November 20, 2015 Hosted by:

Dr. Nikki Stone, Kentucky Oral Health Coalition Chair

 Are you a dentist?  Are you a nurse?  Are you an K-12 educator?  Are you affiliated with a university?  Are you a social worker?  Are you representing a Managed Care Organization?  Are you a KOHC member?  Other?

To bring advocates for improved oral health together in Kentucky for information sharing, learning, networking, and public policy prioritization.

 Shared understanding of Kentucky’s oral health policy initiatives and landscape.  Improved collaboration and communication among oral health advocates.  Shared agreement on policy solutions to improve access to care.

Keynote by Dr. Michael Glick State of the State of Oral Health in Kentucky Oral Health Champion Awards and Lunch Panel moderated by Bill Goodman Visioning and strategy session Optional – Annual Meeting

The Kentucky Oral Health Coalition (KOHC) is a group of concerned citizens, advocates, and professionals working together to improve oral health across Kentucky.

2001 Kentucky Dental Health Coalition (KDHC) Priorities:  Legislative  Public Awareness & Education  Dental Service Delivery Models  Dental Education Initiatives 2010 Kentucky Oral Health Coalition (KOHC) Priorities:  Oral Health Literacy  School-Based Oral Health  Access to Care

KOHC’s Vision of Impact is to engage PARTNERS across the state to create a collaborative oral health literacy campaign designed to:  Educate PARENTS  Activate POLICY-MAKERS  Inspire Health PROFESSIONALS  Engage the PUBLIC to create optimal oral health for all Kentuckians.

 Participate in social media - #KySmileTeam  Stay for the whole day – we need your expertise  Take your own breaks  Read the Medical News Paper – open it up to the middle – there is an oral health supplement!  Populate the Bright Spots Map  Visit sponsors booths  Become a member of the Kentucky Oral Health Coalition (KOHC)  Network and meet someone new

KOHC Planning Group KOHC Executive Committee KOHC members

“a person who fights for or defends any person or cause” dictionary.reference.com/browse/champion?s=t

Dr. Michael Glick, Professor and William M. Feagans Chair at the School of Dental Medicine, University of Buffalo

Dr. Julie McKee, State Dental Director Lisa Lee, Commissioner of Department of Medicaid Services

Dr. Julie Watts McKee Dental Director

20 Core Mission: To assure oral health for Kentucky. 20

21 Statistics: Decay Rates: % U.S. Children with decay Kentucky rate: currently unknown % of 2-5 year olds in U.S. with untreated decay % of Kentucky children with untreated decay 21

22 Statistics: Access and Utilization 46% of all Medicaid/KCHIP children One dental service 60% of 6-9 year olds received services 40% of all received a preventive service 54% of 6-9 year olds received preventive Oral Health Service by a non-dentist provider Physicians Health Departments Nurses Hygienists

23 Statistics: Preventive Services Fluoride Varnish % reduction in smooth surface decay. Last year: 22,000 in local health deparments Smiling Schools: 17,000 this year Public Health Hygiene 7 sites 30,000 services 4,600 patients

24 Statistics: Behavioral Risk Factor Surveillance System High rate of extractions 7 th highest in adults with an extraction Dental Visits 42 nd in the nation (not good) 60% of adults with a dental visit 7 th in edentulism in senior Kentuckians. This is an improvement over the years

25 Statistics: Dental Workforce Deloitte Report Rural areas need dentists Jefferson County needs 150 more dentists Maldistribution 435,000 newly covered mouths Few new providers 13 new dentist license in Appalachia

26 Statistics: Water Fluoridation Reduces decay between 40 and 50% 99.8% of Kentuckians have optimally fluoridated drinking water. Highest covered state Washington, DC at 100% New regulations 0.7 Parts Per Million

27 Key Stakeholders: Health Departments Specific Funding Varnish Sealants Hygiene Programs Special Projects Medicaid Reimbursements

28 Key Stakeholders: Dental Schools University of Kentucky Outreach Varnish Supplies Special Projects University of Louisville Special Projects Collaboration is evident

29 Key Stakeholders: Appalachia Smiling Schools

30 Key Stakeholders: Boards and Associations Kentucky Board of Dentistry Kentucky Dental Association

31 Key Stakeholders: Water Plants Regulatory Responsibility Monitoring Reporting Technical Assistance

32 Emerging Issues: Data Collection University of Kentucky Prevalence Study Early Learners Delta Dental Prevalence Study Third and Sixth Graders University of Louisville On-Going Surveillance System

33 Emerging Issues: PH Hygienists Seven Pilot Programs Start up funding Looking for two more Electronic Health Records Dental is the Canary

34 Emerging Issues: Increased Decay Rates in Early Childhood Permanent Teeth Decay Rates (Nationally) Dropping Slowly Primary Teeth Decay Rates (Nationally) Slight, but significant increase Kentucky? We’ll see

35 Emerging Issues: Teledentistry Oral Health Interested in developing network Involves dental schools Involves private dentists

36 Emerging Issues: Workforce Distribution Possible maldistribution? Medicaid Expansion Leads to delay or avoidance of care

37 Emerging Issues: Community Dental Health Workers Community Dental Health Coordinator Reduces care Reduces impact Proven in other areas of patient navigation and education

38 Emerging Issues: Adult Dentures Significant Increase in Medicaid Extractions Pent Up Dental Need in Expansion Patients Dentures Employability Better Nutrition

39 Program Cost Effectiveness: Community Water Fluoridation Annual per-person cost savings $16-$19 a year Kentucky Saves $69 Million a year

40 Program Cost Effectiveness: Fluoride Varnish 20% reduction shown in Kentucky projects Varies on the studied parameters

41 Program Cost Effectiveness Sealants Evidence Based Procedure After two years $53 Oregon 1313% in 20 years $125 cost of filling-avoided If avoided, PH RDH has avoided $987,164

42 The Future of Oral Health Nationally Provider numbers Stable Decreasing Increasing State Keep on striving for the best oral health status for all Kentuckians

K ENTUCKY Cabinet for Health and Family Services Kentucky Department for Medicaid Services Lisa D. Lee, Commissioner November 20, 2015

44 Medicaid at a Glance 1.3 Million Members Managed Care Delivery System ACA Changes Medicaid Expansion State Based Exchange – kynect Streamlined Eligibility and Enrollment

45 Medicaid Enrollment

46 Expansion Demographics Average age = 38 Evenly distributed between males and females Under 138% of Federal Poverty Level - $16,105 per year Health Status –High Cholesterol –Diabetes –COPD –Asthma –Depression

47 Overview of Selected Preventive Services Relative Increases in number of Medicaid screenings Pre-Expansion (2013) vs. Post-Expansion (2014) Smoking Obesity- Metabolic Cancer Cardio- vascular Dental MH Drug & Alcohol Overall Exams *Based Medicaid Claims Data

48 Adult Preventive Dental Visits % 85,779 More Received Preventive Services

49 Medicaid Paid Dental Services by Category SFY2009SFY2010SFY2011SFY2012SFY2013SFY2014SFY2015 CategoryTotal Spend Checkup/oral Evaluation$9,588,344$11,421,513$12,565,091$8,993,894$10,353,870$11,976,471$13,723,578 Dentures$110,174$99,388$115,992$62,763$41,709$41,652$44,361 Extractions$17,088,917$17,493,869$18,369,086$12,633,457$13,500,062$17,770,223$23,581,249 Gum Treatment/Gingivectomy /Debridement$3,188,629$3,351,197$3,687,230$2,134,566$1,682,975$2,280,412$4,094,162 Other$19,775,079$23,614,684$24,614,556$15,597,318$18,345,909$22,543,234$27,478,381 Preventive/Sealants/Clea nings$15,785,138$19,698,002$21,470,772$16,909,144$21,974,170$23,190,664$24,041,463 Prosthesis$17,163$15,962$15,857$8,991$4,137$2,344$777 Pulp Cap/Root Canal$4,278,946$4,252,226$4,077,407$2,860,812$3,083,581$2,944,465$2,929,443 Restoration/Crowns$5,026,268$5,578,092$6,009,033$4,317,920$5,228,747$5,717,563$6,240,392 Restoration/fillings$27,551,645$30,243,809$30,301,185$22,684,698$26,453,088$28,352,284$33,621,099 Space Maintainers/Retainers$796,420$872,668$907,706$653,071$776,400$714,259$617,649 Xrays/Bitewings/Panora mics$10,569,464$12,563,327$12,886,825$9,487,499$11,618,814$13,514,228$16,224,307 Grand Total$113,776,187$129,204,737$135,020,739$96,344,131$113,063,462$129,047,799$152,596,860

50 Number of Medicaid Members Receiving Dental Services SFYDistinct Member Count (Under Age 19 Only) , , , , , ,171 SFYDistinct Member Count (All Ages) , , , , , ,380

51 SFY 2007SFY 2008 Distinct Members Rcving Dental Service 172,589191,725 Distinct Members Enrolled During Timeframe 466,939482,659 Percent Utilizing37%40% What Happened When Kentucky Raised Dental Rates for Children by 30%?

52 Summary Dental Health is Important to Physical Health Not Everyone has Dental Insurance Medicaid Covers 1.3 Million Members Medicaid Expansion Covers 427,000 People Medicaid Paid $152 Million in Dental Claims in SFY2015 Raising Dental Reimbursement Rates Did Not Appear to Result in a Large Increase in Utilization for Children Policy Changes Impact Services

A lunch buffet will by served at the adjacent room. Please grab your lunch and we will move into the awards session.

Moderated by Bill Goodman, KET

Bios located in the Program *Senate Republicans on the Health and Welfare Committee were not available on this date to participate on the panel

Facilitated by: Lacey McNary

 Work collaboratively to draft a roadmap for Kentucky to move the needle forward in oral health in the next two – five years.  Share thoughts, ideas, proposals, and counterproposals.  Prioritize ideas.

“This is the task before us, to design the systems and platforms for coordinated effort.” Clay Shirkey

1.On your table, you will see a poster, markers, and post it notes. 2.Our goal for the remainder of the time we are together is to work together to identify goals and if possible actions for each priority area listed down the side. 3.For each priority area, you will work individually first to write down goals and activities on the sticky notes that YOU would like to contribute. When you are done post them on the poster at your table. 4.When all people at your table have put their sticky notes on the poster, begin to work TOGETHER to determine what your table wants to contribute to this exercise. 5.Since there are so many areas – the side of the room closest to the sponsors tables starts at the top and the other side of the room starts at the bottom. 6.You will have an hour to work. Each table works at their own pace. It is okay if you do not finish the whole poster – get as far as you can together. Try to move as quickly as possible.

Quickly. Please.

Stop by the posters and have a discussion with a colleague before you leave We will transcribe and share themes.

Thank you to all Stop by the bright spots maps and posters Become a member – staff will be with an Ipad to assist you CEUs Invite to Annual Meeting

 Updates on accomplishments  Bylaws changes  Vote on new steering committee members

 Communications – Mahak Kalra  Membership – Mahak Kalra  Funding – Nikki Stone  Workgroups

Growth since last meeting: Facebook Likes: from 249 to 805 Facebook Twitter Followers: from 159 to 480 Twitter Pinterest: from 22 to 88 followers Pinterest Goals for 2015: 500 Facebook likes Twitter Followers 75 Pinterest Followers

 Goals for upcoming year: Grow KOHC List Serve to 400 Individuals Continue listerve messages Regularly update website with current oral health related happenings in the events section. Accomplishments since last annual meeting: KOHC List Serve Distribution list of 482 Monthly messages KOHC Blog Posts

 Accomplishments since last annual meeting: Attended 6 Kentucky Meetings to Promote KOHC Represented KOHC at 6 National and Regional Meetings Goals for upcoming year: Continue to grow and expand the Oral Health network within our state Continue to expand Kentucky Oral Health Coalition’s presence in the national scene

1. Promote Smiles for Life Curriculum 2. Provide technical support for oral health literacy training sessions for parents across Kentucky 3. Expand the oral health network at the national, state, and local level

1. Enhance the kindergarten oral health screening process, awareness, and data collection. 2. Encourage schools to promote oral health prevention. 3. Support expanded role of hygienists.

1. Promote collaboration between managed care organizations and oral health advocates 2. Increase reimbursement for dentists 3. Encourage dental professionals to become Medicaid providers

 Only dues paying members can vote. If you are unclear about your status, let us know.  Only one vote per organizational member.  We will have 3 votes today.

 An officer term will be from 1 year to 2 year terms.

 We will eliminate the current positions: Vice Chair, Secretary, and Treasurer.  The Executive committee will now comprise of Past Chair, Chair, and three Workgroup Chairs.

CURRENT SLATE  Chair – _______________  Access to Care - Stacy Trowbridge  Oral Health Literacy - Dr Laura Hancock Jones  School Based Oral Health - Eva Stone  NOMINATIONS?

Do we need to include by-laws to allow / disallow corporate representation on the steering committee? This would include serving as Chair or Chairs of the 3 workgroups.

 Oral Health 2020 proposal – Nikki Stone  Surveillance Project - Mahak Kalra  2016 Legislative Session – what is on the horizon?

The three components of the proposal include:

 WHO? Kentucky Youth Advocates will oversee the 18-month project.  WHAT? The surveillance model has two basic components: 1) direct observation to a child’s mouth and 2) parent questionnaire that provides consent, dental and medical insurance information, and other general information about the child.  project is intended to screen 3 rd and 6 th graders.  WHERE? 60 target schools across the state to participate in the surveillance project.  WHY?  We know what gets measured often leads to change. The most recent children’s oral health surveillance in Kentucky was completed in  Provide a landscape of the oral health status of Ky’s 3 rd and 6 th population.

Group Picture?