Mark Doherty, DMD, MPH, CCHP Executive Director of DentaQuest Institute s Safety Net Solutions Program
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1 Tamig the Frotier: Brigig Oral Health ito Rural Health Mark Doherty, DMD, MPH, CCHP Executive Director of DetaQuest Istitute s Safety Net Solutios Program Amy Brock Marti, DrPH Deputy Director & Research Associate Professor, USC Graham Adams, PhD CEO of SC Office of Rural Health South Carolia Rural Health Research Ceter
2 Presetatio Objectives Discuss how DetaQuest Istitute s Safety Net Solutios Program addresses the IOM Report (Crossig the Quality Chasm) for vulerable populatio servig practitioers. Describe why rural is a disparate populatio for oral health. Discuss how State Offices of Rural Health ca be leveraged as a importat state ad atioal parter i addressig rural oral health disparities. Describe South Carolia s proof of cocept with the DetaQuest Istitute i stregtheig rural safety et systems ad itegratig oral health competecies ito primary care ad home visitatio iitiatives. South Carolia Rural Health Research Ceter
3 South Carolia & DetaQuest Istitute`s Safety Net Solutios (SNS) Program HRSA Oral Health Workforce Grat SCORH ewly established Detal Recruitmet & Retetio Program Safety Net Solutios Practice Maagemet Techical Assistace Model DetaQuest Istitute`s Itegratio Cocept ad Support Model South Carolia Rural Health Research Ceter
4 BIG PICTURE Providig safety et services that fulfills the call to actio from Crossig the Quality Chasm report from IOM (2002) u Safe u Effective u Efficiet u Timely u Patiet-cetered u Equitable South Carolia Rural Health Research Ceter
5 Safety Net Solutios Focus Idividual Techical Assistace to 18 Rural Health Practices over 3 Years SNS/DQI Itegratio of OH ito Primary Care Oral Health Safety Net Recruitmet ad Retetio i Rural Areas. MUSC Practice Maagemet Semiar Series DetaQuest Istitute`s O-Lie Learig Ceter ad O-Lie Educatioal Curriculum
6 The Safety Net Solutios Process 1 Practice Aalysis Practice Maagemet Data Survey Key Practice Data 2 Fidigs ad Discussios Presetatio Educatio Strategy 3 Ehacemet Pla Actio steps Roadmap Foudatio 4 Supported Implemetatio Coachig Guidace Motivatio Site Visit
7 Why Itegrate? THE COMPREHENSIVE HEALTH CARE SYSTEM SUPPORTS DENTAL INTEGRATION/COLLABORATIONS THAT TREATS THE PATIENT AT THE POINT OF CARE WHERE THE PATIENT IS MOST COMFORTABLE AND APPLIES A PATIENT- CENTERED APPROACH TO TREATMENT.
8 Patiet Cetered Health Home: Oe Defiitio Patiet Cetered: Care that is respectful of ad resposive to idividual patiet prefereces, eeds ad values. Health Home: A approach to providig primary care where idividuals receive itegrated, comprehesive medical, detal ad metal health care that is focused o prevetio ad early itervetio.
9 Commuicatio Coordiatio Collaborative Care Sharig of Iformatio Referrals Collocated or Separate? Architecture Medical Home-Detal Home-Patiet Cetered Health Home? Reverse Collocatio Treatmet at the Poit of Cotact Comprehesive Care
10 Whe OH Prevetio ad Early Itervetio Become Part of Routie Primary Care Commuicatio Sigle poit of Cotact Coordiatio Patiet Cetered Care Policies PCHH Referral Process Collocated/Stad Aloe Formal Relatioship Reverse Collocatio Sharig of Iformatio Comprehesive Care Collaborative Care Coordiated Care
11 Triple Aim Improve Health Outcomes Lower Health Care Costs Improve Health Care Quality
12 Collaboratio or Itegratio Collaboratio = primary care ad oral health workig with oe aother Itegratio = oral health workig withi ad as part of primary care or vice versa..provisio of detal services withi primary care
13 More fully Itegrated Model Features Patiet experieces oral health as a key compoet of a routie primary care visit Primary care team icorporates oral health ito disease maagemet processes of delivery system; etire patiet populatio is the target Primary care team treats ordiary oral health coditios i their practice, cosult with detist if patiet does ot improve, refers patiets with treatmet eeds to detists; retais resposibility for routie care For those at risk, primary care team delivers brief, focused itervetios Primary care team has comfort level with oral health
14 Meu Compoets: Caries Risk Assessmet EMR/EDR Iterface OH Screeig Aticipatory Guidace Tools/Behavior Chage The Fl varish piece Referral Process Case/Care Maagemet Warm-hadoffs Curbside Cosults Desigated Access Appoitmets O-Site OH Service
15 DetaQuest Istitute Olie Learig Ceter
16 Rural Picture How do these evidece-based priciples traslate ito rural practice ad what are the uaces to cosider? South Carolia Rural Health Research Ceter
17 What is rural? Maps from the USDA Ecoomic Research Service Atlas of Rural ad Small-Tow America Joh Cromartie South Carolia Rural Health Research Ceter
18 What is rural? No-metropolita, 2013 South Carolia Rural Health Research Ceter
19 What is rural? Rural-Urba Cotiuum Codes, 2013 South Carolia Rural Health Research Ceter
20 What is rural? Urba Ifluece Codes, 2013 South Carolia Rural Health Research Ceter
21 Rural & Race Percet Populatio Africa America South Carolia Rural Health Research Ceter
22 Rural & Race Percet Populatio Hispaic South Carolia Rural Health Research Ceter
23 Rural & High Poverty Couties South Carolia Rural Health Research Ceter
24 Rural & Persistet Poverty ( ) South Carolia Rural Health Research Ceter
25 Rural & Child Poverty (0-17), 2012 South Carolia Rural Health Research Ceter
26 Rural Oral Health Disparities Quatifyig rural disparities through atioal surveillace has challeges but we kow from may sources (sythesized i the IOM Report, Improvig Access to Oral Health Care for Vulerable ad Uderserved Populatios) u There is less access u Less detal isurace coverage u Less use of public water systems South Carolia Rural Health Research Ceter
27 Oral Health Disparities amog Kids US Rural less likely to have: teeth i excellet coditio ay detal visits i the precedig year prevetive detal care i the precedig year detal isurace South Carolia Rural Health Research Ceter
28 Why the rural disparities Explaied with Aderso Behavioral Health Model South Carolia Rural Health Research Ceter
29 Persistet Whole Couty Detal Health Professioal Shortage Areas, South Carolia Rural Health Research Ceter
30 Pey saved is a pey eared I the rural safety et, however, ot all peies are created equally as we kow from Medicaid reimbursemet of fluoride varish South Carolia Rural Health Research Ceter
31 South Carolia Rural Health Research Ceter
32 South Carolia Rural Health Research Ceter
33 South Carolia Rural Health Research Ceter
34 Poor aligmet of reimbursemet & risk Highest risk kids i rural are see i FQHCs ad RHCs For may states, FV reimbursemet is ot properly aliged South Carolia Rural Health Research Ceter
35 State Offices of Rural Health Positioed for parterships i leveragig chage for rural commuities. South Carolia Rural Health Research Ceter
36 State Offices of Rural Health What are they? How are they fuded? What is their purpose? South Carolia Rural Health Research Ceter
37
38 Natioal SORH Advocacy NOSORH NRHA ORHP South Carolia Rural Health Research Ceter
39 Their role i addressig rural health disparities Improvig practice Policy developmet, advocacy, or implemetatio Systems ad etwork developmet Provider recruitmet & retetio South Carolia Rural Health Research Ceter
40 SORHs Ivolved i Oral Health Natioal Network for Oral Health Access with NOSORH coducted survey of SORHs to ascertai their ivolvemet i oral health. 48 of 50 SORHs respoded: u 76% were actively workig o oral health issues u 51% are egaged i etwork developmet u Examples of issues: telehealth with detal schools; Medicaid policy; recruitmet/retetio efforts; techical assistace with billig u 70% collaboratig with state oral health programs South Carolia Rural Health Research Ceter
41 Proof of Cocept (i developmet) Through a empowered State Office of Rural Health ad its etwork of parters, we will reduce rural oral health disparities through medical-detal itegratio that emphasizes improvemets i prevetive care ad system performace. South Carolia Rural Health Research Ceter
42 Goals of Cocept Goal 1 Prevet oral disease amog kids at risk for early childhood caries Goal 2 Reduce oral disease burde amog high-risk adults (Special emphasis o periatal) Goal 3 Improve access i resource-thi commuities leveragig existig ad iovative parterships/solutios (e.g. NHSC, FQHC oral health program expasio, residecies, telehealth) Goal 4 Ehace practice maagemet competecies that optimizes efficiecies ad creates capacity. South Carolia Rural Health Research Ceter
43 South Carolia Rural Health Research Ceter
44 Cocept Developmet Phase Assess iterest, capacity, skills of SORHs, possibly from NOSORH/NNOHA states list makig sure we have represetatio of the various SORP models. Egage SORHs i defiig the cocept ad evaluatio metrics (possibly usig PRECEDE PROCEED as a facilitatig framework) DetaQuest Istitute`s Safety Net Solutios provides orietatio, ad ogoig techical assistace. South Carolia Rural Health Research Ceter
45 Demostratio Phase Rural system capacity assessmet This would iclude a cesus of touch poits or providers, as well as competecies for detal & o-detal professioals with rural health etworks System Performace Improvemet Pla Use the IHI Breakthrough Series model to iform a system performace improvemet pla to improve oral health i the cotext of the Triple Aim. Traiig o IHI- BTS would be eeded but could be used i the cotext of SORH expertise areas such as patiet cetered-medical homes, QI collaboratives, etc. The pla should aswer questios such as: u u u u What are the quality idicators worthy of examiig? How do we create chage? What should the diffusio of iovatio look like? What metrics do we examie; what is success? South Carolia Rural Health Research Ceter
46 Replicatio Phase/Sustaiability Develop busiess plas that reflect the diversity of SORH oral health programs (e.g. recruitmet/retetio of providers, cotiuig educatio) Use the NOSORH regios to facilitate IHI learig collaboratives. The regios recetly aliged with HHS regios. South Carolia Rural Health Research Ceter
47 Summary Need ad opportuities for achievig the Triple Aim i rural has uique opportuities Public-private collaboratios may provide opportuities to facilitate chage Rural eeds all the champios it ca ecourage South Carolia Rural Health Research Ceter
48 Cotact iformatio Amy Brock Marti, Dr.P.H. SC Rural Health Research Ceter 220 Stoeridge Drive, Suite 204 Columbia, SC (telephoe) South Carolia Rural Health Research Ceter
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