Minnesota Oral Health Promotion Minnesota Oral Health Promotion Coalition Meeting Coalition Meeting

Coalitions 2.0Coalitions 2.0Considerations for a RoadmapConsiderations for a Roadmap

Reg Louie, DDS, MPH

St. Paul, MinnesotaJune 12, 2009

Presentation OverviewPresentation Overview Minnesota Oral Health Summit – Minnesota Oral Health Summit –

Visions for Oral Health (2009)Visions for Oral Health (2009)

Changing Paradigms in Oral HealthChanging Paradigms in Oral Health

State Oral Health Models from CDC and State Oral Health Models from CDC and other Oral Health Coalitionsother Oral Health Coalitions

Tools from ASTDDTools from ASTDD

State Promising PracticesState Promising Practices

MOH Landscape SWOT MOH Landscape SWOT Roadmap to the Roadmap to the Future Future

Minnesota OH Summit 2009 Minnesota OH Summit 2009

Minnesota Oral Health SummitMinnesota Oral Health Summit --

Oral Health Vision for the Future – 5 topic Oral Health Vision for the Future – 5 topic groupsgroups:: Prevention, Education, AwarenessPrevention, Education, Awareness Policy and FundingPolicy and Funding Access to CareAccess to Care Workforce DevelopmentWorkforce Development Bridging Private/Public SectorsBridging Private/Public Sectors

-- 3 Oral Health Visions 3 Oral Health Visions

for the Futurefor the Future

Changing Paradigms Changing Paradigms for Controlling Dental Cariesfor Controlling Dental Caries

Old Paradigm --> Surgical / ‘Drill & Fill’Old Paradigm --> Surgical / ‘Drill & Fill’(dealing with consequences of disease) (dealing with consequences of disease)

Later Paradigm: Prevention!!!Later Paradigm: Prevention!!!

(generally “one size fits all”)(generally “one size fits all”)

““Current” Paradigm: Early Intervention, Risk Current” Paradigm: Early Intervention, Risk Assessment, Anticipatory Guidance, Assessment, Anticipatory Guidance,

Individualized Prevention and Disease Individualized Prevention and Disease ManagementManagement

(targeted, systematic, evidence-based approaches)(targeted, systematic, evidence-based approaches)

Slide courtesy of Jim Crall

Rethinking Prevention:Rethinking Prevention:Broad Strategies / GoalsBroad Strategies / Goals

Reduce the burden of disease Reduce the burden of disease through the efficient integration of:through the efficient integration of: Health promotionHealth promotion Preventive servicesPreventive services Disease managementDisease management Treatment servicesTreatment services

Expand access to ongoing Expand access to ongoing diagnostic, preventive and treatment diagnostic, preventive and treatment services in “dental homes”services in “dental homes”

Application of risk assessment and Application of risk assessment and targeted, evidence-based targeted, evidence-based interventionsinterventions

Crall JJ. Ped Dent 2006;28:96-101.

Slide courtesy of Jim Crall

Minnesota Minnesota Head Start PIR DataHead Start PIR Data

2006-072006-07CHILDREN SERVED 15,709 -CHILDREN SERVED 15,709 - MNMN USUS

With health insurance With health insurance 89% (93%)89% (93%)

““Dental home” Dental home” 83% (86%)83% (86%)

PS*PS* Dental exam Dental exam 85% (88%)85% (88%)

PS*PS* Preventive care Preventive care 89% (85%)89% (85%)

PS* Needing treatment PS* Needing treatment 28% (25%)28% (25%)

PS*PS* Receiving treatmentReceiving treatment 84% 84% (83%)(83%)

* Preschool Head Start Children Only* Preschool Head Start Children Only

Minnesota Oral Health PIR Trends – Minnesota Oral Health PIR Trends – Percent of Head Start Children Percent of Head Start Children

(2004-07) (2004-07)

20042004 20052005 20062006 20072007Health insurance Health insurance 87% 87%87% 87% 88%88% 89% 89%““Dental Home” Dental Home” 73%73% 73% 73% 79%79% 83% 83%

HS Preschool (3 to 5-years)HS Preschool (3 to 5-years)

Dental Exam Dental Exam 63%63% 65% 65% 74%74% 85% 85%Prevent. Care Prevent. Care 44% 69%44% 69% 90%90% 89% 89%Need TxNeed Tx 20%20% 32% 32% 28%28% 26% 26%Received Tx Received Tx 70% 79%70% 79% 83%83% 84% 84%

Minnesota Early Head Minnesota Early Head Start PIR Data (2006-07)Start PIR Data (2006-07)

INFANTS/TODDLERS (Birth to 3 years)INFANTS/TODDLERS (Birth to 3 years) Dental screenings at well-baby exams –Dental screenings at well-baby exams – 80% (68%)80% (68%) Professional dental exams – Professional dental exams – 47% (54%)47% (54%)

PREGNANT WOMEN/TEENSPREGNANT WOMEN/TEENS With health insurance – With health insurance – 95% (89%) 95% (89%) Receiving dental exams or Treatment – Receiving dental exams or Treatment – 42% (42%)42% (42%)

CDC – Oral Health Infrastructure CDC – Oral Health Infrastructure Development Cooperative Development Cooperative

AgreementsAgreements 2003-2008: 23 projects funded (12 2003-2008: 23 projects funded (12

States and 1 Pacific jurisdiction)States and 1 Pacific jurisdiction)

16 States funded in 200816 States funded in 2008

8 specific/required areas of 8 specific/required areas of program focus (“recipient program focus (“recipient activities”)activities”)

CDC – OH Infrastructure Development CDC – OH Infrastructure Development Cooperative Agreements (2008-13)Cooperative Agreements (2008-13)

Eight Recipient ActivitiesEight Recipient Activities

1.1. Program Infrastructure: Staffing, Program Infrastructure: Staffing, management and supportmanagement and support

2.2. Data collection and surveillanceData collection and surveillance

3.3. Strategic Planning – State OH PlanStrategic Planning – State OH Plan

4.4. Partnerships and coalitionsPartnerships and coalitions

5.5. Access to and utilization of preventive Access to and utilization of preventive interventionsinterventions

6.6. Policy developmentPolicy development

7.7. EvaluationEvaluation

8.8. Program collaborationProgram collaboration

What is a Coalition?What is a Coalition?

Definition: a group of individuals and/or Definition: a group of individuals and/or organizations with common interest who agree organizations with common interest who agree to work together toward a common goalto work together toward a common goal

Coalitions may be loose associations in which Coalitions may be loose associations in which members work for short time to achieve a members work for short time to achieve a specific goal; and then disband, or they may specific goal; and then disband, or they may also become organizations in themselves, with also become organizations in themselves, with governing bodies, particular community governing bodies, particular community responsibilities, funding and permanenceresponsibilities, funding and permanence

Regardless of their size and structure, they exist Regardless of their size and structure, they exist to create and/or support efforts to reach a to create and/or support efforts to reach a particular set of goalsparticular set of goals Slide courtesy of Teresa Schwab 1/09

Goals of a CoalitionGoals of a CoalitionCoalition goals are as Coalition goals are as

varied as coalitions varied as coalitions themselves, but often themselves, but often contain elements of one contain elements of one or more of the following: or more of the following:

Influencing or Influencing or developing public policy, developing public policy, usually around a specific usually around a specific issue.issue.

Changing people's Changing people's behavior.behavior.

Building a healthy Building a healthy community. community. Slide courtesy of Teresa Schwab

1/09

Why Develop a Coaliltion?Why Develop a Coaliltion? Concentrate the Concentrate the

community's focus on community's focus on a particular problem.a particular problem.

Create alliances Create alliances among those who among those who might not normally might not normally work together.work together.

Keep the Keep the community's community's approach to issues approach to issues consistent.consistent.

Slide courtesy of Teresa Schwab 1/09

ASTDD- Infrastructure ASTDD- Infrastructure Development ToolsDevelopment Tools

Surveillance MethodologiesSurveillance Methodologies Policy and Systems StrategiesPolicy and Systems Strategies Best Practices ModelsBest Practices Models

Policy: Coalitions, Oral Health Plans, Policy: Coalitions, Oral Health Plans, MandatesMandates

State OH Program Review ManualState OH Program Review Manual Core functions, competencies and Core functions, competencies and

activitiesactivities http://http://www.astdd.org/index.phpwww.astdd.org/index.php

State &Territorial State &Territorial Dental Public Health ActivitiesDental Public Health Activities

Best Practice ApproachesBest Practice Approaches

State Promising PracticesState Promising Practices

Infrastructure Development (including Infrastructure Development (including coalitions)-Nevada and other CDC coalitions)-Nevada and other CDC funded states – AK, CO, AR, IL, SC, TXfunded states – AK, CO, AR, IL, SC, TX

Kansas – Philanthropic funded coalition Kansas – Philanthropic funded coalition and state Oral Health initiativeand state Oral Health initiative

Massachusetts – Special legislative Massachusetts – Special legislative commission on Oral Healthcommission on Oral Health

New Mexico – Tax considerations for New Mexico – Tax considerations for dentists dentists

State Promising Practices (2)State Promising Practices (2)

State Oral Health Plans (NV, ME, IL, KS)State Oral Health Plans (NV, ME, IL, KS) Statutory Mandate for State Oral Statutory Mandate for State Oral

Health Program (some w/ definitions Health Program (some w/ definitions for state dental director or dental for state dental director or dental officer) - Iowaofficer) - Iowa

Maryland – Dental Action Committee Maryland – Dental Action Committee convened by Secretary of HMH in convened by Secretary of HMH in response to Deamonte Driver; state response to Deamonte Driver; state funding for infrastructure and funding for infrastructure and increasing accessincreasing access

Statewide Efforts to Expand Statewide Efforts to Expand Access to Care for Young Access to Care for Young

ChildrenChildren Washington ABCD ProgramWashington ABCD Program

Training for general dentists to treat very young Training for general dentists to treat very young childrenchildren

Enhanced reimbursement (XIX) Enhanced reimbursement (XIX) North Carolina “North Carolina “Into the Mouths of Into the Mouths of

BabesBabes”” Prevent ECE by reimbursing peds, FPs, CHCs for Px Prevent ECE by reimbursing peds, FPs, CHCs for Px

and referrals for dental careand referrals for dental care Partners: NCAP, NCAFP, NCDS, NCAPD, UNC, NCDM, Partners: NCAP, NCAFP, NCDS, NCAPD, UNC, NCDM,

NCDPHNCDPH California First 5 InitiativeCalifornia First 5 Initiative

Training for general dentistsTraining for general dentists Training for primary care providersTraining for primary care providers

Nevada State Oral HealthNevada State Oral Health

19991999 – Report of Governor’s Advisory Board – Report of Governor’s Advisory Board(rec’ds, redirect MCH Title V grant)(rec’ds, redirect MCH Title V grant)

20022002 – CDC Grant, Series of Regional Summits – CDC Grant, Series of Regional Summits (formed coalitions)(formed coalitions)

20042004 – Summit 2.0, More representative state – Summit 2.0, More representative state OH OH plan keyed to HP2010/SG OH Reportplan keyed to HP2010/SG OH Report

20052005 – Summit 3.0, special focus on non- – Summit 3.0, special focus on non-urban urban areas/regional plansareas/regional plans

20082008 – Evaluation and Summit 4.0 re: 2004 – Evaluation and Summit 4.0 re: 2004 plan, plan, 4 policy work groups : change 4 policy work groups : change perceptions perceptions & increase awareness; & increase awareness; expand prevention; expand prevention; improve access; improve access; assure dental workforce; assure dental workforce; and, renewal of and, renewal of competitive CDC grantcompetitive CDC grant

Oral Health Kansas Oral Health Kansas SponsorsSponsors

Blue Cross and Blue Shield of Kansas Blue Cross and Blue Shield of Kansas Foundation Foundation Delta Dental Plan of Kansas Foundation Delta Dental Plan of Kansas Foundation Health Care Foundation of Greater Kansas CityHealth Care Foundation of Greater Kansas CityKansas Council on Developmental DisabilitiesKansas Council on Developmental DisabilitiesKansas Dental AssociationKansas Dental AssociationKansas Dental Charitable Foundation Kansas Dental Charitable Foundation Kansas Health FoundationKansas Health FoundationKansas State Office of Oral HealthKansas State Office of Oral HealthSunflower FoundationSunflower FoundationThe REACH Health Care Foundation The REACH Health Care Foundation United Methodist Health Ministry Fund United Methodist Health Ministry Fund

Framework for South Carolina Framework for South Carolina More Smiling Faces ProjectMore Smiling Faces Project

Integrated Network:Integrated Network:• Dental • Medical• CHCs• Churches/Faith Groups • School/Preschool • Programs

Community Education:Community Education:Consistent OH MessagesConsistent OH Messages

Pediatric OHPediatric OHTraining: Training: • Medical providers• Dental providers

Outreach to Medical Home: Outreach to Medical Home: Integrate OH promotion and diseaseprevention into the medical home

System Linkage:System Linkage:• Patient navigator links• Link medical homes

with dental providers• Link patients to

resources• Screen for Medicaid or

insurance eligibility• Arrange transportation

for target population

Local Local Advisory Advisory

CommitteeCommittee

Combining Resources for Improved Oral Health for Children

Slide courtesy of Christine Veschusio

STATE

Adjustments Made to Medicaid

Rates (Market-based

Benchmarks)

Changes in Dentists’ Participation in

Medicaid Following Rate Increases

Intervals (mos.) Between Rate Increases and

Changes in Provider

Participation

Alabama 100% of Blue Cross rates

+39% 24

Delaware 85% of each dentist’s submitted charges

From 1 private dentist to 108

(of 302 licensed dentists)48

Georgia 75th percentile of dentists’ fees

+546% (to 1,674 of 4,000)

27

Indiana 75th percentile of dentists’ fees

+58% 54

Michigan (Healthy Kids

Dental Program)

100% of Delta Dental Premier rates

+300% 12

South Carolina 75th percentile of dentists’ fees

+73% 36

Tennessee 75th percentile of dentists’ fees

+60% 4

Virginia 30% increase >+30% 12

State Medicaid Dental Program Changes State Medicaid Dental Program Changes (2007)(2007)

Minnesota Oral Health Minnesota Oral Health Landscape – SWOT AnalysisLandscape – SWOT Analysis

Strengths Strengths

Efforts of stakeholders and Efforts of stakeholders and partners convening to partners convening to proactively define and proactively define and address issues affecting oral address issues affecting oral health in Minnesotahealth in Minnesota

SWOTSWOTWeaknessesWeaknesses

The extent of the access The extent of the access problem and continuing/growing problem and continuing/growing reservoir of needreservoir of need

Emerging SOHP and no broad Emerging SOHP and no broad based, cohesive state oral based, cohesive state oral health advocacy entity and health advocacy entity and need to define future pathneed to define future path

SWOTSWOT“Threats” or Challenges“Threats” or Challenges

A very challenging state economy A very challenging state economy and infrastructure constraintsand infrastructure constraints

Provider issues, including aging Provider issues, including aging cohort and inadequate cohort and inadequate replacementsreplacements

Distribution of workforce vs. Distribution of workforce vs. population population

Growing diversity of populationGrowing diversity of population

SWOTSWOTOpportunitiesOpportunities

New five-year CDC grant to Minnesota New five-year CDC grant to Minnesota Department of Health for Oral Health Department of Health for Oral Health Infrastructure Enhancement and Program Infrastructure Enhancement and Program ImprovementImprovement

Build on the commitment and hard work Build on the commitment and hard work of key stakeholders to deploy new of key stakeholders to deploy new strategies and to enhance existing ones strategies and to enhance existing ones to address the issues in oral healthto address the issues in oral health

New provider models to enhance accessNew provider models to enhance access Broaden the circle of partners and Broaden the circle of partners and

cultivate consensus “agenda”cultivate consensus “agenda”

SWOT … then what?SWOT … then what?

SWOTSWOT(systematic assessment) (systematic assessment)

PrioritiesPriorities

(importance/impact vs. changeability)(importance/impact vs. changeability)

Goals, Objectives, OutcomesGoals, Objectives, Outcomes(process and effect, time-framed, measurable, realistic) (process and effect, time-framed, measurable, realistic)

Action Steps, Activities, ResourcesAction Steps, Activities, Resources

(intentional actions and implementer)(intentional actions and implementer)

Evaluation Evaluation

Active Coalition + Partnerships and Active Coalition + Partnerships and Collaborations Collaborations

= More Direct Path to Improved Oral = More Direct Path to Improved Oral Health Health

for the People of Minnesotafor the People of Minnesota

Thank you!Thank you!reglouie@sbcglobal.netreglouie@sbcglobal.net