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Minnesota Oral Health Promotion Minnesota Oral Health Promotion Coalition Meeting Coalition Meeting
Coalitions 2.0Coalitions 2.0Considerations for a RoadmapConsiderations for a Roadmap
Reg Louie, DDS, MPH
St. Paul, MinnesotaJune 12, 2009
Presentation OverviewPresentation Overview Minnesota Oral Health Summit – Minnesota Oral Health Summit –
Visions for Oral Health (2009)Visions for Oral Health (2009)
Changing Paradigms in Oral HealthChanging Paradigms in Oral Health
State Oral Health Models from CDC and State Oral Health Models from CDC and other Oral Health Coalitionsother Oral Health Coalitions
Tools from ASTDDTools from ASTDD
State Promising PracticesState Promising Practices
MOH Landscape SWOT MOH Landscape SWOT Roadmap to the Roadmap to the Future Future
Minnesota OH Summit 2009 Minnesota OH Summit 2009
Minnesota Oral Health SummitMinnesota Oral Health Summit --
Oral Health Vision for the Future – 5 topic Oral Health Vision for the Future – 5 topic groupsgroups:: Prevention, Education, AwarenessPrevention, Education, Awareness Policy and FundingPolicy and Funding Access to CareAccess to Care Workforce DevelopmentWorkforce Development Bridging Private/Public SectorsBridging Private/Public Sectors
-- 3 Oral Health Visions 3 Oral Health Visions
for the Futurefor the Future
Changing Paradigms Changing Paradigms for Controlling Dental Cariesfor Controlling Dental Caries
Old Paradigm --> Surgical / ‘Drill & Fill’Old Paradigm --> Surgical / ‘Drill & Fill’(dealing with consequences of disease) (dealing with consequences of disease)
Later Paradigm: Prevention!!!Later Paradigm: Prevention!!!
(generally “one size fits all”)(generally “one size fits all”)
““Current” Paradigm: Early Intervention, Risk Current” Paradigm: Early Intervention, Risk Assessment, Anticipatory Guidance, Assessment, Anticipatory Guidance,
Individualized Prevention and Disease Individualized Prevention and Disease ManagementManagement
(targeted, systematic, evidence-based approaches)(targeted, systematic, evidence-based approaches)
Slide courtesy of Jim Crall
Rethinking Prevention:Rethinking Prevention:Broad Strategies / GoalsBroad Strategies / Goals
Reduce the burden of disease Reduce the burden of disease through the efficient integration of:through the efficient integration of: Health promotionHealth promotion Preventive servicesPreventive services Disease managementDisease management Treatment servicesTreatment services
Expand access to ongoing Expand access to ongoing diagnostic, preventive and treatment diagnostic, preventive and treatment services in “dental homes”services in “dental homes”
Application of risk assessment and Application of risk assessment and targeted, evidence-based targeted, evidence-based interventionsinterventions
Crall JJ. Ped Dent 2006;28:96-101.
Slide courtesy of Jim Crall
Minnesota Minnesota Head Start PIR DataHead Start PIR Data
2006-072006-07CHILDREN SERVED 15,709 -CHILDREN SERVED 15,709 - MNMN USUS
With health insurance With health insurance 89% (93%)89% (93%)
““Dental home” Dental home” 83% (86%)83% (86%)
PS*PS* Dental exam Dental exam 85% (88%)85% (88%)
PS*PS* Preventive care Preventive care 89% (85%)89% (85%)
PS* Needing treatment PS* Needing treatment 28% (25%)28% (25%)
PS*PS* Receiving treatmentReceiving treatment 84% 84% (83%)(83%)
* Preschool Head Start Children Only* Preschool Head Start Children Only
Minnesota Oral Health PIR Trends – Minnesota Oral Health PIR Trends – Percent of Head Start Children Percent of Head Start Children
(2004-07) (2004-07)
20042004 20052005 20062006 20072007Health insurance Health insurance 87% 87%87% 87% 88%88% 89% 89%““Dental Home” Dental Home” 73%73% 73% 73% 79%79% 83% 83%
HS Preschool (3 to 5-years)HS Preschool (3 to 5-years)
Dental Exam Dental Exam 63%63% 65% 65% 74%74% 85% 85%Prevent. Care Prevent. Care 44% 69%44% 69% 90%90% 89% 89%Need TxNeed Tx 20%20% 32% 32% 28%28% 26% 26%Received Tx Received Tx 70% 79%70% 79% 83%83% 84% 84%
Minnesota Early Head Minnesota Early Head Start PIR Data (2006-07)Start PIR Data (2006-07)
INFANTS/TODDLERS (Birth to 3 years)INFANTS/TODDLERS (Birth to 3 years) Dental screenings at well-baby exams –Dental screenings at well-baby exams – 80% (68%)80% (68%) Professional dental exams – Professional dental exams – 47% (54%)47% (54%)
PREGNANT WOMEN/TEENSPREGNANT WOMEN/TEENS With health insurance – With health insurance – 95% (89%) 95% (89%) Receiving dental exams or Treatment – Receiving dental exams or Treatment – 42% (42%)42% (42%)
CDC – Oral Health Infrastructure CDC – Oral Health Infrastructure Development Cooperative Development Cooperative
AgreementsAgreements 2003-2008: 23 projects funded (12 2003-2008: 23 projects funded (12
States and 1 Pacific jurisdiction)States and 1 Pacific jurisdiction)
16 States funded in 200816 States funded in 2008
8 specific/required areas of 8 specific/required areas of program focus (“recipient program focus (“recipient activities”)activities”)
CDC – OH Infrastructure Development CDC – OH Infrastructure Development Cooperative Agreements (2008-13)Cooperative Agreements (2008-13)
Eight Recipient ActivitiesEight Recipient Activities
1.1. Program Infrastructure: Staffing, Program Infrastructure: Staffing, management and supportmanagement and support
2.2. Data collection and surveillanceData collection and surveillance
3.3. Strategic Planning – State OH PlanStrategic Planning – State OH Plan
4.4. Partnerships and coalitionsPartnerships and coalitions
5.5. Access to and utilization of preventive Access to and utilization of preventive interventionsinterventions
6.6. Policy developmentPolicy development
7.7. EvaluationEvaluation
8.8. Program collaborationProgram collaboration
What is a Coalition?What is a Coalition?
Definition: a group of individuals and/or Definition: a group of individuals and/or organizations with common interest who agree organizations with common interest who agree to work together toward a common goalto work together toward a common goal
Coalitions may be loose associations in which Coalitions may be loose associations in which members work for short time to achieve a members work for short time to achieve a specific goal; and then disband, or they may specific goal; and then disband, or they may also become organizations in themselves, with also become organizations in themselves, with governing bodies, particular community governing bodies, particular community responsibilities, funding and permanenceresponsibilities, funding and permanence
Regardless of their size and structure, they exist Regardless of their size and structure, they exist to create and/or support efforts to reach a to create and/or support efforts to reach a particular set of goalsparticular set of goals Slide courtesy of Teresa Schwab 1/09
Goals of a CoalitionGoals of a CoalitionCoalition goals are as Coalition goals are as
varied as coalitions varied as coalitions themselves, but often themselves, but often contain elements of one contain elements of one or more of the following: or more of the following:
Influencing or Influencing or developing public policy, developing public policy, usually around a specific usually around a specific issue.issue.
Changing people's Changing people's behavior.behavior.
Building a healthy Building a healthy community. community. Slide courtesy of Teresa Schwab
1/09
Why Develop a Coaliltion?Why Develop a Coaliltion? Concentrate the Concentrate the
community's focus on community's focus on a particular problem.a particular problem.
Create alliances Create alliances among those who among those who might not normally might not normally work together.work together.
Keep the Keep the community's community's approach to issues approach to issues consistent.consistent.
Slide courtesy of Teresa Schwab 1/09
ASTDD- Infrastructure ASTDD- Infrastructure Development ToolsDevelopment Tools
Surveillance MethodologiesSurveillance Methodologies Policy and Systems StrategiesPolicy and Systems Strategies Best Practices ModelsBest Practices Models
Policy: Coalitions, Oral Health Plans, Policy: Coalitions, Oral Health Plans, MandatesMandates
State OH Program Review ManualState OH Program Review Manual Core functions, competencies and Core functions, competencies and
activitiesactivities http://http://www.astdd.org/index.phpwww.astdd.org/index.php
State &Territorial State &Territorial Dental Public Health ActivitiesDental Public Health Activities
Best Practice ApproachesBest Practice Approaches
State Promising PracticesState Promising Practices
Infrastructure Development (including Infrastructure Development (including coalitions)-Nevada and other CDC coalitions)-Nevada and other CDC funded states – AK, CO, AR, IL, SC, TXfunded states – AK, CO, AR, IL, SC, TX
Kansas – Philanthropic funded coalition Kansas – Philanthropic funded coalition and state Oral Health initiativeand state Oral Health initiative
Massachusetts – Special legislative Massachusetts – Special legislative commission on Oral Healthcommission on Oral Health
New Mexico – Tax considerations for New Mexico – Tax considerations for dentists dentists
State Promising Practices (2)State Promising Practices (2)
State Oral Health Plans (NV, ME, IL, KS)State Oral Health Plans (NV, ME, IL, KS) Statutory Mandate for State Oral Statutory Mandate for State Oral
Health Program (some w/ definitions Health Program (some w/ definitions for state dental director or dental for state dental director or dental officer) - Iowaofficer) - Iowa
Maryland – Dental Action Committee Maryland – Dental Action Committee convened by Secretary of HMH in convened by Secretary of HMH in response to Deamonte Driver; state response to Deamonte Driver; state funding for infrastructure and funding for infrastructure and increasing accessincreasing access
Statewide Efforts to Expand Statewide Efforts to Expand Access to Care for Young Access to Care for Young
ChildrenChildren Washington ABCD ProgramWashington ABCD Program
Training for general dentists to treat very young Training for general dentists to treat very young childrenchildren
Enhanced reimbursement (XIX) Enhanced reimbursement (XIX) North Carolina “North Carolina “Into the Mouths of Into the Mouths of
BabesBabes”” Prevent ECE by reimbursing peds, FPs, CHCs for Px Prevent ECE by reimbursing peds, FPs, CHCs for Px
and referrals for dental careand referrals for dental care Partners: NCAP, NCAFP, NCDS, NCAPD, UNC, NCDM, Partners: NCAP, NCAFP, NCDS, NCAPD, UNC, NCDM,
NCDPHNCDPH California First 5 InitiativeCalifornia First 5 Initiative
Training for general dentistsTraining for general dentists Training for primary care providersTraining for primary care providers
Nevada State Oral HealthNevada State Oral Health
19991999 – Report of Governor’s Advisory Board – Report of Governor’s Advisory Board(rec’ds, redirect MCH Title V grant)(rec’ds, redirect MCH Title V grant)
20022002 – CDC Grant, Series of Regional Summits – CDC Grant, Series of Regional Summits (formed coalitions)(formed coalitions)
20042004 – Summit 2.0, More representative state – Summit 2.0, More representative state OH OH plan keyed to HP2010/SG OH Reportplan keyed to HP2010/SG OH Report
20052005 – Summit 3.0, special focus on non- – Summit 3.0, special focus on non-urban urban areas/regional plansareas/regional plans
20082008 – Evaluation and Summit 4.0 re: 2004 – Evaluation and Summit 4.0 re: 2004 plan, plan, 4 policy work groups : change 4 policy work groups : change perceptions perceptions & increase awareness; & increase awareness; expand prevention; expand prevention; improve access; improve access; assure dental workforce; assure dental workforce; and, renewal of and, renewal of competitive CDC grantcompetitive CDC grant
Oral Health Kansas Oral Health Kansas SponsorsSponsors
Blue Cross and Blue Shield of Kansas Blue Cross and Blue Shield of Kansas Foundation Foundation Delta Dental Plan of Kansas Foundation Delta Dental Plan of Kansas Foundation Health Care Foundation of Greater Kansas CityHealth Care Foundation of Greater Kansas CityKansas Council on Developmental DisabilitiesKansas Council on Developmental DisabilitiesKansas Dental AssociationKansas Dental AssociationKansas Dental Charitable Foundation Kansas Dental Charitable Foundation Kansas Health FoundationKansas Health FoundationKansas State Office of Oral HealthKansas State Office of Oral HealthSunflower FoundationSunflower FoundationThe REACH Health Care Foundation The REACH Health Care Foundation United Methodist Health Ministry Fund United Methodist Health Ministry Fund
Framework for South Carolina Framework for South Carolina More Smiling Faces ProjectMore Smiling Faces Project
Integrated Network:Integrated Network:• Dental • Medical• CHCs• Churches/Faith Groups • School/Preschool • Programs
Community Education:Community Education:Consistent OH MessagesConsistent OH Messages
Pediatric OHPediatric OHTraining: Training: • Medical providers• Dental providers
Outreach to Medical Home: Outreach to Medical Home: Integrate OH promotion and diseaseprevention into the medical home
System Linkage:System Linkage:• Patient navigator links• Link medical homes
with dental providers• Link patients to
resources• Screen for Medicaid or
insurance eligibility• Arrange transportation
for target population
Local Local Advisory Advisory
CommitteeCommittee
Combining Resources for Improved Oral Health for Children
Slide courtesy of Christine Veschusio
STATE
Adjustments Made to Medicaid
Rates (Market-based
Benchmarks)
Changes in Dentists’ Participation in
Medicaid Following Rate Increases
Intervals (mos.) Between Rate Increases and
Changes in Provider
Participation
Alabama 100% of Blue Cross rates
+39% 24
Delaware 85% of each dentist’s submitted charges
From 1 private dentist to 108
(of 302 licensed dentists)48
Georgia 75th percentile of dentists’ fees
+546% (to 1,674 of 4,000)
27
Indiana 75th percentile of dentists’ fees
+58% 54
Michigan (Healthy Kids
Dental Program)
100% of Delta Dental Premier rates
+300% 12
South Carolina 75th percentile of dentists’ fees
+73% 36
Tennessee 75th percentile of dentists’ fees
+60% 4
Virginia 30% increase >+30% 12
State Medicaid Dental Program Changes State Medicaid Dental Program Changes (2007)(2007)
Minnesota Oral Health Minnesota Oral Health Landscape – SWOT AnalysisLandscape – SWOT Analysis
Strengths Strengths
Efforts of stakeholders and Efforts of stakeholders and partners convening to partners convening to proactively define and proactively define and address issues affecting oral address issues affecting oral health in Minnesotahealth in Minnesota
SWOTSWOTWeaknessesWeaknesses
The extent of the access The extent of the access problem and continuing/growing problem and continuing/growing reservoir of needreservoir of need
Emerging SOHP and no broad Emerging SOHP and no broad based, cohesive state oral based, cohesive state oral health advocacy entity and health advocacy entity and need to define future pathneed to define future path
SWOTSWOT“Threats” or Challenges“Threats” or Challenges
A very challenging state economy A very challenging state economy and infrastructure constraintsand infrastructure constraints
Provider issues, including aging Provider issues, including aging cohort and inadequate cohort and inadequate replacementsreplacements
Distribution of workforce vs. Distribution of workforce vs. population population
Growing diversity of populationGrowing diversity of population
SWOTSWOTOpportunitiesOpportunities
New five-year CDC grant to Minnesota New five-year CDC grant to Minnesota Department of Health for Oral Health Department of Health for Oral Health Infrastructure Enhancement and Program Infrastructure Enhancement and Program ImprovementImprovement
Build on the commitment and hard work Build on the commitment and hard work of key stakeholders to deploy new of key stakeholders to deploy new strategies and to enhance existing ones strategies and to enhance existing ones to address the issues in oral healthto address the issues in oral health
New provider models to enhance accessNew provider models to enhance access Broaden the circle of partners and Broaden the circle of partners and
cultivate consensus “agenda”cultivate consensus “agenda”
SWOT … then what?SWOT … then what?
SWOTSWOT(systematic assessment) (systematic assessment)
PrioritiesPriorities
(importance/impact vs. changeability)(importance/impact vs. changeability)
Goals, Objectives, OutcomesGoals, Objectives, Outcomes(process and effect, time-framed, measurable, realistic) (process and effect, time-framed, measurable, realistic)
Action Steps, Activities, ResourcesAction Steps, Activities, Resources
(intentional actions and implementer)(intentional actions and implementer)
Evaluation Evaluation
Active Coalition + Partnerships and Active Coalition + Partnerships and Collaborations Collaborations
= More Direct Path to Improved Oral = More Direct Path to Improved Oral Health Health
for the People of Minnesotafor the People of Minnesota
Thank you!Thank [email protected]@sbcglobal.net