November 8, 2016

THE HEALTH CENTER DENTAL DASHBOARD:

MAKE YOUR DATA WORK FOR YOU!

Speakers• Allison Cusick, MPA

Senior Program Officer

Delta Dental of Colorado Foundation

High Performing Health Centers and Dashboard Pioneer

• Isaac Zeckel, DDS

Chief Dental Officer

HealthLinc Community Health Center

NNOHA Dashboard Collaborative Team & National Oral Health Learning Institute Graduate

• Sandra Garbely-Kerkovich, DMD

Senior Vice President & Chief Dental Officer,

Choptank Community Health Center

NNOHA Dashboard Collaborative Pilot Team

• An Nguyen, DDS, MPH

Vice-President of Dental Services,

Clinica Family Health

Faculty, Dental Dashboard Collaborative

• Chad Lennox, MPH

Director

Washington Dental Service Foundation

High Performing Health Centers and Dashboard Pioneer

Participants Will Be Able To:

Recognize recommended oral health measures

Understand ways that Health Centers can monitor and measure oral health data

Learn how to use the Dental Dashboard template

Hear from experts on best practices in using dashboards and possible roadblocks with gathering and using data

Session Overview

• History of the Project

• Why Dashboards?

• What are the 15 Oral Health Measures?

• Case Studies – real health center examples

• How to Use the Dashboard

– Survey results

– Online Dashboard & User’s Guide

• Questions & Answers/Discussion

History Of The Project

• Delta Dental of Colorado Foundation and

Washington Dental Service Foundation have

been working with expert advisers to develop

a set of recommended oral health measures

for High-Performing Health Centers.

• We have also developed an online, tool to

help Health Centers gather data and graph it

for the measures.

Development

Participants from:

• CMS

• NNOHA

• Institute for Oral Health

• Colorado and Washington CHC

• CHCs working on oral health

• WA Dental Service Foundation

• Delta Dental of Colorado

Foundation

Vision For This Work

Health Centers are sustainable, high

performing healthcare providers with strong

operations to ensure high productivity and

health improvements (including oral health

improvements) among their patients.

Quality Improvement And Data

• Health Centers are required to have an ongoing Quality Improvement/Quality Assurance (QI/QA) program that includes clinical services and management.

• The QI/QA program must include:

Clinical director who supports the QI/QA program and provision of high quality patient care

Periodic assessment of the appropriateness of the utilization of services provided or proposed to be provided to individuals served by the health center

Attention To Dental

Metrics Expanding

• National Quality Measures Clearinghouse

• CHIPRA Pediatric Quality Measures Program

• Meaningful Use measures

• Dental Quality Alliance

• Healthy People 2020

• National Committee on Quality Assurance HEDIS

• NNOHA

• National Oral Health Quality Improvement Committee

• National Quality Forum

• Oregon Dental Quality Metrics Workgroup

Why Use A Dashboard • Dashboards give a quick status update

for key measures.

• They are a snapshot, not an in-depth analysis.

• Regularly seeing the data makes it much easier to respond quickly to areas of concern, or to change courses of action.

• Dashboards can be used to facilitate communication between departments, highlight successful strategies, to maintain momentum in QI activities, and identify operational deficiencies.

• It is a tool to take action!

Who Uses Dashboards?

• “Shorter, more focused dashboards that are reviewed on a

frequent basis are associated with higher performance.

According to the results of this dashboard analysis,

hospitals that use dashboards with fewer measures are

more likely to be in the high-performance group, suggesting

that higher-performing hospitals have developed

dashboards that focus on areas they see as critical for

quality. Furthermore, performance data are more

actionable when such data are consistently reviewed by the

board on a relatively frequent basis.”

Kroch et al. (2006)

The Dental Dashboard

• The Dental Dashboard is a set of measures that

is an optional tool for Health Centers to use as

part of their quality improvement program to…

– More effectively monitor and measure factors that

affect quality

– Establish baselines for key measures

– Set targeted improvements for individual measures

– Develop methods to improve performance

– Track improvements over time

The Dental Dashboard

WHAT ARE THE 15

ORAL HEALTH MEASURES?

1. Treatment Plan Completion

2. Caries at Recall

3. Oral evaluation and/or Risk Assessment

of all Primary Care Patients

4. Risk Assessment of all Dental Patients

5. Topical Fluoride

MEASURES continued

6. Sealants (6-9 year olds)

7. Sealants (10-14 year olds)

8. Self-Management Goal Setting and

Review

9. Self-Management Goal Sharing

10.Charges (Production) per Encounter

MEASURES continued

11. Encounters per Hour

12. No Shows

13. Direct Cost per Visit

14. Recall Rates

15. Recommendation to Family and Friends

How HealthLinc Uses Our

Dashboard And Why We Would

Never Go Back

Isaac Zeckel,

Chief Dental Officer,

HealthLinc

Our Organization’s Dashboard• Dental

• Rev Per = $203.18

• Exp Per = $216.42

• Loss Per = -$13.24

Staff Meetings

Emerging State of Our Dashboard

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Direct Costs per Visit (South Bend)

Day-to-day Implementation

Front DeskPractice

Management DA/RDH/DDSEDRProcess

CoordinatorPractice

ManagementExcelData Analytics

tool

Dashboard

Workgroup

Application Support

PDSA PDSA

How We Use Our Dashboard

• Drive a transition of culture

• Start conversations about how to provide a

framework for evidence based preventative

care

• Identify baselines and short/long term goals

Best Practices

• Start with small changes and test with

volunteers that will be flexible

• Have reports that reflect the differences

between clinics (they may start to compete)

• Work with the staff to improve the workflow

Best Practices

Possible Roadblocks

• Challenging “legacy data”

• Translation of dental lingo and dental staffing to those that collect the data

• Training and workflow changes especially with complex software

Advice

• Be consistent

• Make data visible

• Ensure Accuracy of data

• Collaborate with staff to modify/test

workflows (PDSA)

• If you can collect the HRSA sealant measure,

you can collect any measure.

How Choptank Community Health Uses Our Dashboard and Why We

Will Never Go Back

Sandra Garbely-Kerkovich, DMD

Senior VP and Chief Dental Officer

SGarbely@choptankhealth.org

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0% 0% 0%

54% 61% 69% 72% 77% 84%

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Goal=95%

Patients with F/U and recare

Appointment

YTD New Patient Count

– growth measure

Site Total: 446

CCHS Total: 3,556

YTD No Show Count

Site Total: 747

CCHS Total: 3,014

CCHS QI measure –access to care -Access team - - each Medical and Dental site dashboards reviewed monthly

Dashboards

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OM2: % Pts w. decreased risk N

CRA/SMG – goal is 95% for every patient Data collected in both EDR and EHR

Tx Plan Complete w/in 6 Months 0-20 yrs old – goal 100%PA report generated usingD0150 code and D9992 code

Decreased Risk- % of pts that we are able to keep their risk decreased as we Complete tx. plans and enforce CRA amd SMGCRA documented in EDR and EHR at every appt.

Sealant Dashboard

January FebYTD MarYTD AprYTD MayYTD JunYTD JulYTD AugYTD SepYTD

Total at risk with Qual Visit 137 293 456 665 921 1034 1111 1270 1499

Total NDSEAL 37 76 142 210 281 326 367 441 520

Total D1351 18 42 74 110 160 201 231 279 332

% YDT 48.65% 55.26% 52.11% 52.38% 56.94% 61.66% 62.94% 63.27% 63.85%

%Monthly Goal2015 67.94% 50%

Jan-16 48.65% 70%

Feb-16 55.26% 70%

Mar-16 52.11% 70%

Apr-16 52.38% 70%

May-16 56.94% 70%

Jun-16 61.66% 70%

Jul-16 62.94% 70%

Aug-16 63.27% 70%

Sep-16 63.85% 70%

Oct-16 70%

Nov-16 70%

Dec-16 70%

Case Completion Dashboard

2016 Dental Case Completion

% YTD/Month % Monthly Goal

2015 Results 74.6% 75%

Jan-16 63.6% 63.6% 76%

Feb-16 66.3% 69.3% 76%

Mar-16 65.5% 64.2% 76%

Apr-16 65.0% 63.8% 76%

May-16 65.2% 66.1% 76%

Jun-16 67.0% 75.4% 76%

Jul-16 66.6% 64.6% 76%

Aug-16 66.4% 65.2% 76%

Sep-16 66.3% 65.6% 76%

Oct-16 76%

Nov-16 76%

Dec-16 76%

CCHS has monitored this goal since 2010 –Quality Pillar Goal last year reached 73% -but recent barriers with opening all Dental schedules to Adult Medicaid NP and Adult uninsured/S/F NP

HunchesTheoriesIdeas

System changes that will result in improvement

Learning

Cycle 3: A Cheat Sheet was fabricated by the Committee.

Cycle 1: Use SmartCodes /ADA Codes to differentiate HRSA Sealant Measure needs in Dentrix (EDR)& Intergy(EDR).

Cycle 2: Committee worked on how the codes would be used and how to put the codes in Dentrix & Intergy

Cycle 4: The Cheat Sheet was approved & given to all dental sites. Changes were made after testing to

differentiate the patients needing sealants vs not needed.

Cycle 5: Full implementation of the finalized codes

on Cheat Sheets at all dental sites was achieved and will be

recorded appropriately

by all “ACTIVE” providers.

We asked ourselves…

How can we change our current system and now document accurately on the HRSA Sealant Measure?

How We Use Our Dashboard Data

Day-to-day Implementation

At CCHS, our Quality Department collects the data and relays that information to our Dental Quality Improvement Team.

We follow a guide (much like a PDSA) in teaching and coaching our staff.

NNOHA QI Committee

Team /site Champions

Site Huddles

Patients“Tips & Tricks”

QI Committee and site

champions

Best Practicescreate tools /cheat sheets

Possible Roadblocks

• Employee engagement or buy-in-change in culture – difficult for staff – already overwhelmed

• Data collection /retrieval– EDR/EHR do not talk

• Starting TOO big – aims/goals or PDSA’s

• Non buy-in SMT team/ executive staff/administrative

• Complacency among staff – data slips and not best practice or optimal anymore – keeping things fresh in minds

Our Advice

• Get buy-in from staff and SMT – re-enforce how it will improve patient care - mission

• Accept advice from peers – join collaborative• Analyze/Utilize data and dig deep to see trends• Encourage staff with incentives– celebrate WINS• Listen to your staff – they have great ideas and implement

their ideas• Start small, small, small!• Use PDSA’s

– One Day– One Location– One Provider– One Patient– One Test

How Clinica Family Health Uses

Our Dashboard And Why We

Would Never Go Back

An Nguyen, DDS, MPH

Vice-President of Dental Services

Clinica Family Health

November 2016

Our Organization’s Dashboard

How We Use Our Dashboard1. To support our

chronic disease

management model

of care.

2. To drive quality

improvement.

3. To support risk-based

care and evidence-

based practice.

4. To manage

population health.

5. To support team-

based care &

ownership.

1. To support our

chronic disease

management model

of care.

2. To drive quality

improvement.

3. To support risk-

based care and

evidence-based

practice.

4. To manage

population health.

5. To support team-

based care

How We Use Our Dashboard

How We Use Our Dashboard1. To support our

chronic disease

management model

of care.

2. To drive quality

improvement.

3. To support risk-based

care and evidence-

based practice.

4. To manage

population health.

5. To support team-

based care &

ownership.

A RESPONSIBLE SYSTEM

SUPPORTING

RESPONSIVE TEAMS

How We Use Our Dashboard

Re

sp

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on

siv

e

1. Support Chronic Disease

Management

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Clinica- % Caries at Recall Clinica - Median

2. Drive Quality Improvement

A Possible Solution: To create more access, reduce scheduling complexity (by reducing number of rules) to facilitate fewer unbooked slots.

MULTIPLE “successful PDSA cycles build knowledge and accelerate the adoption of proven and effective changes.”

2. Drive Quality Improvement

• 6 PDSA Cycles: Process Goal Accomplished!

3. Support Risk-Based Care

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Recall Rates

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Treatment Plan Completion

Treatment Plan Completion

Rate

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Fluoride Application Rate

4. Manage Population Health

38.52

37.84

46.11

20.74

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Caries at Recall

Clinica % Caries Clinica - % Caries Median

5. Support Team-Based Care

• Dentist and Hygienist implement best bundled treatment planning practices to reduce number of visits required.

• Dental Assistants implement best practices for efficient room set up and turnover to support more patient visits per day.

• Receptionists outreach to patients with outstanding treatment plan care gaps and fill the schedules.

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• Business Intelligence

(BI) team generates &

manages reports.

Departments are

allocated BI support

according to

organization’s

strategic priorities.

• Administrative team

runs & pushes reports

to end users according

to defined processes.

• Data can be pulled at

will from the BI tool on

employee desktops.

Day-to-Day Implementation

Best Practices• Report intake process (use the User’s Guide!).

– Define terms, numerator, denominator.

– Identify data sources & flows to support data entry.

– Determine actionable level of specificity (“roll-up”)

and frequency of review for run charts.

– Validate the data before rolling reports out.

– Make the measures meaningful to you!

Best Practices

• Integrate use of data into everyday practice.

– “Cadence of Accountability”

– Use data to drive projects.

MA

NA

GE

R

Ownership of data and

team performance.

TE

AM

Daily team huddles

make performance

goals clear. EM

PLO

YE

E Data reviewed in

1:1 meetings with manager

make data actionable.

Possible Roadblocks

• Competition for BI resources.

– Prioritized report development.

– Financial incentives for medical performance. Is this coming for dental?

• Limited structured data sources & impact on data quality.

– “Artificial” operational processes for data entry that require end-user training/adherence.

– Need for “dummy” codes.

Creating a Culture of Quality

Leadership and vision.

“A vision is not just a picture of what could be; it is an

appeal to our better selves, a call to become

something more.” (Rosabeth Moss Kanter)

Data is a powerful storyteller. Give it

a voice, and let it speak frequently.

Support good habits.

Building Blocks of

Advice

• Start small, but don’t forget to start!

• Prioritize your work and learn as you go.

– Some metrics feed into each other & help paint a

fuller picture.

– Outcome measures are long-range. Use process

measures as proxies for short-term performance.

– Don’t get sidetracked by more data.

• Use measurement to inspire action.

Advice• If we all agree that the goal of our work is to

improve the health of our patients, how will

we know that we are successful?

– DATA!

– Comfort with transparency and a will to improve.

Using the Dental Dashboard

Chad Lennox, MPH, Director

Washington Dental Service Foundation

Survey of Dashboard Users

September 2016

Results:

• Use for meaningful data, quality improvement,

and to see change for patients

• Majority are in the process of implementation

(some haven’t started yet)

• TIME, buy-in, and getting data out of the EDR

are the biggest barriers in using the Dashboard

For what purpose do you use the

Health Center Dental Dashboard©?

• Facilitate communication between

departments

• Highlight successful strategies

• Maintain momentum in Quality Improvement

activities

• Identify operational deficiencies

• Compare to other organizations when

national measures are used

Which of the 15 of The Health Center Dental Dashboard©

measures are you regularly using?

How are YOU using the Dashboard?

• 3 most used measures

– Sealants

– No shows

– Treatment plan completion

“Prior to introducing the dashboard, the sealant measure

was very inaccurate. Non-dental staff members were

pulling the data, but they had no idea of full sealant

measure requirements, so the did not pull all the

necessary data for the measure”

Why Use the Dashboard at All?

• We are moving into a world of outcomes driven reimbursement

• States are beginning to demand dental metrics

• UDS sealant measure

• If you can’t measure it, you’ll never move the dial

• Most important – It provides you a tool to develop your Vision as a dental leader in your organization

HOW TO USE THE

ORAL HEALTH MEASURES• Selecting oral health measures places a value on

oral health and focuses quality improvement efforts towards them.

• You do not need to select all 15 measures. Start with 1-2 measures (3 max in the first 3 months) that are inline with your center’s mission, your strategic plan, or parallel national standards.

• Collect data regularly, share with the appropriate people, use the data to instigate action.

• Add additional measures when you’re ready.

• These measures were designed for IMPROVEMENT.

Overview

• The Dental Dashboard includes two resources: Users’ Guide and data charting.

• The User’s Guide is a companion to support the implementation and use of the Dental Dashboard.The in-depth document gives users more details about:

• How the recommended measures were selected

• Specifies the numerators and denominators

• What codes are needed to track the measures

• Tips for how to collect the data

• Instructions for how to access the online template

Users Guide & Dental Quality

Alliance Specifications

• Measures list inspired by the 2015 NNOHA Dashboard Version 1.0

http://www.nnoha.org/resources/dental-dashboard-information/users-guide/

• Measure specifications for clinical measures and no-shows developed by Dental Quality Alliance

Charting Tools

• The Dental Dashboard includes two

resources: Users’ Guide and data charting.

• An online template is available at

www.nnoha.org

• You can also download a simple Excel

spreadsheet to create your graphs

• Users import the downloaded data into the chart presentation tool

and can easily view graphs of their selected measures.

THE ONLINE

DENTAL DASHBOARD

QI Learning Collaborative Dashboard – September 2016

Next Steps

• The Dashboard is free to use, but user’s will

need to sign up to receive the Excel

template;

• Access to the Dashboard and the User’s

Guide is posted on NNOHA’s website:

http://www.nnoha.org

• Measures continue to be refined through

NNOHA’s Dashboard Learning Collaborative;

Next Steps

• NNOHA will be hosting a Learning

Community to:

– Support measurement

– Develop comparison reports.

• NNOHA will send out information about the

opportunity to be involved.

• What type of technical assistance or

support would you need to be successful

in implementing a Dashboard in your

health center? What would you need

from:

– NNOHA

– HRSA

– Partners such as Delta Dental foundations or

other funders

•

Turn and Talk

Sharing & Next Steps

Contact Information

• Colleen Lampron, MPH

NNOHA Dashboard Consultant & Collaborative Director

colleenlampron@afl-enterprises.com

• Irene Hilton, DDS, MPH

NNOHA Dental Consultant & Collaborative Chair

Irene@nnoha.org