‘‘Points of Light’Points of Light’

Presented to the Presented to the

Michigan Oral Health CoalitionMichigan Oral Health Coalition

January 30, 2008January 30, 2008

Enduring Goals of the Enduring Goals of the Organized Dental CommunityOrganized Dental Community::

Improve the Oral Health of the Improve the Oral Health of the Citizenry. Citizenry.

Improve Access to Oral Health Care.Improve Access to Oral Health Care. Improve the effectiveness of Oral Improve the effectiveness of Oral

Health Care delivery systems.Health Care delivery systems. Improve the Oral Health of Children, Improve the Oral Health of Children,

(MAPD).(MAPD).

Defining the Issue: MichiganDefining the Issue: Michigan

~ 130,000 live births/year ~ 130,000 live births/year Nationally, 15 to 17 million children Nationally, 15 to 17 million children

without access to oral health care without access to oral health care (increasing).(increasing).

~900K of Michigan’s 2.5 million kids are ~900K of Michigan’s 2.5 million kids are Medicaid eligible, (increasing).Medicaid eligible, (increasing).

Decay rates are on the rise in pre-school Decay rates are on the rise in pre-school children (4% in last 10 years; CDC, 07)children (4% in last 10 years; CDC, 07)

58% of Michigan 358% of Michigan 3rdrd Graders have caries. Graders have caries.

Dentistry in Michigan: By the Dentistry in Michigan: By the NumbersNumbers

82 pediatric dentists of which an 82 pediatric dentists of which an estimated 84% (~70) see 1 year olds. estimated 84% (~70) see 1 year olds.

4630 general dentists, (MDA, 08)4630 general dentists, (MDA, 08) Evidence suggests that Pediatric Dentist Evidence suggests that Pediatric Dentist

migrate to upper income communities.migrate to upper income communities. There will never be enough Pediatric There will never be enough Pediatric

Dentists and most general dentists are not Dentists and most general dentists are not comfortable treating very young children. comfortable treating very young children.

Good doctors treat disease.Good doctors treat disease.Great doctors prevent Great doctors prevent

disease.disease.

Justifying IOH: General OverviewJustifying IOH: General Overview

Demographics of the Professional Demographics of the Professional Communities, (Medical and Dental).Communities, (Medical and Dental).

Cariology that defines: Primary Prevention Cariology that defines: Primary Prevention vs. Secondary Prevention that create vs. Secondary Prevention that create timing dependant opportunities.timing dependant opportunities.

Economic Implications that define the Economic Implications that define the impact on dental practices and lower the impact on dental practices and lower the cost of managing low SES populations. cost of managing low SES populations.

Culminating in a new ‘Best Practice’. Culminating in a new ‘Best Practice’.

Addressing the Needs of Addressing the Needs of Michigan’s InfantsMichigan’s Infants

Currently: 130,000 live births Currently: 130,000 live births =>1800 new patients/pediatric =>1800 new patients/pediatric dentist/year.dentist/year.

If all Pediatric Dentists accepted If all Pediatric Dentists accepted infants = ~1500 infants/year. infants = ~1500 infants/year.

If all Dentists accepted infants = ~27 If all Dentists accepted infants = ~27 infants/year. (If only half see infants infants/year. (If only half see infants = ~ 60 infants/year)= ~ 60 infants/year)

Conclusion: This is possible!Conclusion: This is possible!

Advocacy:Advocacy:

Improving the Oral Health of the Improving the Oral Health of the entire community. (Not just low SES, entire community. (Not just low SES, because low SES will benefit along because low SES will benefit along with the community)with the community)

Enacting the ‘Atlas Concept’: Taking Enacting the ‘Atlas Concept’: Taking responsibility for all patients within a responsibility for all patients within a community regardless of the fact community regardless of the fact that they will never walk into your that they will never walk into your practice. practice.

Advocacy Goals:Advocacy Goals:

To improve the Health and Oral To improve the Health and Oral Health of the Citizenry, (Pan SES).Health of the Citizenry, (Pan SES).

To Create behavioral transitions in To Create behavioral transitions in arenas of impact: Dentistry, arenas of impact: Dentistry, Medicine, Legislative, General Public.Medicine, Legislative, General Public.

To have infants presented to a To have infants presented to a ‘Dental Home’ for primary prevention ‘Dental Home’ for primary prevention rather than surgical intervention.rather than surgical intervention.

The Challenge of The Challenge of providing care to Low providing care to Low

SES:SES: Medicaid covers 25% of children Medicaid covers 25% of children

and 33% of infantsand 33% of infants Nationally, 27 million children are Nationally, 27 million children are

covered by Medicaid. (Michigan: covered by Medicaid. (Michigan: 1:1.5)1:1.5)

Economic distress is increasing , Economic distress is increasing , impacting middle income families. impacting middle income families. These are NOT ‘Welfare Deadbeats’!These are NOT ‘Welfare Deadbeats’!

Relationships are not about Relationships are not about obligation. Relationships are obligation. Relationships are

about opportunity.about opportunity. This tenant pertains to all relationships.This tenant pertains to all relationships. If you not looking at relationships from If you not looking at relationships from

this perspective, you are really missing this perspective, you are really missing the point of relationships altogether. the point of relationships altogether.

What opportunities can you create for What opportunities can you create for your patients and your community? your patients and your community?

Caring for our poorest and Caring for our poorest and most vulnerable:most vulnerable:

Consider that children seen early Consider that children seen early are less costly to care for over time.are less costly to care for over time.

Consider that, with very young Consider that, with very young patients, preventing decay is far patients, preventing decay is far easier than restoring teeth.easier than restoring teeth.

Consider that children with less Consider that children with less complex restorative needs are less complex restorative needs are less likely to require referral to a likely to require referral to a pediatric dentist. pediatric dentist.

Involvement vs. Involvement vs. Commitment:Commitment:

The difference between involvement The difference between involvement and commitment is like an eggs & and commitment is like an eggs & ham breakfast. The chicken was ham breakfast. The chicken was

‘involved’, the pig was ‘committed’!‘involved’, the pig was ‘committed’!

Ongoing EffortsOngoing Efforts::

Varnish! MichiganVarnish! Michigan Adopt-a-Head Start programAdopt-a-Head Start program Early Head Start & Head Start ProgramsEarly Head Start & Head Start Programs PA 161PA 161 Community Dental Health CoordinatorCommunity Dental Health Coordinator

Scan0004.jpg

Ideal Dental Care: ‘Dental Ideal Dental Care: ‘Dental Home’Home’

Ongoing relationship between the Ongoing relationship between the dental office and the family.dental office and the family.

Care that is ComprehensiveCare that is Comprehensive Care that is AccessibleCare that is Accessible Care that is family-centeredCare that is family-centered Care that is Culturally-effectiveCare that is Culturally-effective Care that you would want for your Care that you would want for your

childchild

Meta-Questions:Meta-Questions:

How do we improve the oral health of How do we improve the oral health of very young children?very young children?

How do we lower the cost of providing How do we lower the cost of providing oral health care to low SES oral health care to low SES populations?populations?

How do improve the oral health of the How do improve the oral health of the community at large?community at large?

How do we best utilize our workforce?How do we best utilize our workforce?

What is ‘Points of Light’?What is ‘Points of Light’?

Organizational Transition:Organizational Transition: Changing Behaviors on a Changing Behaviors on a

large scalelarge scale

Mavens Brokers Pragmatists Conservatives

Tipping Point

# of Adopters

(early adopters) (late adopters)

‘‘Social Proof’Social Proof’A behavior that has reached a A behavior that has reached a ‘tipping point’ within a given ‘tipping point’ within a given population group resulting in population group resulting in

mass adoption and mass adoption and participation, (Herd Behavior).participation, (Herd Behavior).

i.e., stock runs, fads, voting i.e., stock runs, fads, voting tends, drug use, suicides, tends, drug use, suicides, movie attendance, etc….movie attendance, etc….

Organizations of Interest:Organizations of Interest:

The General Public: Parents & children.The General Public: Parents & children. Dentistry: General Dentists, Pediatric Dentistry: General Dentists, Pediatric

Dentists, Dental Hygienists, etc…Dentists, Dental Hygienists, etc… Medicine: Pediatricians, Family Practice, Medicine: Pediatricians, Family Practice,

Nurse Practitioners, Physician Assistants, Nurse Practitioners, Physician Assistants, etc…etc…

Legislative Bodies: Federal, State & local.Legislative Bodies: Federal, State & local. Educational Institutions: Pre & Post Educational Institutions: Pre & Post

Doctoral Programs in Medicine and Doctoral Programs in Medicine and Dentistry.Dentistry.

Organizations of ImpactOrganizations of Impact

Dentistry Medicine

General Public

Education

Legislators

““Points of Light”Points of Light”

Identify a ‘Point Dentist’ within a Identify a ‘Point Dentist’ within a community.community.

Establish a dental provider network, ‘EPII’.Establish a dental provider network, ‘EPII’. Provide the EPII list to Pediatric Medical Provide the EPII list to Pediatric Medical

Providers.Providers. Interact with medical providers, ‘ECTAMR’.Interact with medical providers, ‘ECTAMR’. Educate medical providers, AAP policy.Educate medical providers, AAP policy. Operationalize ‘Points of Light’ locally.Operationalize ‘Points of Light’ locally. Operationalize ‘Points of Light’ state wide.Operationalize ‘Points of Light’ state wide. Infant Dental Exams become a ‘Social Infant Dental Exams become a ‘Social

Proof’.Proof’.

Three Levels of Three Levels of AdvocacyAdvocacy::

Bronze Level: Initiating an Infant Bronze Level: Initiating an Infant Oral Health program in your Oral Health program in your practice.practice.

Silver Level: Instigating ‘Infant Silver Level: Instigating ‘Infant Oral Health’ Programs in your Oral Health’ Programs in your community, (EPII).community, (EPII).

Gold Level: Developing a multi-Gold Level: Developing a multi-community project that impacts community project that impacts the entire state over time, the entire state over time, (Points of Light).(Points of Light).

““Life has taught us that Life has taught us that love does not consist in love does not consist in

gazing at each other gazing at each other but in looking outward but in looking outward together in the same together in the same

direction”direction”

-Antonio de Saint--Antonio de Saint-ExupExupééryry

Question/CommentsQuestion/Comments

MOHC, Thank You!!MOHC, Thank You!!