Maryland Oral Health Reforms: Progress in the Face of Tragedy Maryland Oral Health Summit October...
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Transcript of Maryland Oral Health Reforms: Progress in the Face of Tragedy Maryland Oral Health Summit October...
Maryland Oral Health Reforms: Progress in the Face of Tragedy
Maryland Oral Health SummitOctober 20, 2011
Dr. Harry GoodmanDirector, Maryland Office of Oral Health
Importance of Oral Health
58.6
11.1 84.2
0
10
20
30
40
50
60
DentalCaries
Asthma Hayfever ChronicBronchitis
Percent of 5 to 17 year-olds with Various Disorders
U.S. Third National Health and Nutrition Examination Survey 1988-1994
Importance of Oral Health
They are “just baby teeth”, but this damage can be permanent…..
Cause permanent damage to their adult successors
Inhibit nutrition and physical development
Keep a child up at night Affect the child’s ability to
concentrate and learn in school
Importance of Oral Health Pictures Tell a Thousand StoriesBut if this doesn’t grab you…
…Will This? The Death of Deamonte Driver
12-year Maryland boy from PG County
Never complained/no one was looking
Untreated dental infection resulted in 2 brain surgeries, seizures, 1 tooth extracted, and spent 6 weeks in a hospital at a cost of $250,000 Medicaid cost of simple extraction -
<$100 and preventive services - <$60 - $80/year
Died unexpectedly-February 25, 2007
Lacked access to treatment and education and prevention services
“We can't solve problems by using the same kind of thinking we used when we created them.”
Albert Einstein
“So when a good idea comes, you know, part of my job is to move it around, just see what different people think, get people talking about it, argue with people about it, get ideas moving among that group of 100 people, get different people together to explore different aspects of it quietly, and, you know – just explore things.”
Steve Jobs
MARYLAND HISTORY: IN SEARCH OF A DENTAL HOME
Proud history: Robust Medicaid dental program until the 1970’s Early implementation of water fluoridation
99.8% of Maryland residents on public water systems receive fluoridated water (4,839,490 people) – CDC
Ranked #1 in U.S.
MARYLAND HISTORY: IN SEARCH OF A DENTAL HOME
Not so proud history: Since the 1970’s, nominal emphasis on oral health Poorly supported Office of Oral Health – continually
cut Only half of Maryland jurisdictions with public health
(safety net) dental services 1997–Medicaid managed care arrived with policy to
withdraw State funding from county dental clinics No partnerships/No oral health advocacy Late 1990’s, Maryland reported to have lowest
access to Medicaid oral health services in U.S.
MARYLAND’S EXPERIENCE: Planting the Seeds (1998 – 2007)
Oral Health Advisory Committee: Government agencies, organizations
from professional dentistry, academia, child advocacy, managed care, and public health
Advocacy efforts Mostly focused on access to care Networking
Legislation – State Senator Lawlah Surveillance
MCHB/Dental School Survey – Dr. Rossetti
HRSA SOCHS Grant Early 5-year Oral Health Plan
ADVOCACY and PARTNERSHIPS BEGIN: Legislation
Medicaid Reforms (SB 590 - 1998) Medicaid Utilization Targets Increased Medicaid Funding Oral Health Advisory Committee
Dental Loan Assistance Repayment Program (2000)
Pediatric Dental Fellowship Program (2001) Oral Cancer Prevention Program (2002) Increased HealthChoice MCO Dental Rates
(2003) Oral Health Safety Net (2007)
DENTAL ACTION COMMITTEE (DAC)Oral Health Access Reforms in the Face of Tragedy
February 2007 – Death of Deamonte Driver
June 2007 - Convened by DHMH Secretary Colmers after death of Deamonte Driver
September 2007 – DAC report 7 primary recommendations
October 2007 – All DAC recommendations supported by DHMH Secretary and Governor
April 2008 - Governor’s DAC budget initiatives and other DAC-related legislation passed and signed into law
DAC Recommendations and Progress
Focus Mainly on Access to Care
1. Statewide single Medicaid dental vendor – July 2009
Maryland Healthy Smiles Program (Medicaid dental program) – DentaQuest
Eased bureaucratic, paperwork, credentialing issues
2. Over three years, increase dental rates to ADA 50th percentile - 1st year of increase started July 1, 2008
All preventive, most diagnostic, other procedures Additional increases delayed due to state budget deficit Approximately 400 new dentists have joined Maryland
Healthy Smiles Program since July 2009 More pediatric dentists now participate
DAC Recommendations and Progress
3. Begin to restore dental public health infrastructure New/expanded dental clinical and school-based/linked
public health programs – also dental van By April 1, 2011, residents in every Maryland jurisdiction
now have access to a dental public health program Deamonte Driver Dental Van Project
4. Create public health dental hygienist Legislation passed 2008 Being implemented in many public health programs
5. Institute school-based oral health screenings MDAC Kaiser Foundation grant for pilot project – Sept.
2011
DAC Recommendations and Progress
6. Train general dentists in pediatric dental care 550 trained
6a. Train pediatricians, family physicians, and nurse practitioners for oral health assessments and apply fluoride varnish
Integrate oral health into routine primary care practice for 9mo – 3 yr olds as part of EPSDT well child visits
Receive Medicaid fluoride varnish reimbursement – 7/2009 Over 400 trained/Over 30,000 medical claims to date
7. Oral Health Literacy Campaign Federal grant thanks to Maryland Congressional
Delegation
Oral Health Literacy Campaign – Spring 2012
Leading the way in oral health literacy taking its cue from the Institute of Medicine (IOM) oral health report
Educate low income families about the importance of oral health and its effects on overall health and well-being Targets pregnant women and children ages 0-6 Encourage the public to request and keep dental
appointments and be better able to navigate the oral health delivery system
Empower the public to enhance oral health behaviors such as proper oral hygiene practices and nutritional choices at home
Need to evaluate campaign effectiveness Need to develop strategies and expand to other age
groups and health care providers
Maryland Oral Disease Prevention Program
5-Year Cooperative Agreement (2008-2013): Infrastructure Data and Surveillance State Oral Health Plan Partnerships and Coalitions Prevention Activities Policy Development Evaluation Collaborations
CDC State-Based Oral Disease Prevention Program
Maryland Healthy Smile Dental Providers
Region August 2009 J une 2010
Baltimore Metro
242 344
Montgomery/ Prince George's
208 296
Southern Maryland
29 39
Western Maryland
65 97
Eastern Shore
43 53
MD Bordering States 62 110
Total Dentists
649 939 (22.8% of active
dentists)
Fluoride Varnish Providers (Medical) 225 319
Total Dental and Medical Providers 874 1258
Dentists Participating in Medicaid Maryland: 2009/2010
Percentage of Children Enrolled in HealthChoice who had at Least One Dental Encounter by Age Group, Enrolled for Any
PeriodAge Group
CY 2005 CY 2006 CY 2007 CY 2008 CY 2009
0-3 7.8% 7.9% 10.0% 12.3% 18.6%
4-5 37.7% 37.2% 42.4% 47.7% 56.0%
6-9 42.5% 42.3% 47.6% 53.1% 60.7%
10-14 39.4% 39.5% 44.2% 48.8% 56.4%
15-18 32.4% 32.3% 35.8% 39.5% 46.0%
19-20 19.0% 18.4% 20.1% 23.4% 30.1%
Total 29.6% 29.3% 32.9% 36.7% 43.8%
Number of Children Receiving Dental ServicesChildren ages 4-20, Enrolled for at least 320 days
(HEDIS)Year Total Number
of EnrolleesEnrolleesReceiving One or More DentalServices
PercentReceivin
gServices
HEDISNationalMedicaidAverage
FY 1997 88,638 17,637 19.9%
CY 1999 122,756 31,742 25.9% 36.41 %
CY 2000 132,399 38,056 28.7% 40.34 %
CY 2001 142,988 48,066 33.6% 37.4 %
CY 2002 194,351 67,029 34.5% 39.0 %
CY 2003 203,826 88,110 43.2% 39.4 %
CY 2004 213,234 93,154 43.7% 42.7 %
CY 2005 227,572 104,188 45.8% 41.0 %
CY 2006 223,936 103,561 46.2% 42.5 %
CY 2007 216,885 111,791 51.5% 43.5 %
CY 2008 243,076 135,403 55.7% 44.2%
CY 2009 254,811 150,275 59.0% N/A
Maryland Dental Action Coalition (MDAC)
Conversion from government charged Committee (DAC) to an independent Coalition (MDAC)
Funding from: Office of Oral Health
CDC State State-Based Oral Disease Prevention Cooperative Agreement
DentaQuest Foundation Many accomplishments A true partner in every sense of the word
Thanks and Acknowledgements
Making Good MusicTogether – the Value of
Partnerships
“Being in a band is always a
compromise. Provided that the balance is good, what you lose in compromise, you gain by collaboration.”
Mike Rutherford (Genesis)
Congratulations!OOH Staffer
Ms. Chris Leo, RDH
Winner of the Maryland Rural
Health Association“2011 Outstanding
Rural Health Practitioner Award”
Progress and Recognition…
PEW Dental Health “Report Card”: Maryland received an "A" grade and was
determined to be the top performer in the country for dental health
…But We’re Not “There” by Any Stretch
Challenges Maintaining our current momentum Expanding statewide prevention
programs Providing a dental home for all
Marylanders: Adults and senior citizens Special needs children and adults
Integration of oral health with overall health system services
Expanding Oral Health Literacy Campaign to other age groups\healthcare workforce
Having a truly oral health literate populace
Countering anti-fluoridation efforts
But Together – We Can Continue Our
Progress!Still Awake?
(my always inspired boys)
[email protected](410) 767-5942