Medical-Dental-Behavioral Integration: One Health Center’s Example Integrating Oral Health into Primary Care Practice to Increase Access to Care Kym Taflinger, Chief Analytics Officer Beth West, DBH, LISW-S, Chief Operations Officer Health Partners of Western Ohio July 25, 2016

Objectives  Review the characteristics of health centers with successful integration  Understand the systems that support integration  Describe one model of how patient care can be structured to incorporate multiple disciplines  Give examples of how patients benefit from this care model

Background

2000 Surgeon General & 2011 IOM Reports

U.S. Preventive Services Task Force Recommendations – May 2014  Primary care clinicians prescribe oral fluoride supplementation starting at age 6 months for children whose water supply is deficient in fluoride  NEW! Primary care clinicians apply fluoride varnish to the primary teeth of all infants and children starting at the time of primary tooth eruption to prevent dental caries in children from birth through age 5 years

Medicaid & Private Insurer Payment  Medicaid in 49 states reimburse PCPs for assessment and/or FV placement  Commercial medical insurance plans benefit

2005- Oral Health Disparities Collaborative Pilot Implementation Manual Oral Health & the Patient Centered Health Home: Action Guide content/uploads/2013/09/PCHHActionGuide02.12_final.pdf Implementation-Manual-with-References.pdf

2014 HRSA Integration of Oral Health and Primary Care Practice (IOHPCP) Initiative  Develop oral health core clinical competencies for primary care clinicians  Translate into primary care practice in safety net settings Goal:  Improve access for early detection and preventive interventions leading to improved oral health

Integration of Oral Health and Primary Care Practice Initiative  Oral Health Core Clinical Competency Domains 1.Risk assessment 2.Oral health evaluation 3.Preventive interventions 4.Communication & education 5.Interprofessional collaborative practice  Primary Care Providers MD/DO Certified Nurse Midwives Nurse Practitioners Physician Assistants

A User’s Guide for Implementation of Interprofessional Oral Health Core Clinical Competencies Systems that Support Integration  Training system  Health information system  Clinical care system  Evaluation system

Characteristics of Success  Leadership Vision & Support  Integrated HC Executive Team  Co-location  Organizational Culture of Quality Improvement  Staff Buy-in: Understanding the “Why”  Champions  Bonus: Integrated EHR system

Integrating Oral Health into Primary Care Practice Health Partners of Western Ohio Kym Taflinger Chief Analytics Officer Beth West, DBH, LISW-S Chief Operations Officer

Bryan Community Health Center Defiance Community Health Center Dr. Gene Wright Community Health Center New Carlisle Community Health Center Kenton Community Health Center Spartan Health Center Health Partners Quick Care Tiffin Community Health Center Tiffin Community Health Center - Dental Tiffin Community Health Center - Firelands Health Partners of Western Ohio

Health Partners of Western Ohio Number of Patients

Health Partners of Western Ohio Number of Visits

Services

Electronic Health Record

Integrated Model of Care

Why Integrated Care?

The “Triple Aim”

Dental Integration Medical Behavioral Health Chiropractic

Early Childhood Oral Health Project

Adult Fluoride Varnish Applications During Medical Visits Dentists Providing Oral Health Education to Medical, Behavioral Health, and Pharmacy Providers EHR Template Revisions Policy/Standing Orders Changes Medical Front Desk Scheduling Dental Appointments Providing Oral Health Education to Patients in the Medical Waiting Area (Once/Month) Oral Health Core Clinical Competency Pilot Project

HPWO Medical Assistant & Dental Assistant Providing Education in Waiting Shared Room

EMR Template Revision

Distributing Oral Health Kits to Patients During Medical Visit Medical Providers and Support Staff Observing Dental Operations/Procedures in Dental Area Dental Staff Observing Medical Operations/Procedures in Medical Areas Additional Activities

2014 Proportion of Medical Patients Receiving Dental Services *Based on 2014 Uniform Data System Report

2014 Percentage of Patients Receiving Depression Screenings *Based on 2014 Uniform Data System Report

Contact Information Kym Taflinger Chief Analytics Officer Website: Like us on Facebook: Beth West, DBH, LISW-S Chief Operations Officer

Conclusion “You cannot have good health if you have bad teeth”

NNOHA 2016 Annual Conference Nov 6-9 Sheraton Denver Downtown Hotel “Celebrating 25 Years of Advancing Oral Health Access” 36

Contact Us! National Network for Oral Health Access Questions?