SMILES Dental Project Spanning Miles In Linking Everyone to Services Mountain Family Health Centers Garry Millard, DDS gmillard@mountainfamily.org
MFHC Overview Community Health Center serving 16,000 pts Dental services currently in 2 locations/6 chairs Target population is low income students Previous sealant program identified very high unmet need, and over 50% Medicaid eligible Serving rural communities in W. Colorado High cost resort area Over 50% of patients prefer Spanish Transportation barriers
SMILES Dental Project SMILES Grantees/Pioneers Moffat Rio Blanco Mesa Montrose San Miguel Garfield Montezuma Delta Ouray Hinsdale DoloresSan Juan Routt Mountain Family Health Center Tri-County Health Network La Plata Archuleta Pitkin Gunnison Mineral Jackson Eagle Grand Lake Clear Creek Summit Chaffee Saguache Rio Grande Alamosa Conejos Larimer Park Gilpin Fremont Costilla Boulder Custer Weld Dental Aid Summit Community Care Clinic Huerfano Pueblo Morgan Adams Washington Denver Arapahoe Planning Yuma Planned Implementation March 2017 Douglas Kit Carson Elbert El Paso Crowley Otero Las Animas Logan Lincoln Sedgwick Salud Family Health Centers Bent Phillips Cheyenne Baca Kiowa Prowers
Barriers/Learning & Partners 5 Main barriers to implementing SMILES: 1. Challenging transition from existing oral health programs 2. School districts reluctant to be early adopters ; concerned w/ student privacy 3. Minimal data collection with existing programs 4. Staffing challenges 5. Billing challenges
Barriers/Learning & Partners 5 Main barriers to implementing SMILES: 1. Challenging transition from existing oral health programs: Difficult to establish glide path from current programs to new models, while serving the community need Important to have unified leadership within implementing agency and with community partners Schools comfortable with status quo
Barriers/Learning & Partners 5 Main barriers to implementing SMILES: 2. School districts reluctant to be early adopters Biggest surprise Schools short staffed and underfunded School district cannot afford legal help Legal help unfamiliar with new model Sense of mistrust with unknown program Took nearly one year to get MOU s signed
Barriers/Learning & Partners 5 Main barriers to implementing SMILES: 3. Minimal data collection with existing programs When applying for grant, unmet dental need data is limited Data underestimates true unmet need, since non-participants (uninsured) have higher decay rate
Barriers/Learning & Partners 5 Main barriers to implementing SMILES: 4. Staffing challenges Difficult to find staff to work in remote areas SMILES work schedule follows school schedule Backfill staff (filling in for SMILES team) not needed during school breaks
Barriers/Learning & Partners 5 Main barriers to implementing SMILES: 5. Billing challenges Need innovative Billing Manager Billing uninsured patients (Nominal fee per procedure or per visit) Need long-term mindset (big upfront costs to hire and train staff, and buy equipment).
Implementation We plan on opening a total of 4 school based SMILES locations. We have decided to start at the School Based Health Center we already operate because the Dental Hygienist already has a relationship with the school
Implementation Challenges The schools generally do not want us sharing their internet connection, because it will increase their cost. We are planning on setting up our own wireless network, and will transmit data at night when there is less data traffic (via HotSpot)
Implementation Challenges School districts very concerned with patient privacy (FERPA) If school agrees to transmit your data on their internet connection, they are by definition a Business Partner, and you must sign a BAA ( Business Associate Agreement)
SMILES Project Advice Have one SMILES admin day per week for 2 years to be able to plan and implement program Involve the existing oral health programs from the beginning, and see if they are supportive Present student/school benefits to School Board/District Nurse early in process. Be sure to only choose sites that have a locking room for your equipment, or you will have to transport it in all kinds of weather.
SMILES Project Advice Be sure to get state board of dentistry involved from the beginning Focus state board on this cost-effective model to meet unmet dental need in underserved communities, without adding independent dental therapists Tell reluctant dentists that this model could help them expand their practice at a lower cost than satellite clinics. Be patient with older dentists who are unfamiliar with newer techniques and materials
SMILES Project Advice Don t let outspoken and unaware dentists talk you out of doing what is right for the underserved among us You do NOT need permission from local dentists, if your state law has adopted the expanded scope for DH s to place ITR and take needed radiographs