MEDICAL/BEHAVIORAL HEALTH/DENTAL INTEGRATED CARE PROCESSES

FOR FQHC PATIENT POPULATIONS

Dr. Angela Graham-Williams, PhD, LPC, NCC, LLPDr. Lisandra Soto, DMD, MPH

Medical/Behavioral Health/Dental Integrated Care Processes

Benefits of Integrated Care (IC):• Evidence and team based method of comprehensive health delivery

dependent on high levels of communication and collaboration

• One stop “shopping” incorporating medical, behavioral, Substance Use Disorders (SUD) treatment, and soon dental services into the patient experience

• Produces best practice health outcomes and is the most effective approach in caring for patients with complex healthcare needs

• Decreases cost of healthcare

• Increases FHC show rates!

• Evolution of traditional care models; Silo’d, Co-located, Collaborative, Integrated

Impetus of Integrated Care

• Reimbursement has become more related to population health outcomes

• Most evident in behavioral health (Co-located is NOT same as collaborated or integrated care, show rates equal)

What happens in traditional care:• Dental provider referred for treatment

• Assumption that patients were coming back, only about half the time, at best

• Dental providers and Behavioral Health therapists would be in their offices waiting for patients to come back, inadvertently missing those already there

What happens in traditional care: (cont’d)

• Begs question, why wait for patients to come back INSTEAD of treating those present/in clinic

• FQHCs were spending time hunting down “no shows” instead of addressing multi-faceted needs of patients who were present

• Integrated Care is a team based, comprehensive, outcome driven approach to creating synergy for all providers, reducing barriers for patients, and improving outcomes of our most vulnerable patients

Oral Health• Oral disease described as ‘silent epidemic’ in 2000 by

the US surgeon general.• Most oral disease is preventable.• Dental caries most common chronic disease of

childhood.• Close to 25% of seniors have no natural teeth.• In 2013 dental services spending $111 billion• In 2010 – 2.1 million visits to ED for dental conditions at

an estimate cost of $867 million- $2.1 billion

Oral Disease Effect

• Impacts systemic health

• Impacts quality of life

• High costs

• Wasted resources

Triple Aim

Patient- centered care: must include oral health and must be part of the strategic plan

Improve referral processes with dentistry

Breaking the Silo effect• Traditionally dental has been separated from medical• Oral health is integral to systemic health. Oral health and

systemic health are interrelated• Transformation in primary care delivery system strives for a

patient-centered care that is coordinated and value-oriented• HRSA developed domains for integration of Oral Health into

primary practice:– Risk assessment– Oral health evaluation– Preventive interventions– Communication and education– Interprofessional collaborative practice

Integrated Care

• Primary care setting• Enhance access• Oral disease prevention

Planning stages• Literature review• Model of integrated care• Leadership team• Meeting with providers• Meetings with staff (Hygienists and identify a Lead)• Goal• Define your pilot population• Map the process• Define IT needs including reports• Launched initiative• Evaluated and redefine• Expand to other populations

Everybody needs to understand the importance of oral health integration and how it aligns with the organization’s strategic plan.

FHC Pediatric Oral health Integrated Care Initiative

• Population- Children up to 5 year old; later was changed to up to 13 y/o

• Goal: To prevent or reduce dental disease in the pediatric population at least 50% of patients 13 and under seen by pediatrician will have an integrated care visit with dental at least once a year.

• Staff- Pediatrician, MA, Dental Hygienists, Registration staff– Scripting for registration staff

Mapping the process

Operations tasks• Creating Daily Schedule

• Assessing eligible patients

• Checking insurance eligibility

• Patient visit

The Visit

DocumentActDecideLookAsk

Risk Assessment Oral Disease Hygiene practices

Education FluorideReferral

Provide intervention

Ask

• Pediatrics– How many days per week or times per day the child

teeth are brushed? Who brush/monitor?– Feeding habits (bottle and /or sippy cup use) the

teeth?– Evaluate refine carbohydrates and sugar

consumption (Diet)– Has anyone in the immediate family had tooth decay

or last a tooth in the last year– Pain or bleeding gums

Look• Normal• Oral Dryness• Plaque• Signs of decay• Inflamed gums• Broken teeth• Missing teeth• Under active dental treatment?

Decide

• Existence of risk factors

• Signs of disease

Act

• Education– Tooth brush frequency– Diet– Oral hygiene techniques– Delineate a care plan

• Prophylaxis/plaque removal• Fluoride• Referral

Document

• Document all information and procedures performed in record.

Use of Portable Chair acquired with Delta Dental grant money

Trend by month

Daily Reports

Next Steps

• Adult populations– Diabetes– Pregnant women– Cardiovascular disease

• Oral Health and Behavioral Health– Referrals

Questions