When Two Becomes One: Mark Doherty October 24, 2011 An Effective Model for Medical-Dental Integration
What do you think of when you hear: Medical-Dental Integration
???? ? ? ? ?
Communication Coordination Sharing of Information Co-located or Separate? Medical Home-Dental Home-Patient Centered Home? ...
Collaboration or Integration <ul><li>Collaboration  =  primary care and oral health working  with   one another </li></ul>...
Why Consider Collaboration/Integration? <ul><li>Dental disease and medical health problems are inter-related </li></ul><ul...
Collaboration/Integration cont. <ul><li>OH prevention and disease management is cost effective when provided in primary ca...
Predicted, dentally related, cumulative costs according to age at the first preventive visit. Savage M F et al. Pediatrics...
FQHC OH Vision <ul><li>The creation of an oral health program which provides affordable, quality managed care which docume...
Barriers to Integration/Collaboration <ul><li>Medical and Dental Professionals : </li></ul><ul><ul><li>Educated separately...
<ul><li>Time </li></ul><ul><ul><li>No time built into physician visit for the oral health component </li></ul></ul><ul><li...
<ul><li>Coordinated care service delivery models connecting oral health primary care and medical primary care lead to prom...
<ul><li>The comprehensive health care system supports dental collaborations/integration that treats the patient at the poi...
<ul><li>Integrated with the healthcare system </li></ul><ul><li>Emphasizes health promotion/disease prevention </li></ul><...
<ul><li>Effective  </li></ul><ul><li>Efficient  </li></ul><ul><li>Sustainable  </li></ul><ul><li>Equitable </li></ul><ul><...
Stepped Care <ul><li>Causes the  least disruption  in patient’s life </li></ul><ul><li>Least  extensive  care for positive...
FQHC with an OH Mandate for Care <ul><li>FQHC does not have dental </li></ul><ul><li>Separate locations  </li></ul><ul><li...
Spectrum of Integration/Collaboration  of OH & PC  Care Model Business Model Implementation Issues Examples Evidence Base ...
Continuum  Separate locations Outside referrals only CHC Pvt  Little to no communication Good communication
Continuum Co-Located No formal collaboration
Continuum Co-Located Formal collaboration Refer Discuss Warm handoffs Communicate Coordinate Formal relationship With a po...
Continuum Co-Located Partial Integration Screening Guidance CRA Fl Varnish Referral Non-dental providers providing OH serv...
More fully Integrated Model Features… <ul><li>Patient experiences oral health as a key component of a routine medical visi...
Challenges <ul><li>Education and training for PCPs  </li></ul><ul><li>Training for general dentists to treat small childre...
Cavity Risk Assessment  (CRA)
Smiles for Life
Populations of Focus <ul><li>Children 0-5 </li></ul><ul><li>All Children  </li></ul><ul><li>Pregnant women </li></ul><ul><...
Considerations for choosing a model: <ul><li>In-house alternative to care </li></ul><ul><li>Referring to oral health provi...
Outcomes <ul><li>Early Intervention </li></ul><ul><li>Prevention Invention </li></ul><ul><li>Portal to the family </li></u...
Partnering to Strengthen and Preserve  the Oral Health Safety Net   2400 Computer Drive, Westborough, MA 01581 Tel: 508-32...
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When Two Becomes One: An Effective Model for Medical Dental Integration for Ohio

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When Two Becomes One: An Effective Model for Medical Dental Integration for Ohio by Mark Doherty

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When Two Becomes One: An Effective Model for Medical Dental Integration for Ohio

  1. 1. When Two Becomes One: Mark Doherty October 24, 2011 An Effective Model for Medical-Dental Integration
  2. 2. What do you think of when you hear: Medical-Dental Integration
  3. 3. ???? ? ? ? ?
  4. 4. Communication Coordination Sharing of Information Co-located or Separate? Medical Home-Dental Home-Patient Centered Home? Treatment at the Point of Contact Collaborative Care Reverse Co-location Referrals
  5. 5. Collaboration or Integration <ul><li>Collaboration = primary care and oral health working with one another </li></ul><ul><li>Integration = oral health working within and as part of primary care or vice versa….. Provision of dental services within primary care </li></ul>
  6. 6. Why Consider Collaboration/Integration? <ul><li>Dental disease and medical health problems are inter-related </li></ul><ul><li>Safety net population has a higher level of dental disease </li></ul><ul><li>Service gap for dental disease in the safety net is huge and getting bigger! </li></ul><ul><li>OH access is enhanced when provided in primary care settings. ( Extra point of contact ) </li></ul>
  7. 7. Collaboration/Integration cont. <ul><li>OH prevention and disease management is cost effective when provided in primary care settings </li></ul><ul><li>Outcomes for children receiving preventive and disease management protocols in PC settings are good </li></ul><ul><li>One stop shopping model of care is a proven + </li></ul><ul><li>Children and pregnant women are focus groups with documented needs and are a good source of revenue. </li></ul>
  8. 8. Predicted, dentally related, cumulative costs according to age at the first preventive visit. Savage M F et al. Pediatrics 2004;114:e418-e423 ©2004 by American Academy of Pediatrics
  9. 9. FQHC OH Vision <ul><li>The creation of an oral health program which provides affordable, quality managed care which documents the improved oral health status of the patients we serve which is carried out in a financially responsible manner targeted toward sustainability. </li></ul>
  10. 10. Barriers to Integration/Collaboration <ul><li>Medical and Dental Professionals : </li></ul><ul><ul><li>Educated separately </li></ul></ul><ul><ul><li>Licensed separately </li></ul></ul><ul><ul><li>Regulated separately </li></ul></ul><ul><ul><li>Practice independently </li></ul></ul><ul><ul><li>Non-integrated benefits/insurance programs </li></ul></ul><ul><ul><li>PCPs see the mouth as the property of dentists </li></ul></ul><ul><ul><li>Sharing of information rarely occurs </li></ul></ul><ul><ul><li>Seen by the public as separate </li></ul></ul><ul><ul><li>Oral Health Training for health professionals has been sparse to non-existent </li></ul></ul>
  11. 11. <ul><li>Time </li></ul><ul><ul><li>No time built into physician visit for the oral health component </li></ul></ul><ul><li>Comfort </li></ul><ul><ul><li>Many PCPs uncomfortable with the mouth, due to lack of oral education and training </li></ul></ul><ul><ul><li>Lack of comfort with caries risk assessment, anticipatory guidance, screening </li></ul></ul><ul><li>Reimbursement </li></ul><ul><ul><li>Lack of incentive to provide dental services because PCPs do not get reimbursed for all procedures they can perform </li></ul></ul><ul><li>Referrals </li></ul><ul><ul><li>If there is no place to refer patients when a dental problem is found…. why find the problem? </li></ul></ul>Barriers to Integration/Collaboration
  12. 12. <ul><li>Coordinated care service delivery models connecting oral health primary care and medical primary care lead to promising approaches of collaboration and integration </li></ul>
  13. 13. <ul><li>The comprehensive health care system supports dental collaborations/integration that treats the patient at the point of care where the patient is most comfortable and applies a patient-centered approach to treatment </li></ul>
  14. 14. <ul><li>Integrated with the healthcare system </li></ul><ul><li>Emphasizes health promotion/disease prevention </li></ul><ul><li>Monitors population OH status and needs </li></ul><ul><li>Offers QA, CQI and cultural competency </li></ul>“ Attributes of an Ideal Oral Health System” JPHD Volume 70 Issue S1
  15. 15. <ul><li>Effective </li></ul><ul><li>Efficient </li></ul><ul><li>Sustainable </li></ul><ul><li>Equitable </li></ul><ul><li>Universal </li></ul><ul><li>Comprehensive </li></ul><ul><li>Ethical </li></ul><ul><li>Patient Centered </li></ul>“ Attributes of an Ideal Oral Health System”
  16. 16. Stepped Care <ul><li>Causes the least disruption in patient’s life </li></ul><ul><li>Least extensive care for positive results </li></ul><ul><li>Least intensive care for positive results </li></ul><ul><li>Least expensive care for positive results </li></ul>
  17. 17. FQHC with an OH Mandate for Care <ul><li>FQHC does not have dental </li></ul><ul><li>Separate locations </li></ul><ul><li>Referral: minimal to good communication </li></ul><ul><li>FQHC has Dental=co-located PC and OH </li></ul><ul><li>In-House: </li></ul><ul><ul><li>Minimal to good communication </li></ul></ul><ul><ul><li>Minimal to good collaboration </li></ul></ul><ul><ul><li>Partial Integration </li></ul></ul>
  18. 18. Spectrum of Integration/Collaboration of OH & PC Care Model Business Model Implementation Issues Examples Evidence Base Outcomes MODELS OF MEDICAL/DENTAL COLLABORATION / INTEGRATION Separate locations Co-Located Min Collaboration More Collaboration Min Collaboration Part Integrated Dental more Integrated into PC
  19. 19. Continuum Separate locations Outside referrals only CHC Pvt Little to no communication Good communication
  20. 20. Continuum Co-Located No formal collaboration
  21. 21. Continuum Co-Located Formal collaboration Refer Discuss Warm handoffs Communicate Coordinate Formal relationship With a policy
  22. 22. Continuum Co-Located Partial Integration Screening Guidance CRA Fl Varnish Referral Non-dental providers providing OH services Dental suite in Primary care
  23. 23. More fully Integrated Model Features… <ul><li>Patient experiences oral health as a key component of a routine medical visit </li></ul><ul><li>Primary care team incorporates oral health into disease management processes of delivery system; entire patient population is the target </li></ul><ul><li>Primary care team treats ordinary oral health conditions in their practice, consult with dentist if patient does not improve, refers patients with treatment needs to dentists; retains responsibility for routine care </li></ul><ul><li>For those at risk, primary care team delivers brief, focused interventions </li></ul><ul><li>Primary care team has comfort level with oral health </li></ul>
  24. 24. Challenges <ul><li>Education and training for PCPs </li></ul><ul><li>Training for general dentists to treat small children </li></ul><ul><li>Patient communication – low literacy, culturally competent education materials </li></ul><ul><li>Policy defining the process </li></ul><ul><li>Case Management system </li></ul><ul><li>Training for application of FL varnish by non-dental personnel </li></ul><ul><li>Reimbursement mechanism </li></ul><ul><li>Designated access appointments </li></ul><ul><li>Time allotment </li></ul><ul><li>CRA tool </li></ul>
  25. 25. Cavity Risk Assessment (CRA)
  26. 26. Smiles for Life
  27. 27. Populations of Focus <ul><li>Children 0-5 </li></ul><ul><li>All Children </li></ul><ul><li>Pregnant women </li></ul><ul><li>Medically compromised patients with high risk for dental problems </li></ul><ul><ul><li>Diabetics </li></ul></ul><ul><ul><li>Cardiovascular patients </li></ul></ul>
  28. 28. Considerations for choosing a model: <ul><li>In-house alternative to care </li></ul><ul><li>Referring to oral health providers that medical providers know </li></ul><ul><li>Quick access for acute oral health situations </li></ul><ul><li>Better coordination </li></ul><ul><li>Warm hand-offs and curbside consults </li></ul><ul><li>Better hands-on chronic disease management </li></ul><ul><li>More reimbursement options now (e.g. 40 states reimburse non-dental professionals for fluoride varnish applications) </li></ul>
  29. 29. Outcomes <ul><li>Early Intervention </li></ul><ul><li>Prevention Invention </li></ul><ul><li>Portal to the family </li></ul><ul><li>One stop shopping </li></ul><ul><li>> OH Literacy </li></ul><ul><li>< OH disparities </li></ul><ul><li>>OH Promotion </li></ul><ul><li>Innovative finance and service delivery </li></ul><ul><li>Drives accountability </li></ul><ul><li>Healthy People 2020 </li></ul><ul><li>Non dental professionals providing care </li></ul><ul><li>Increased access </li></ul><ul><li>Win-Win…Finance/OH </li></ul><ul><li>Improved Health </li></ul><ul><li>Reimbursement for children’s dental services </li></ul>
  30. 30. Partnering to Strengthen and Preserve the Oral Health Safety Net 2400 Computer Drive, Westborough, MA 01581 Tel: 508-329-2280 Fax: 508-329-2285 www.dentaquestinstitute.org A PROGRAM OF THE

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