1. ORAL HEALTH INFRASTRUCTURE ENHANCEMENT FEASIBILITY ANALYSIS Project Update to DHCC November 5, 2009 Source: John Snow, Inc. presentation to Steering Committee on August 3, 2009

2. Approach:  Phase I, II - completed  Phase III & IV  Agree on most promising initiatives  Develop detailed business and operational plans (Including identification of partners and collaborators)  Conduct feasibility assessment (Sensitivity analysis and testing assumptions)  Final reporting and presentation (Including written and oral presentation)

3. Guiding Principles  Need for coordinated / systematic approach  Focus on most vulnerable  Pragmatic response that is inclusive of all stakeholders  Builds capacity and strengthens workforce  Involves the private sector overtime  Incorporates patient-centered approach  Aware of provider concerns and business realities

4. Update on Stakeholder Interviews (examples…)  Hospitals in Sussex County  Private dentists in Sussex County  Delaware Dental Society  DIDER Board of Directors  Dental Hygiene Clinic in Wilmington, DelTech  State Medicaid Office  La Red Health Center  Stockley Center  Delaware Healthcare Association

5. Preliminary Key Findings & Draft Recommendations   Multi-Purpose Clinic   Downstate Residency Program   Case Management Program

6. Multi-Purpose Clinic  Support La Red Community Health Center (Designated FQHC) with its on-going efforts to develop primary care dental operations  Once up and running, La Red could work with various stakeholders to implement training activities starting in years 3 or 4 –Community-based residency program in collaboration with Sussex County hospitals –Dental hygienist training site with DelTech hygiene program students residents of Kent and Sussex Counties –Dental assistant training site with Sussex County vocational schools

7. Downstate Residency Program  General Practice Residency sponsored by Sussex County hospital w/ community- based clinical co-sponsor –Bayhealth, Beebe, or Nanticoke Hospital would be primary applicant (Could be collaborative effort between 2 or more hospitals) –La Red CHC would be clinical co-sponsor –Wilmington-based GPR would play supportive role –Sussex / Kent County private dentists and medical doctors would play supportive role

8. Statewide Case Management Program  Work with La Red CHC to case manage existing medical patients to obtain dental care.  Once established, work with the Public Health Clinics, area schools, and other organizations (as appropriate) to case manage children –Coordinate respective outreach within area schools –Collaborate to assist in providing treatment to high need children and facilitating a dental home for ongoing preventive care

9. Next Steps  Wrap-up and Finalize:  detailed business and operational plans (Including identification of partners and collaborators)  feasibility assessment (Sensitivity analysis and testing assumptions)  final report and presentation (DIDER, Steering Committee, & DHCC) (Including written and oral presentation)  Action – Approve contract extension until May 30, 2010 to wrap-up project activities and JSI presentation on recommendations and findings to DIDER Board (Dec) and DHCC (Feb)