implementing change in oral health policy: lessons learned stephen beetstra, dds arkansas...

Implementing Change in Implementing Change in Oral Health Policy:Oral Health Policy:

Lessons LearnedLessons LearnedStephen Beetstra, DDSStephen Beetstra, DDS

Arkansas Children’s HospitalArkansas Children’s Hospital

Implementing Change in Oral Implementing Change in Oral Health PolicyHealth Policy

Change occurs when a problem has been Change occurs when a problem has been identified and public opinion demands a identified and public opinion demands a solution.solution.

Most successful policy changes begin locally Most successful policy changes begin locally and move up through the state and federal and move up through the state and federal systems.systems.


Do your research. Come across as an expert Do your research. Come across as an expert and a resource for the policy makers. and a resource for the policy makers.

Think broadly about who the policy change Think broadly about who the policy change will effect. will effect.

Develop collaborative relationships with other Develop collaborative relationships with other organizations before pushing for a policy organizations before pushing for a policy change.change.


Inquire with local, state, and federal leaders if Inquire with local, state, and federal leaders if change is possible under the current political change is possible under the current political environment. environment.

When meeting with policy makers, discuss the When meeting with policy makers, discuss the problem, but also possible (multiple) solutionsproblem, but also possible (multiple) solutions

Come with cost estimates. Come with cost estimates. A cost benefit analysis will determine if A cost benefit analysis will determine if

changes in policy will occur.changes in policy will occur.


Strike when the iron is hot. Use current events Strike when the iron is hot. Use current events to help strengthen your position.to help strengthen your position. Demonte DriverDemonte Driver

Be prepared to defend your position Be prepared to defend your position intelligently when adversity strikes.intelligently when adversity strikes. North Little Rock ToddlerNorth Little Rock Toddler

Access IssuesAccess Issues

Dental Medicaid Fee IncreasesDental Medicaid Fee Increases ProPro

Federal MatchFederal Match Increase in non traditional practicesIncrease in non traditional practices Initial support from the dental communityInitial support from the dental community Increase in Access Increase in Access Assists in support for safety net systemAssists in support for safety net system Medicaid programs can manipulate quantity of services Medicaid programs can manipulate quantity of services

by fee schedulesby fee schedules


Cons Cons Sometimes not supported by other Health professionals Sometimes not supported by other Health professionals Viewed as a quick fix by many lawmakersViewed as a quick fix by many lawmakers Increase in non traditional practicesIncrease in non traditional practices Becomes a perceived threat to traditional dental Becomes a perceived threat to traditional dental

practices because of corporate involvementpractices because of corporate involvement Allegations of cherry picking and patient dumping Allegations of cherry picking and patient dumping

between providers and practicesbetween providers and practices Fee schedules determine what services will be providedFee schedules determine what services will be provided


Bottom Line with Medicaid Fee IncreasesBottom Line with Medicaid Fee Increases

1.1. Significant increases in preventive services for Significant increases in preventive services for patientspatients

2.2. Strengthens already established safety net providersStrengthens already established safety net providers

3.3. Slight increase in restorative and emergency Slight increase in restorative and emergency servicesservices

4.4. If already established traditional practice, chances If already established traditional practice, chances are they will not participate even with fee increase.are they will not participate even with fee increase.


Bottom Line with Medicaid Fee IncreasesBottom Line with Medicaid Fee Increases5.5. Corporate practices will develop quickly due Corporate practices will develop quickly due

to fee increasesto fee increases6.6. Cost of program will increase significantly Cost of program will increase significantly

for the Statefor the State7.7. Mobile dental practices begin to appearMobile dental practices begin to appear8.8. Due to competition for staff, pay rates Due to competition for staff, pay rates

increase for assistants, hygienists, and staff increase for assistants, hygienists, and staff dentistsdentists

Case StudiesCase Studies

Problem One: No Access For Problem One: No Access For AnyoneAnyone

Hidalgo County DemographicsHidalgo County Demographics

County Population – 7500County Population – 7500 Home of the Gray RanchHome of the Gray Ranch Sixty miles from anywhereSixty miles from anywhere Hospital Closed in the 1970’s (Hill-Burton)Hospital Closed in the 1970’s (Hill-Burton) Home to two prisoner of war camps in WWIIHome to two prisoner of war camps in WWII Current major employer is the Public SchoolsCurrent major employer is the Public Schools

Hidalgo Medical ServicesHidalgo Medical Services

Started in 1994 after no medical providers Started in 1994 after no medical providers were in the county for more than 10 years.were in the county for more than 10 years.

State and Federal Support were necessary to State and Federal Support were necessary to get program started.get program started.

Initial mission was to provide health care to an Initial mission was to provide health care to an underserved population.underserved population.

Mission drastically changed when Phelps-Mission drastically changed when Phelps-Dodge closed the smelter at Playas in 1998.Dodge closed the smelter at Playas in 1998.


Community survival and economic Community survival and economic development became the major focus of the development became the major focus of the organization.organization.

Primary Goal became economic development.Primary Goal became economic development. Second largest employer in the county.Second largest employer in the county. Largest construction project in 20 years.Largest construction project in 20 years. Used local taxes to pay for improvementsUsed local taxes to pay for improvements


ResultsResults Largest primary care provider in Southwest New Largest primary care provider in Southwest New

MexicoMexico Currently 4 dentists, 4 hygienists, 10 assistants, Currently 4 dentists, 4 hygienists, 10 assistants,

and part time orthodontistand part time orthodontist May re-open the hospital for an acute care May re-open the hospital for an acute care

inpatient facilityinpatient facility Expanded services to four other communitiesExpanded services to four other communities Was able to persuade Department of Homeland Was able to persuade Department of Homeland

Security to open training siteSecurity to open training site


Problem Two: No Access for Problem Two: No Access for Medicaid RecipientsMedicaid Recipients

BackgroundBackground

In 2000, a community leader from the Barrio In 2000, a community leader from the Barrio complained to Senator Bingaman about lack of complained to Senator Bingaman about lack of dental care for children.dental care for children.

No pediatric dentists in Eastern New Mexico.No pediatric dentists in Eastern New Mexico. Two dentists accept Medicaid. One 60 miles Two dentists accept Medicaid. One 60 miles

away, the other 100.away, the other 100. Met with local dentists about issues.Met with local dentists about issues.

BackgroundBackground

Dentist ConcernsDentist Concerns Practices at capacityPractices at capacity Lack of support staffLack of support staff High missed appointment ratesHigh missed appointment rates Unable to refer patients to specialists for complex Unable to refer patients to specialists for complex

casescases Unable to recruit dentists to communityUnable to recruit dentists to community

Roswell Dental ProjectRoswell Dental Project

Collaboration between Eastern New Mexico Collaboration between Eastern New Mexico University-Roswell, University of New University-Roswell, University of New Mexico, NM Department of Health,Chaves Mexico, NM Department of Health,Chaves County, and City of RoswellCounty, and City of Roswell

Roswell used the project to make it an All Roswell used the project to make it an All American CityAmerican City

Used creation of dental education programs at Used creation of dental education programs at all levels to increase access to underserved all levels to increase access to underserved populationspopulations


Create access and training to and from Create access and training to and from specialists for local providers.specialists for local providers.

Create hospital programCreate hospital program The Dental Van ProjectThe Dental Van Project New Facility in 2008New Facility in 2008 Residency expansion in 2009Residency expansion in 2009 Three new dentists in the community since Three new dentists in the community since

projected startedprojected started


Major Funding of the project came from Major Funding of the project came from Federal and State Governments, and W.K. Federal and State Governments, and W.K. Kellogg Foundation, Community Voices Kellogg Foundation, Community Voices ProjectProject

Barriers during projectBarriers during project DentistDentist Other Community CollegeOther Community College StaffingStaffing


Problem Three: Community Water Problem Three: Community Water FluoridationFluoridation

Henderson County StatisticsHenderson County Statistics

Population – 70,000Population – 70,000 Hendersonville City Water System – 47,000Hendersonville City Water System – 47,000 Known as the “City of Four Seasons”Known as the “City of Four Seasons” Population either affluent or poor, very small Population either affluent or poor, very small

middle classmiddle class

Fluoridation Fluoridation

Largest water system not fluoridated in North Largest water system not fluoridated in North CarolinaCarolina

Failed in the early 60’s, 70’s, and 80’s.Failed in the early 60’s, 70’s, and 80’s. Caries rates 40% higher in low income Caries rates 40% higher in low income

population than the rest of the statepopulation than the rest of the state

Fluoridation Battle of 1996Fluoridation Battle of 1996

Talked with Parents and Providers about what Talked with Parents and Providers about what I was seeing in clinicI was seeing in clinic

Talked to Community Partners to see if they Talked to Community Partners to see if they would support the initiativewould support the initiative

Called State Dental Director and Dean of the Called State Dental Director and Dean of the Dental School for AssistanceDental School for Assistance

Obtained Cost information for fluoridation Obtained Cost information for fluoridation equipmentequipment


Obtained grant information for City OfficialsObtained grant information for City Officials Met with the Mayor, and each city council Met with the Mayor, and each city council

person individuallyperson individually Was able to have issue placed on council Was able to have issue placed on council

agendaagenda


ProPro Dental AssociationDental Association Medical AssociationMedical Association School BoardSchool Board Board of HealthBoard of Health Head StartHead Start Council on AgingCouncil on Aging State AgenciesState Agencies Local NewspaperLocal Newspaper

ChurchesChurches IndustriesIndustries Chamber of CommerceChamber of Commerce Civic OrganizationsCivic Organizations


AntiAnti Henderson County Coalition to Prevent Water Henderson County Coalition to Prevent Water

FluoridationFluoridation One ChiropractorOne Chiropractor


Initial City Council MeetingInitial City Council Meeting Public Hearing in ArmoryPublic Hearing in Armory Anti-fluoridation SummitAnti-fluoridation Summit Meeting with City CouncilmenMeeting with City Councilmen ProtestsProtests

HarassmentsHarassments PicketingPicketing

VoteVote LawsuitLawsuit


AftermathAftermath Coalition membershipCoalition membership Ice stormIce storm Sealant ProgramSealant Program

Stephen Beetstra, DDSStephen Beetstra, DDS

Arkansas Children’s HospitalArkansas Children’s Hospital

[email protected]@archildrens.org

implementing change in oral health policy: lessons learned stephen beetstra, dds arkansas...

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