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State Oral Health Plan and Prevention Agenda Update

Jayanth Kumar, DDS, MPH

Director, Bureau of Dental Health

New York State Department of Health

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Framework for ComprehensiveState Oral Health Plans

Knowledge forEvidence-BasedDecision Making

What should be done?Setting Optimal National

and State Objectives:(data-driven)

What can be done?Planning Feasible Strategies

(capacity-driven)

What is achieved?Implementing

Effective Strategies(outcome-driven)

What could be done?Determining

Possible Strategies(science-driven)

Data: societal influences,current capacity,

environmental analysis

SurveillanceData: unmet

needs, serviceand data gaps

Data: provenprevention andbest processes

Data: process,outcome, impact

evaluations

Data: diseaseburden, target

populations, andimplementation

barriers

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Setting State Objectives

• Increase awareness of the importance of oral health to overall health and well-being.

• Reduce the prevalence of tooth decay.• Increase acceptance and adoption of effective preventive interventions.

• Reduce disparities in access to effective preventive and dental treatment services.

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A Framework for Public Health Action: The Health Impact Pyramid

Education & Counseling

Clinical interventions

Long lasting protective interventions

Change the context to make individual’s default decisions healthy

Socioeconomic factors

Increasing population impact

Increasing individual effort needed

Chairside guideCampaigns

Evidence-based practice

School Dental Sealant Program

Fluoridation

Insurance coverage

Prevalence of caries, untreated caries and dental sealant, 2002-04 and 2009-12. New York State 3rd Grade Survey.

Caries Experience Untreated Caries Sealant Prevalence0

10

20

30

40

50

6054.1

33

26.8

45.2

23.6

39.5

2002-2004 2009-2012

Dental insurance, fluoride tablet use and dental visit, 2002-04 and 2009-12. New York State 3rd Grade Survey

Dental Insurance Fluoride Tablets Last visit within 1 year0

10

20

30

40

50

60

70

80

90

70.8

14.7

60.5

79.8

30.8

81.3

2002-04 2009-12

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Figure 9a. Trends in tooth loss. Percentage of persons (ages 65 and older) who have lost all natural permanent teeth. New York State BRFSS, 1999 to 2010.

1999 2002 2004 2006 2008 20100

5

10

15

20

2522.5

18.516.9 17.5 17

14.7

State Target and Disparities, 2009-2012 Survey

Caries Experience0

10

20

30

40

50

60

32.5

56.1

41.5

High Income Low Income State Target

%

State Target and Disparities, 2009-2012 Survey

Untreated Caries Sealant0

10

20

30

40

50

60

14.3

43.6

31.536

21.6

50

High Income Low Income State Target

Childhood Caries in NYS: Emergency Department and Ambulatory Surgery

Facility Visits

2900

4361

4972 51225484 5683 5635

1500

Percent with at Least One Dental Visit and One Preventive Dental Visit, NYS Medicaid Program 2011

00 Y

ears

01 Y

ears

02 Y

ears

03 Y

ears

04 Y

ears

05 Y

ears

06 Y

ears

07 Y

ears

08 Y

ears

09 Y

ears

10 Y

ears

11 Y

ears

12 Y

ears

13 Y

ears

14 Y

ears

15 Y

ears

16 Y

ears

17 Y

ears

18 Y

ears

19 Y

ears

20 Y

ears

21-2

4 Yea

rs

25-3

4 Yea

rs

35-4

4 Yea

rs

45-5

4 Yea

rs

55-6

4 Yea

rs

65-7

4 Yea

rs

75-8

4 Yea

rs

85+

Years

0

10

20

30

40

50

60

Dental Visit Preventive Dental Visit

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Trends in Dental Visit in Children by Income Groups

Source: ADA

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Trends in Dental Visits

Source: ADA

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Clinical Preventive ServicesMore than half (56%) of children and adolescents did not visit the dentist during the preceding year in 2009, and 86% of children and adolescents did not receive a dental sealant or a topical fluoride application during the preceding year in 2009. More than two thirds (69%) of 5–19 year-olds did not have a dental sealant during 2005–2010 (7).

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Challenges

• Improving • public perception • utilization of effective preventive measures• Insurance coverage• diversity and flexibility of the dental workforce, & uneven

distribution of dental professionals• measurement and tracking of oral diseases, risk factors,

the dental workforce and utilization of dental services.

• Addressing the high cost of dental education and the debt burden

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GoalsGoal 1: Integrate oral health into systems, policies and programs which improve overall health.

Goal 2: Prevent oral diseases and address risk factors through evidence-based interventions.

Goal 3: Eliminate oral health disparities and improve access to high quality, comprehensive, continuous oral health services for all New Yorkers.

Goal 4: Strengthen systems which improve the oral health of people with special health needs.

Goal 5: Increase knowledge sharing statewide to enhance the adoption of best practices, replicate proven efforts, and improve community oral health literacy.

Goal 6: Increase capacity, diversity, and flexibility of the workforce to meet the needs of all New Yorkers.

Goal 7: Maintain and enhance the existing surveillance system to measure key indicators and for tracking progress.

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Strategies

• Bring together stakeholders periodically and develop a statewide agenda for action

• Explore opportunities to form regional partnerships

• Strengthen the oral health surveillance system

• Encourage educational and training programs to update competencies and standards

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People with special health needs: Objectives

• Identify successful reimbursement strategies• Increase inter-professional collaboration• Implement changes in the surveillance system to enable

data collection• Identify Centers of Excellence for providing oral health

care• Assess the number of dental providers serving people

with special health care needs• Address waiting times for appointment• Train caregivers• Develop research activities that address the oral health

issues

Prevention Agenda Goal #5: Reduce the prevalence of dental caries among NYS children.

• Objective 5-1: By December 31, 2017, reduce the prevalence of tooth decay among NYS children by at least 10%.

• Objective 5-2: By December 31, 2017, increase the proportion of NYS children who have protective dental sealants by at least 10%.

• Objective 5-3: By December 31, 2017, increase the proportion of NYS children who receive regular dental care by at least 10%.

• Objective 5-4: By December 31, 2017, increase the percentage of NYS population receiving fluoridated water by 10%.

• Objective 5-5: By December 31, 2017, strengthen systems to improve the oral health of people with special health needs.

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Surveillance & Epidemiology

State Oral Health Program

Achieving targets

Population-based Programs

Health Systems Interventions

Community-Clinical Linkages

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Fluoridation in New York StatePrevention Agenda Target 78.5%

Population served: 12.9 m (71.4%)

Fluoridating Systems: 123

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Fluoridation: Defend and Promote

• Monitoring the fluoride level

• Training • Upgrading equipment & technical assistance

• Evaluation

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Prevalence of Caries by Subgroups

NYC Lower Income ROS Lower Income0

10

20

30

40

50

60

70

41.4

61.9

2009-2012

%

The best kick-off question:Do you and your family typically drink bottled water or tap water?

Addressing common risk factors in dental offices

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School policies and programs

School dental screening School dental programs

ECC Learning Collaborative

• Partnered with DentaQuest Institute for their Phase III ECC Learning Collaborative• Enrolled four teams from WNY• Developing New York State faculty to replicate the collaborative

• Goals1. Reduce % of patients with new cavitation by 50%

2. Reduce % of patients complaining of pain by 30%

3. Reduce % of patients with referral for operating room treatment and sedation by 50%

• Ends on February 28, 2015• Planning expansion strategies

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HRSA Maternal and Child Health Initiative

• Learning Collaborative • Integration into MCH programs• Education & Training• Reimbursement for primary care

providers• Collaboration with Perinatal Networks• Community linkage• Perinatal Care Standards in Medicaid

PERFORMANCE MEASURE 12A) Percent of women who had a dental visit during pregnancy and B) Percent of infants and children, ages 1 to 6 years, who had a preventive dental visit in the last year

Policy and Guidance• Reimbursement for smoking cessation

counseling (SCC) must meet the following criteria:

• SCC must be provided face-to-face by either a dentist or by a dental hygienist that is supervised by the dentist.

• SCC must be billed by either an office-based dental practitioner or by an Article 28 clinic that employs a dentist.

• Dental practitioners can only provide individual SCC services, which must be greater than three minutes in duration, NO group sessions are allowed.

• Dental claims for SCC must include the CDT procedure code D1320 (tobacco counseling for the control and prevention of oral disease).

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Health Workforce Shortage

• Creating incentives to locate practices in shortage areas• Loan repayment• Practice support

• Innovative workforce solutions• Virtual dental home• Teledentistry

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SUMMARYState Oral Health Programs Achieve the Vision of

Healthy People in Healthy Communities• Build consensus, develop a common agenda, and mobilize for action

• Build and foster partnerships• Collaborate and promote integration • Leverage resources• Support communities• Measure progress and review policies and programs

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Thank You

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Eliminate health disparities

State Oral Health ProgramSalience

Improve the quality of life

Promote oral health as integral to overall

health

Promote optimum oral health for all

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Collecting, Analyzing & Providing Data

State Oral Health Program

Supporting communities

Education & TrainingProgram Support

Grants, Technical Assistance, Guidance

Building Partnerships, Coalitions, Networks

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Federal FundingCDC, HRSA

State Oral Health Program

Leveraging resources

State Funds Foundations

Establishing Collaborations

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People with special health needs• Objective 4.a: By 2017, identify successful reimbursement

strategies for providers and hospitals that address the additional time and resources needed to treat people with special health needs.

• Objective 4.b: By 2017, ensure that systems developed to increase interprofessional collaboration and inform consumers about dental care address the challenges faced by people with special health needs.

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• Objective 4.c: By 2017, implement changes in the surveillance system to enable data collection on oral health and access to dental care for people with special health needs.

• Objective 4.d.: By 2017, identify Centers of Excellence for providing oral health care to people with special health needs.

• Objective 4.e: By 2017, assess the number of dental providers serving people with special health care needs and determine how many are needed to serve people with special health needs.

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• Objective 4.e: By 2017, develop and implement strategies to ensure that waiting times for routine appointments are no longer than one month, and dental emergencies are addressed within 24 hours for patients with special health needs.

• Objective 4.f.: By 2020, ensure that all health care workers employed to assist people with special health care needs are trained in their daily oral health care.

• Objective 4.g: By 2017, develop research activities that address the oral health issues of people with special health care needs.