Association <ul><li>Education and Advocacy </li></ul><ul><ul><li>Public </li></ul></ul><ul><ul><li>Non...
Providers <ul><li>MUSC class size report </li></ul><ul><li>HRSA study (Sheps center) on SC </li></ul><ul><li>Rank 45/50 in...
Workforce Report: Policy Options <ul><li>Increase enrollment at MUSC </li></ul><ul><li>Increase pediatric dentists </li></...
Workforce Report: Target Under Served Populations <ul><li>Maintain increase in Medicaid rates </li></ul><ul><li>Reduce Med...
Medicaid <ul><li>Data </li></ul><ul><li>1.2 M children <21(1999 est.) </li></ul><ul><li>441,000 Medicaid (and CHIP) “eligi...
Medicaid  Program Improvements <ul><li>Fee increase to 75 th  percentile </li></ul><ul><li>No prior authorization </li></u...
Dental Public Health Programs (local level) <ul><li>Allendale Alive </li></ul><ul><li>Anderson/Oconee </li></ul><ul><li>Ca...
Summary <ul><li>SC recognizes oral health disparities </li></ul><ul><li>Initial steps to address </li></ul><ul><li>Budgeta...
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  1. 1. Oral Health Plan Update 4/13/01 Raymond Lala, DDS
  2. 2. We envision a South Carolina where every child enjoys optimal oral health as part of total well-being and: <ul><li>Prevention and education are priorities; </li></ul><ul><li>Treatment is available, accessible, affordable, timely, and culturally competent; </li></ul><ul><li>Responsibility is shared among parents, providers and insurers; and </li></ul><ul><li>Collaboration by government, higher education, and the private sector ensures resources, quality, and patient protection. </li></ul>
  3. 3. National Governors’ Association <ul><li>Education and Advocacy </li></ul><ul><ul><li>Public </li></ul></ul><ul><ul><li>Non-dental providers </li></ul></ul><ul><ul><li>Policy Makers </li></ul></ul><ul><ul><li>Dental Providers </li></ul></ul><ul><li>Dental Public Health Infrastructure </li></ul><ul><li>Workforce Development and Funding </li></ul>
  4. 4. Education <ul><li>Children’s Oral Health Coalition </li></ul><ul><ul><li>School survey 1999-2000 </li></ul></ul><ul><ul><ul><li>3% referred children completed treatment </li></ul></ul></ul><ul><ul><li>Oral health education </li></ul></ul><ul><ul><ul><li>44% health educators – no oral health </li></ul></ul></ul><ul><ul><li>Barriers to access </li></ul></ul><ul><ul><ul><li>Families lack money/insurance </li></ul></ul></ul><ul><ul><ul><li>Dental care low priority for family </li></ul></ul></ul><ul><ul><ul><li>Few dentists accept Medicaid </li></ul></ul></ul><ul><li>Regional School Nurse conferences </li></ul>
  5. 5. Oral Health Promotion <ul><li>Create and disseminate OH Information </li></ul><ul><li>“Seals on wheels” education program </li></ul><ul><li>Dental education task force </li></ul><ul><li>Children’s Oral Health Coalition </li></ul>
  6. 6. Public Awareness <ul><li>Oral Health Campaign </li></ul><ul><ul><li>Funding </li></ul></ul><ul><ul><li>Partnership </li></ul></ul><ul><li>Targeted Message </li></ul><ul><ul><li>Readiness to learn </li></ul></ul><ul><ul><li>Relationship to overall well being </li></ul></ul><ul><li>Prevention Programs </li></ul>
  7. 7. Prevention Programs <ul><li>Dental Sealants </li></ul><ul><li>Fluoride Varnish </li></ul><ul><li>Tobacco Use </li></ul><ul><ul><li>NSTEP </li></ul></ul><ul><ul><li>Smoking </li></ul></ul><ul><li>Child Abuse </li></ul><ul><li>and Neglect </li></ul>
  8. 8. Water Fluoridation <ul><li>Presently only monitor MCL (EPA) </li></ul><ul><li>CDC monitoring system (WFRS) </li></ul><ul><li>2000 National Fluoridation Census </li></ul><ul><li>Disseminate information to local providers </li></ul>
  9. 9. Education of Non-Dental Providers <ul><li>Collaboration with AHEC and MUSC </li></ul><ul><li>Regional School Nurse Conferences </li></ul><ul><li>Advanced Practice Nurse Conference </li></ul><ul><li>Perinatal Associations </li></ul><ul><li>Family Practice Physicians </li></ul><ul><li>Parenting Center </li></ul><ul><li>Head Start and Day Care </li></ul><ul><li>SC Primary Health Care Association </li></ul>
  10. 10. Political Will <ul><li>Budget major concern </li></ul><ul><ul><li>Delayed increase in SCHIP poverty threshold </li></ul></ul><ul><ul><li>MICH Council Eliminated </li></ul></ul><ul><li>Advocacy Groups </li></ul>
  11. 11. Dental Provider Education <ul><li>874 of 1561 DMD’s Medicaid enrolled (56%) </li></ul><ul><li>Medicaid Provider education program </li></ul><ul><ul><li>Collaboration (SCDA, DHEC, DHHS, </li></ul></ul><ul><ul><li>Family Connection) </li></ul></ul><ul><ul><li>Targets entire dental team </li></ul></ul><ul><li>Medicaid ad hoc committee </li></ul><ul><li>Collaboration with MUSC </li></ul>
  12. 12. National Governors’ Association <ul><li>Education and Advocacy </li></ul><ul><ul><li>Public </li></ul></ul><ul><ul><li>Non-dental providers </li></ul></ul><ul><ul><li>Policy Makers </li></ul></ul><ul><ul><li>Dental Providers </li></ul></ul><ul><li>Dental Public Health Infrastructure </li></ul><ul><li>Workforce Development and Funding </li></ul>
  13. 13. Public Health Dentistry <ul><li>Prevent and Control dental disease </li></ul><ul><li>Community as patient </li></ul><ul><li>Concerned with: </li></ul><ul><ul><li>Dental education of the public </li></ul></ul><ul><ul><li>Administration of group dental programs </li></ul></ul><ul><ul><li>Applied dental research </li></ul></ul><ul><ul><li>Community efforts </li></ul></ul>
  14. 14. Dental Public Health Infrastructure <ul><li>1982-83 statewide needs assessment </li></ul><ul><li>Children receiving a preventive dental service </li></ul><ul><ul><li>12% HCFA, state data (1997-8) </li></ul></ul><ul><ul><li>25% as of 6/00 – Medicaid data </li></ul></ul><ul><li>Dental disease EPSDT referrals </li></ul><ul><ul><li>44% all referrals (PSHAP, 1997-98) </li></ul></ul><ul><ul><li>32% dental referrals not completed </li></ul></ul><ul><li>DHEC initiated new statewide dental activity in June, 2000 </li></ul>
  15. 15. Needs Assessment <ul><li>Dental disease burden </li></ul><ul><ul><li>Update 1982 assessment in fall 2001 </li></ul></ul><ul><li>Human resources report from HRSA </li></ul><ul><li>Surveillance system </li></ul><ul><ul><li>BRFSS </li></ul></ul><ul><ul><li>BSS (dental screenings) </li></ul></ul><ul><ul><li>NOHSS </li></ul></ul>
  16. 16. Advisory Group <ul><li>Provide community specific consultation </li></ul><ul><li>Blue Ribbon Task Force </li></ul><ul><li>Oral Health Policy Academy Team </li></ul><ul><li>Children’s Oral Health Coalition </li></ul><ul><li>Dental Education Task Force </li></ul><ul><li>Tobacco Collaborative </li></ul>
  17. 17. Special Needs <ul><li>270,000 children </li></ul><ul><li>Funding – Medicaid and CSHCN </li></ul><ul><li>CSHCN </li></ul><ul><ul><li>Targeted population </li></ul></ul><ul><ul><ul><li>Craniofacial anomalies </li></ul></ul></ul><ul><ul><ul><li>Heart disease </li></ul></ul></ul><ul><ul><ul><li>Seizures </li></ul></ul></ul><ul><ul><li>Orthodontics </li></ul></ul><ul><li>DDSN </li></ul><ul><li>Special Olympics/Special Smiles </li></ul>
  18. 18. Community and Rural Health <ul><li>Community Health Center safety net </li></ul><ul><li>Only 4 CHC sites with active dental clinics </li></ul><ul><li>2 added to new funding requests </li></ul><ul><li>No pediatric dentists </li></ul><ul><li>Most rural health centers are physician-only offices </li></ul>
  19. 19. Partnerships <ul><li>Existing models </li></ul><ul><ul><li>Pediatric partnership model </li></ul></ul><ul><ul><li>Volunteer Clinics </li></ul></ul><ul><ul><li>Screening and referral programs </li></ul></ul><ul><li>New Models </li></ul><ul><ul><li>Commun-I-Care in Allendale </li></ul></ul><ul><ul><li>Primary Care Organizations </li></ul></ul><ul><li>Community Based Programs </li></ul>
  20. 20. National Governors’ Association <ul><li>Education and Advocacy </li></ul><ul><ul><li>Public </li></ul></ul><ul><ul><li>Non-dental providers </li></ul></ul><ul><ul><li>Policy Makers </li></ul></ul><ul><ul><li>Dental Providers </li></ul></ul><ul><li>Dental Public Health Infrastructure </li></ul><ul><li>Workforce Development and Funding </li></ul>
  21. 21. Providers <ul><li>MUSC class size report </li></ul><ul><li>HRSA study (Sheps center) on SC </li></ul><ul><li>Rank 45/50 in DMD/Pop. ratio </li></ul><ul><li>Rank 48/50 RDH/Pop. ratio </li></ul><ul><li>41/46 counties are DHPSA’s </li></ul><ul><li>Only 47 pediatric dentists for 1 M <18 years of age </li></ul>
  22. 22. Workforce Report: Policy Options <ul><li>Increase enrollment at MUSC </li></ul><ul><li>Increase pediatric dentists </li></ul><ul><ul><li>MUSC </li></ul></ul><ul><ul><li>Alternative locations </li></ul></ul><ul><li>Train general dentists in care of very young and those with special needs </li></ul><ul><li>Licensure by credentials </li></ul><ul><li>Increase in-migration of DMD’s </li></ul><ul><li>Increase RDH’s </li></ul>
  23. 23. Workforce Report: Target Under Served Populations <ul><li>Maintain increase in Medicaid rates </li></ul><ul><li>Reduce Medicaid admin. procedures </li></ul><ul><li>Increase NHSC DMD’s </li></ul><ul><li>Establish practices in Community and Public Health sites </li></ul><ul><li>Financial incentives to young DMD’s </li></ul><ul><li>Expand and strengthen volunteerism </li></ul><ul><li>Increase diversity of workforce </li></ul>
  24. 24. Medicaid <ul><li>Data </li></ul><ul><li>1.2 M children <21(1999 est.) </li></ul><ul><li>441,000 Medicaid (and CHIP) “eligible” </li></ul><ul><li>28,500 potentially “eligible” </li></ul><ul><li>35% public school students eligible </li></ul><ul><li>46% children Reduced/Free Lunch Program </li></ul><ul><li>28% any dental service FY 2000 </li></ul><ul><li>25% preventive dental service </li></ul><ul><li>Present expenditures exceed increases in access </li></ul>
  25. 25. Medicaid Program Improvements <ul><li>Fee increase to 75 th percentile </li></ul><ul><li>No prior authorization </li></ul><ul><li>ADA codes and forms standardized </li></ul><ul><li>Codes for medical and behavior management </li></ul><ul><li>Reduced required information to 8 fields </li></ul><ul><li>No provider signature required </li></ul><ul><li>“ Pay and chase” </li></ul><ul><li>Family Support Services </li></ul>
  26. 26. Dental Public Health Programs (local level) <ul><li>Allendale Alive </li></ul><ul><li>Anderson/Oconee </li></ul><ul><li>Catawba HD </li></ul><ul><li>Smiles for a Lifetime </li></ul><ul><li>Palmetto HD Partnership </li></ul><ul><li>App. III HD School project </li></ul><ul><li>MUSC </li></ul><ul><li>Commun-I-Care </li></ul><ul><li>Health Reach </li></ul><ul><li>Technical Colleges </li></ul><ul><li>Women’s Shelter </li></ul><ul><li>Vols. In Medicine </li></ul><ul><li>Religious Groups </li></ul><ul><li>Greenville Free Clinic </li></ul><ul><li>HPS School Program </li></ul>
  27. 27. Summary <ul><li>SC recognizes oral health disparities </li></ul><ul><li>Initial steps to address </li></ul><ul><li>Budgetary and programmatic challenges </li></ul><ul><li>Strategies to increase access </li></ul>

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