school-based oral health programs operated by health …
TRANSCRIPT
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School-Based Oral Health Programs Operated by Health Centers
Irene V. Hilton, DDS, MPH Dental Consultant National Network for Oral Health Access Karyl Patten, DDS, MPH Dental Director Whitefoord, Inc. November 24, 2014
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Objectives 1. Describe different school-based models for providing
dental services to underserved children.
2. List sources of start-up funding for school-based oral health programs
3. Summarize the major payer categories that cover the cost of providing school-based dental care in Health Centers.
4. Describe strategies to address common operational issues in school-based dental programs.
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Background
Increase in Health Center inquiries
ACA support for school-based health centers
Strategy to reach vulnerable populations
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Health Center School-Based Dental Programs Little is known
2011 UDS data- 280/1,128 (25%) Health Centers provide services in schools
National Association of School-Based Health Centers Survey- Health Centers run 33% of school clinics
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Survey Results
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Sample
280 Health Centers with SBHC Programs
62 Completed Surveys (22%)
29 States
All 10 HRSA Regions
76% Provide Medical and Dental Care
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Dental Program Size
# Schools
• Average 12 sites
• Range 1-74 sites
• 64% 10 or fewer sites
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Number Students Served
Children
• Average 1,900
• 61% 1,000 or fewer
• Two Health Centers 9,000+
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Months Operation
57% 9/10 months
38% 11/12 months
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Delivery Models Model % Health
Centers
Portable 41.9
Fixed Clinics
27.4
Mobile Vans
8.1
Multiple 22.6
27.4%
8.1%
41.9%
22.6%
Fixed Site Only
Mobile Van Only
Portable Only
Multiple Models
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Dental Service % Health Centers Providing
Education 95%
RDH Screen Exam 53
DDS Exam 81
RDH Exam 27
Radiographs 64
Prophys 79
Sealants 81
Fluoride Varnish 89
General Care 53
Specialty Care 14
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Percentage of Students Served, by Grade
Grade Range % of Students
Preschool 12.9
Elementary (grades K-5 ) 50.2
Middle (grades 6-8) 17.9
High (grades 9-12) 18.9
Other 0.1
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Payers
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Focus Group Recommendations
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Staring a School-Based Program
Assume management of existing school-based oral health programs in the local community- local charities, hospitals, or school districts
• Billing infrastructure, economies of scale
• PPS rate
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Staring a School-Based Program
Contact local schools or school districts to assess interest in partnering to develop a school-based oral health program
Health Centers are approached to collaborate
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Financing Start-up Expenses
When assuming control of an existing school-based oral health program, utilize existing equipment and other operating resources already present.
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Financing Start-up Expenses
Grants
• HRSA
• State offices of rural health
• State or county programs targeting children’s needs
• City or county health department
• Local school districts
• Local foundations and other private grants
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Enrolling Students
Implement at the beginning of the school year.
Include information about oral health services and consent forms with materials given to families when enrolling or registering children for new school year.
Back-to-school nights and parent orientations.
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Enrolling Students
Continue enrollment during school year where program staff interact with parents.
• Registrar’s office
• Parents dropping children off morning
• School sports events
• Major school events
• PTA meetings
• Parent-teacher nights.
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Obtaining Consent
Combine consent for all types of services-primary care, oral health, vision, and behavioral health, on one form.
Use outreach coordinators to increase program enrollment and manage relationships.
Incentive programs- reward classroom returning most enrollment/consent forms.
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Obtaining Consent Traveling Programs
Distribute consent packets at the beginning of school year and then follow up with a second batch at schools scheduled for spring
Distribute consent forms 2-6 weeks before the traveling program’s visit , sending packets home with “backpack mail”
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Operating During Non-School Hours/Months
Move mobile vans or portable equipment to other community locations
• HC sites that do not offer oral health services
• Head Start sites, migrant worker facilities
• Homeless shelters, nursing homes
• State division of youth services residential facilities
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Referrals & Care Coordination Prevention-Only Programs
Send letters to parents of children that need restorative care and follow up with calls to the parents by program staff.
Schedule students needing restorative care into the main Health Center dental schedule through a shared HIT appointment system.
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Referrals & Care Coordination Fixed Programs
Goal of minimizing referrals
• Important in rural schools, high schools
Oral surgery, endodontics, and pediatric behavior management most common
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Recordkeeping & Billing
Bill at the time of service in programs where the school-based dental software and the main Health Center billing system are integrated.
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Recordkeeping & Billing
Programs with dental software that does not interface with the main Health Center billing system
• Paper encounter form sent to the main Health Center for manual entry
• Encounter data sent electronically to the main Health Center for re-entry into the billing system.
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Community Challenges
Pushback from local dentists
• Does not appear to be a barrier to program functionality at the local level.
• Felt private-sector dentists need education that school-based program target students not receiving services in private dental practices.
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“The Future is Very Bright” Several plan to double the number of schools
& increase the number of school districts
Programs continue to receive requests from other school districts to provide oral health services for their students.
Programs plan to expand the scope of services offered and/or to incorporate services for adults.
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Whitefoord Inc.
Whitefoord Elementary School
Coan Middle School
Maynard Jackson High School
Crim High School
Karyl C. Patten, DDS, MPH
Dental Director
Assistant Professor Emory University
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School Based Description
• Number of schools: 4
• Number of children: 1,323
• Type of program: Fixed Clinic
• Grades served: Pre-school through HS, adults
• Open: Year round
• Services: Full scope of service
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How the Program Started….
the Vision
In 1995, Dr. George Brumley and his former
student, Dr. Veda Johnson, established
Whitefoord, Inc. to address the health and
educational needs of children and families of
the Whitefoord Elementary School District in
southeast Atlanta
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Partners
• United Way of Metro Atlanta
• Best Buy Foundation
• Bright From the Start
• Fulton County “Fresh”
• Health Resources and
Service Administration
• Georgia Department of Health
and Human Services
• The Georgia Association For
Primary Health Care
• Zeist Foundation
• National Association for the
Education of Young Children
• Georgia State University
• School-Based Health Alliance
• Emory University
• Chris Kids
• Atlanta Public School
• National Association of
Community Health Centers
• Atlanta Speech School
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Funding Capital Equipment and/or
Clinic Build-out Expenses
School Grants
Federal Grants-HRSA 95%
In-kind Donations- (architect, desks, etc.)
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Clinic Protocols • Consent process:
School registration, screening, PTA
• Clinical chart documentation process:
Open Dental (eClinical Works)
• Referral process:
FQHC and private providers
• After/non-school hours emergency resource:
Grady Hospital
• Interdisciplinary collaboration:
Primary care clinic-on site
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Finances • Bill for services:
Billing company
• Receive FQHC rate:
YES
• Billing documentation:
Bill at the time of service through eCW
• Payer mix?
Private insurance, sliding fee, Medicaid
95%
• School- based program financial status:
Revenue neutral
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Strategies for Success
• Open year round
• Families like to come because ALL their
health needs are met
• Continuity of care is strategic
• People trust us because we care and it
shows
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Challenges
• Consent forms
• Contact numbers
• Combining medical and dental in electronic health record
• Clinical space development
• APS undergoing changes
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Future
• Redesigning work space for oral health
patients
• Continue to develop and enhance student
training
• Embracing ACA…enrolling new patients in
clinic to making Whitefoord their patient
centered medical home. Engage current
stakeholders while cultivating new
stakeholders and collaborative!
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Whitefoord Elementary Clinic
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Patient Centered Health Home
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Trauma
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Esteem
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Conclusions
Wide variety of delivery models
Main revenues from public insurance
Strategies exist for addressing implementation challenges
HC school-based oral health programs are community supported & successful
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http://www.nnoha.org/nnoha-content/uploads/2014/07/SBHC-Report-FINAL_2014-07-28.pdf
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Join NNOHA NNOHA is a network of safety-
net oral health providers and their supporters committed to improving the health of the underserved.
NNOHA member ($50 individual / $350 organization) benefits include: • Publications
• Technical Assistance
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• Discount to annual conference
http://www.nnoha.org/join/overview/
Save the Date!
2015 NNOHA
Conference
November 15-18, 2015
Indianapolis, Indiana
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Contact Information Irene Hilton, DDS, MPH| Dental Consultant, NNOHA [email protected] Karyl Patten, DDS, MPH| Dental Director, Whitefoord, Inc. [email protected] National Network for Oral Health Access 181 E. 56th Ave, Suite 501 Denver, CO 80216 Phone: (303) 957-0635 www.nnoha.org
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QUESTIONS?