Apple Tree Dental Was Inspired by The Mayo Clinic... Apple Tree Dental Nuts and Bolts. Leadership Roles. Mike s Education

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1 Apple Tree Dental Nuts and Bolts Kansas City, April 25th 2015 Dr. Michael Helgeson Chief Executive Officer Mike s Education Leadership Roles Skyline High, Oakland California Majored in Physics at St. Olaf College in Northfield, Minnesota Received a B.S. and D.D.S. degrees from the University of Minnesota Two-year geriatric and special care dentistry fellowship Mini-MBA program in nonprofit management Served as past presidents of both the American Society for Geriatric Dentistry and Special Care Dentistry Association. Serves as a member of the American Dental Association s National Elder Care Advisory Committee. National Eldercare Advisory Committee (NECAC) Advancing Geriatric and Special Care Dentistry In our 30th Year! Apple Tree Dental Was Inspired by The Mayo Clinic... In Rochester, Minnesota

2 The Mayo Clinic is the oldest and largest integrated, not-for-profit group practice in the world. It began in the mid-1800 s during the Civil War. In 2012, 7,650 physicians, scientists, residents and fellows and 53,600 allied staff were working at Mayo Clinics in Minnesota, Florida and Arizona. Why Not Follow? Nonprofit structure aligns accountability with Apple Tree s mission. Apple Tree s mission is to improve the oral health of all people, including those with special access needs who face barriers to care. Board of Directors Nonprofit Mission and Governance

3 The Board of Directors Has Interdisciplinary Expertise Sets the Mission and Vision Conducts Strategic Planning Creates a Culture of Innovation A staff model builds a Team with special expertise Examples of Staff Expertise Geriatric, pediatric, public health and special care dentistry IV sedation, oral medicine, hospital dentistry Prosthodontics, oral surgery and implantology Dental education, clinical student rotations Fundraising and nonprofit development Public policy leadership and advocacy Centers for Dental Health Executive Staff Chief Executive Officer Finance and Administration Innovations Center Chief Operating Officer Chief Financial Officer Chief Innovations Officer Career Opportunity Benefits Recognition Work Environment Salary Compensation Clinical productivity Unique clinical roles Clinical quality measures Patient satisfaction ratings Educational background Teaching and research roles Contributions to mission Peer and manager reviews Employee Benefits Paid Holidays and flexible PTO program Medical and Dental Insurance - with several options Life Insurance - with options Short and Long Term Disability Insurance Flexible Benefits - for medical/dental/childcare 401(k) Retirement Plan with employer match Professional Licensure, DEA, etc reimbursements Continuing Education and more

4 Collaborative Practice Community Collaborative Practice Three-Way Organizational and Staff Partnerships Proactive vs. Passive 2 School Group Home Nursing Facility 1 Center for Dental Health Collaborating to deliver oral health services where people live, go to school, or receive other health and social services proactive prō aktiv adjective 3 On-Site Hygienist-Dentist Teams Creating or controlling a situation by causing something to happen rather than responding to it after it has happened : Apple Tree is proactive in identifying and preventing mouth infections in individuals and high risk populations. Institute of Medicine We Design Our Programs to Be... Health Care Quality Measures Proactive and patient centered Focused on prevention and outcomes Geographically distributed Collaborative and interdisciplinary Tele-health enabled 1 Safe 4 Timely 2 Effective 5 Efficient 3 Patient-Centered 6 Equitable

5 1 Safety safety ˈsāftē noun 1 the condition of being protected from or unlikely to cause danger, risk, or injury: Patient safety is increased when the dental team has broad expertise. Apple Tree s Innovations Center Dental Care Delivery Pilot Projects Clinical Dental Education Innovations Policy and Advocacy Programs Health Services Research Projects Marketing and New Program Development Collaborating Institutions Types of Students Practicing Professionals Dental Residents Dental Students Dental Hygiene Students Dental Therapy and Advanced Dental Therapy Students Dental Assisting Students Nursing Students Certified Nursing Assistants (CNA) Personal Care Assistants (PCA) Minnesota 30Years MN What s been accomplished? California Early 2015 CA NC NC Apple Tree Programs and Replications LA Louisiana 14years North Carolina 19 and 17 years

6 Six Minnesota Centers 130 Community Sites Low income children and their families Age Distribution, ,401 individual patients treated in ,943 dental visits and screenings provided Adults with disabilities Seniors and elders in long-term care Urban and rural communities Dental Care Value: 1986 to 2014 Dental Care Value totaled $20.3 Million in 2014 How Does Apple Tree Deliver Services? Hub and Spoke Clinics Oral Health and Dental Care Teams Hub Clinic: Clinic Designed for Special Care Care Coordination Center Spoke Clinics Skilled Nursing Facilities (SNF) Mental Health Campus (MH) School (K-12) Head Start (HS) etc. SNF GH AL MH Hub Clinic HS SNF K-12 AL Oral Health Team Led by the Collaborative Practice Hygienist, who uses lightweight equipment and travels in a car or minivan. Dental Care Team Led by the On-Site Dentist, it uses the Apple Tree Mobile Dental Office and includes dental therapists, hygienists, dental assistants, and others.

7 Both on-site Oral Health and Dental Care Teams are deployed School Cloud-Based Electronic Health Record Nursing Facility Cloud-Based Electronic Health Record RDH DDS CRDA DDS RDH CRDA Nursing Facility Group Home Apple Tree has entered into Phase II meaningful use with our customized EHR

8 Special Care Treatment Rooms Advanced Services IV Sedation (with Nurse Anesthetists)

9 General Anesthesia in Hospital 3 Patient-centered patient ˈpāSH$nt noun Able patient to accept is a recipient or tolerate of delays, health care problems, services: or suffering The without patient s becoming interest annoyed is the only or interest anxious: to be considered. be patient, your Dr. dentist Mayo will see you soon. Apple Tree Multi-Site Delivery Vehicle

10 How do the Mobile Offices work? 56 As a geriatrician, I know that having a healthy mouth is very important for older adults. Apple Tree s dental staff provides on- site dental care that keeps residents healthy and helps avoid traumatic mouth infections and medical complications. They are making a difference in the Rochester area. Sarah J. Crane, MD Geriatrician, Mayo Clinic Rochester, MN Apple Tree Mobile Dental Office Treatment in Wheelchairs

11 Patient Safe Handling Through their innovative use of new providers and telehealth technology, Apple Tree serves as a great example for other states exploring ways to increase access to dental care. Shelly Gehshan, Director The Pew Charitable Trusts Children s Dental Campaign Nurse A Unique Financial Model Health Plan Denture Lab Ongoing operating costs are paid with earned revenues. Responsible Party Care Coordinator Collaborative RDH A balance of earned revenues from private, public and nonprofit sources is maintained. Physician On-Site Dentist Capital to launch programs is provided by local communities, but ongoing operations are sustained by Apple Tree Revenues by Source 2014 Gross Revenues By Source Revenues Gross %Gross Net % Net Medicaid $ 17,697, % $ 9,060, % Private $ 1,997, % $ 1,785, % Veterans $ 149, % $ 109, % Insurance $ 2,200, % $ 1,768, % Veterans 1% Private 9% Insurance 10% Medicaid 80% Medicaid Private Veterans Insurance Grants & Gifts $ 1,527, % Totals $ 22,045, % $ 14,252, %

12 Insurance 12% Veterans 1% Private 13% 2014 Net Revenues (%) Grants & Gifts 11% Medicaid 64% Medicaid Private Veterans Insurance Grants & Gifts Annual Expenses Expenses % Program $ 13,218, % Management $ 924, % Fundraising $ 108, % Totals $ 14,252, % Discussion mhelgeson@appletreedental.org