1. Weaving a Strong Safety Net: Oral Health Care Access
Presentation to the HDC 2005 National Primary Oral Health Care Conference
Weaving a Strong Safety Net:
Health Centers and
Oral Health Care Access
Donald L. Weaver, MD
Assistant Surgeon General
Deputy Associate Administrator
U.S. Department of Health and Human Services
Health Resources and Services Administration
Bureau of Primary Health Care
August 8, 2005

2. comprehensive, culturally competent, quality care.
HRSA Strategic Plan
Improve Access to Health Care
Improve Health Outcomes
Achieve Excellence in Management Practices
Enhance the Ability of the Health Care System to Respond to Public Health Emergencies
Access to
comprehensive, culturally competent, quality care.
Improve the Quality of Health Care
Improve the Public Health and Health Care Systems
Eliminate Health Disparities

3. HRSA Supported Programs Weaving a Strong Safety Net
Future Partnerships
Future Partnerships
Consolidated Health Center Program
Primary Care Associations
Health Center Controlled Networks
Primary Care Offices
RESEP*
Access to
comprehensive, culturally competent, quality care.
Health Disparities Collaboratives
Minority and Special Populations
Healthy Communities Access Program
Black Lung Clinics
National Partners
National Hansen’s Disease Program
Future Partnerships
Future Partnerships
Native Hawaiian Health Care
*Radiation Exposure Screening
and Education Program

4. Goal: Improve Access to Care Health Center Program – CY 2004
13.1 Million served
52.3 Million patient encounters
51.4% Rural Centers
48.6% Urban Centers
3,651 comprehensive service sites
Source: Uniform Data System, 2004

5. Health Center Program – CY 2004
Who We Serve
63.5% are Racial/Ethnic Minority
726,813 Migrant/Seasonal Agricultural Workers
703,023 Homeless Clients
Serve all ages:
Source: Uniform Data System, 2004

6. Health Center Program-CY 2004: Who We Serve
Source: Uniform Data System, 2004; Census Bureau, Health Insurance Coverage in the U.S., 2003, Aug. 2004

7. Goal: Improve Access to Care President’s Health Centers Initiative
NAP – New Access Point
EMC – Expanded Medical Capacity

8. Goal: Improve Access to Care Expanding Oral Health Access
210 New or Expanded Oral Health Service Awards since the start of the President’s Initiative
In 2004:
66% of health centers provided onsite preventive dental services*
82% of health centers provided preventive dentistry either on site or by referral.
43% provided dental rehabilitative services onsite, up from 37% in 2003.
*Healthy People 2010 defines on-site dental programs as those organizations with 0.5 or more Dentist FTEs or 500 or more dental encounters.

9. Percent of Health Centers Offering Dental Services Onsite* 1999 to 2004
Source: Uniform Data System
*Healthy People 2010 defines on-site dental programs as those organizations with 0.5 or more Dentist FTEs or 500 or more dental encounters.

10. Goal: Improve Access to Care Oral Health Encounters and Staff
Overall: 52.3 million Medical Encounters, 6% increase from 2003
Dental Encounters: 5.13M; 15% increase
Dental Users – m; 14% increase
Dentists/Hygienists – 2,134; 13% increase

11. Health Centers Dental Users 1999 to 2004

12. Health Centers Dental Encounters 1999 to 2004

13. President’s Initiative to Expand Health Centers
By 2006:
1,200 new or expanded health centers
6 million additional people served
Workforce Needs
Health Centers need 36,000 new staff including:
11,000 clinicians; 3,100 MDs; 4,000 nurses; 1,700 NPs, PAs, CNMs; 600 DMDs; 200 dental hygienists; 900 mental health & substance abuse specialists; 900 other health professionals
Demand for health professionals will grow at twice the rate of all other occupations
Nation can anticipate overall physician shortages and shortages in nursing and pharmacy

14. HEALTH CENTERS: SOURCES OF FUNDING (CY 2004)
Self Pay 6%
Other Federal 3%
Other 3rd Party 6%
Other Public 2%
Medicaid
36%
Medicare 6%
State/Local/Other
19%
Federal HC Grant
22%
Source: Uniform Data System, 2004

15. Goal: Achieve Excellence in Management Practices Medicaid & Health Centers
Medicaid enrollment grew by 5.2 percent in FY 2004 and is expected to grow by 4.7 percent in FY Enrollment also grew among seniors and people with disabilities whose health care needs are greater and substantially more costly than low-income families.
Between 2002 and 2005, all states reduced provider rates and implemented prescription drug cost controls, 38 states reduced eligibility, and 34 states reduced benefits.
Sources: State Fiscal Conditions and Medicaid Kaiser Commission on Medicaid and the Uninsured, The Henry J. Kaiser Family Foundation, publication (#7220), November, 2004.

16. Consistent Performance
Goal: Achieve Excellence in Management Practices Health Center High Quality Care
Consistent Performance
Cost of treating Health Center Medicaid patients is 30-34% less than cost for those receiving care elsewhere; 26-40% lower for prescription costs; 35% lower for diabetics; 20% lower for asthmatics. Center for Health Policy Studies. Final Report; November 1994.
Health Center Medicaid patients are 22% less likely to be hospitalized for potentially avoidable conditions than those obtaining care elsewhere. Falik et al. Medical Care Vol. 39, No 6; 2001.
Health Center Medicaid patients are 11% less likely to be hospitalized for potentially avoidable conditions than those with a usual source of care who obtained care elsewhere. ACSC II Study Accepted for Publication, Journal of Ambulatory Care Management