National Oral Health Expenses Oral Health Care for People with - - PowerPoint PPT Presentation

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Paul Glassman DDS, MA, MBA Professor and Director of Community Oral Health University of the Pacific School of Dentistry San Francisco, CA pglassman@pacific.edu

Pacific Center for Special Care at the University of the Pacific Arthur A. Dugoni School of Dentistry

Disclosures

• The speaker has nothing to disclose

Pacific Center for Special Care at the University of the Pacific Arthur A. Dugoni School of Dentistry

Oral Health Care for People with Developmental Disabilities

• Ability to access and have

dental care in a dental office

• Complex health history
• Ability to apply prevention

procedures

Pacific Center for Special Care at the University of the Pacific Arthur A. Dugoni School of Dentistry

National Oral Health Expenses

Source: CMS National Health Expenditure NHE Historical and projections, http://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/NationalHealthAccountsHistorical.html http://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/NationalHealthAccountsProjected.html 0% 50% 100% 150% 200% 250% 300% 350% $0 $50 $100 $150 $200 $250

U.S. National Dental Expenditures 2000 - 2025 ($ Billions)

Dental Services (DS) DS % of 2000 Level (321%)

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Pacific Center for Special Care at the University of the Pacific Arthur A. Dugoni School of Dentistry

Health Spending by Condition

General Health: MEPS: Expenditures by Medical Condition 2013, Table 3 http://meps.ahrq.gov/data_stats/tables_compendia_hh_interactive.jsp?_SERVICE=MEPSSocket0&_PROGRAM=MEPSPGM.TC.SAS&File=HCFY2013&Table=HCFY2013%5FCNDXP%5FC&_Debug= Dental Health: MEPS: Expenditures per Person by Health Care Service 2012, Table 3 http://meps.ahrq.gov/mepsweb/data_stats/tables_compendia_hh_interactive.jsp?_SERVICE=MEPSSocket0&_PROGRAM=MEPSPGM.TC.SAS&File=HCFY2013&Table=HCFY2013%5FPLEXP%5FB&VAR1=AGE& VAR2=SEX&VAR3=RACETH5C&VAR4=INSURCOV&VAR5=POVCAT13&VAR6=REGION&VAR7=HEALTH&VARO1=4+17+44+64&VARO2=1&VARO3=1&VARO4=1&VARO5=1&VARO6=1&VARO7=1&_Debug= $0 $10,000 $20,000 $30,000 $40,000 $50,000 $60,000 $70,000 $80,000 $90,000 $100,000 $110,000

(Millions)

Medical Expenditure Panel Survey - Top 25, 2013

Pacific Center for Special Care at the University of the Pacific Arthur A. Dugoni School of Dentistry Pacific Center for Special Care at the University of the Pacific Arthur A. Dugoni School of Dentistry Pacific Center for Special Care at the University of the Pacific Arthur A. Dugoni School of Dentistry

Center for Health Care Strategies. Examining Oral Health Care Utilization and Expenditures for Low-Income Adults. November 2017. https://www.chcs.org/media/FOM-Oral-Health_111617.pdf

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Pacific Center for Special Care at the University of the Pacific Arthur A. Dugoni School of Dentistry

Disruptive Innovation

Pacific Center for Special Care at the University of the Pacific Arthur A. Dugoni School of Dentistry

Disruptive Innovation

• Companies tend to innovate faster than their

customers’ needs evolve

• Their products or services become too sophisticated,

too expensive, and too complicated for many customers in their market.

• Historically the greatest profitability has been

achieved by charging the highest prices to their most demanding and sophisticated customers at the top of the market.

Pacific Center for Special Care at the University of the Pacific Arthur A. Dugoni School of Dentistry

Disruptive Innovation

• However, by doing so, companies unwittingly open

the door to “disruptive innovations” at the bottom of the market.

• An innovation that is disruptive allows a whole new

population of consumers at the bottom of a market access to a product or service that was historically

• nly accessible to consumers with a lot of money or

a lot of skill.

Pacific Center for Special Care at the University of the Pacific Arthur A. Dugoni School of Dentistry

• J. Am. College Dentists. 2016(83)2. Disruptive Innovation and the Oral Health System.

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Pacific Center for Special Care at the University of the Pacific Arthur A. Dugoni School of Dentistry

Care for Chronic Oral Diseases

Acute Care/ Surgical Intervention Chronic Disease Management

Pacific Center for Special Care at the University of the Pacific Arthur A. Dugoni School of Dentistry

Total Health: How Long and How Well We Live

McGinnis JM & Foege WH. Actual Causes of Death in the United States. JAMA 1993; 270(18):2207-12 (Nov 10). McGinnis JM, Williams-Russo P, Knickman JR. The case for more active policy attention to health promotion. Health Affairs 2002; 21(2):78-93 (Mar).

Behaviors (alcohol, tobacco, diet, exercise, preventive dental procedures?)

40% 10% 20% 30%

Genetics Environment, Public Health Health Care Delivery (procedures)

Pacific Center for Special Care at the University of the Pacific Arthur A. Dugoni School of Dentistry

Overcoming Obstacles to Oral Health

Pacific Center for Special Care at the University of the Pacific Arthur A. Dugoni School of Dentistry

Overcoming Obstacles Program

• Collaborators

– Pacific School of Dentistry – Apple Tree Dental – California Dental Association – California Dental Hygiene Association – American Dental Association Elder Care Committees – California Association of Health Facilities – American Health Care Association

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Pacific Center for Special Care at the University of the Pacific Arthur A. Dugoni School of Dentistry

The Pyramid Training Model

Oral health professionals Social service professionals, nurses, facility managers, etc. Parents, caregivers, direct care staff, individuals with special needs

Pacific Center for Special Care at the University of the Pacific Arthur A. Dugoni School of Dentistry

The Obstacles to Oral Health

• Informational obstacles

– Not sure what to do – Or, do not understand the importance

• f doing it
• Physical obstacles

– Can’t physically perform needed procedures

• Behavioral obstacles

– Resistive to performing procedures

• Organizational obstacles

– Systems within an institutional setting

Pacific Center for Special Care at the University of the Pacific Arthur A. Dugoni School of Dentistry

Solving Informational Obstacles

• Recognize the difference between a healthy

and an unhealthy mouth

Pacific Center for Special Care at the University of the Pacific Arthur A. Dugoni School of Dentistry

Solving Informational Obstacles

Special Toothbrushes

Surround Brush

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Pacific Center for Special Care at the University of the Pacific Arthur A. Dugoni School of Dentistry

Solving Informational Obstacles

• Understanding

– replacement, storage, of oral hygiene equipment – and infection control

Pacific Center for Special Care at the University of the Pacific Arthur A. Dugoni School of Dentistry

Adapted Oral Hygiene Instruments

Pacific Center for Special Care at the University of the Pacific Arthur A. Dugoni School of Dentistry

Solving Physical Obstacles

Mouth rests

Open Wide Prop

Pacific Center for Special Care at the University of the Pacific Arthur A. Dugoni School of Dentistry

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Pacific Center for Special Care at the University of the Pacific Arthur A. Dugoni School of Dentistry Pacific Center for Special Care at the University of the Pacific Arthur A. Dugoni School of Dentistry

Solving Behavioral Obstacles

• Structuring the environment
• Involving the individual
• Using reinforcers
• Shaping
• Generalization
• Desensitization

Pacific Center for Special Care at the University of the Pacific Arthur A. Dugoni School of Dentistry Pacific Center for Special Care at the University of the Pacific Arthur A. Dugoni School of Dentistry

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Pacific Center for Special Care at the University of the Pacific Arthur A. Dugoni School of Dentistry Pacific Center for Special Care at the University of the Pacific Arthur A. Dugoni School of Dentistry Pacific Center for Special Care at the University of the Pacific Arthur A. Dugoni School of Dentistry

The Declining Role for the Dental Drill

Pacific Center for Special Care at the University of the Pacific Arthur A. Dugoni School of Dentistry

Fluoride Varnish Silver Diamine Fluoride

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Pacific Center for Special Care at the University of the Pacific Arthur A. Dugoni School of Dentistry

Sealing Caries

Pacific Center for Special Care at the University of the Pacific Arthur A. Dugoni School of Dentistry

Science of caries and chronic disease management

Pacific Center for Special Care at the University of the Pacific Arthur A. Dugoni School of Dentistry

Science of caries and chronic disease management Community- based telehealth enabled teams

Pacific Center for Special Care at the University of the Pacific Arthur A. Dugoni School of Dentistry

The CA Health Workforce Pilot Project

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Pacific Center for Special Care at the University of the Pacific Arthur A. Dugoni School of Dentistry

The CA Health Workforce Pilot Project

Pacific Center for Special Care at the University of the Pacific Arthur A. Dugoni School of Dentistry

The CA Health Workforce Pilot Project

• 1. RDAs, RDHs, and RDHAPs will make the

decision about which radiographs to take, if any, to facilitate an initial oral evaluation by a dentist.

• 2. RDAs, RDHs, and RDHAPs will place “Interim

Therapeutic Restorations” (ITR)

Pacific Center for Special Care at the University of the Pacific Arthur A. Dugoni School of Dentistry Pacific Center for Special Care at the University of the Pacific Arthur A. Dugoni School of Dentistry

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Pacific Center for Special Care at the University of the Pacific Arthur A. Dugoni School of Dentistry

EHR: Radiographs

Pacific Center for Special Care at the University of the Pacific Arthur A. Dugoni School of Dentistry

EHR: Photographs

Pacific Center for Special Care at the University of the Pacific Arthur A. Dugoni School of Dentistry

Space and Equipment

Pacific Center for Special Care at the University of the Pacific Arthur A. Dugoni School of Dentistry

Space and Equipment

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Pacific Center for Special Care at the University of the Pacific Arthur A. Dugoni School of Dentistry

Space and Equipment

Pacific Center for Special Care at the University of the Pacific Arthur A. Dugoni School of Dentistry

Space and Equipment

Pacific Center for Special Care at the University of the Pacific Arthur A. Dugoni School of Dentistry

Space and Equipment

Pacific Center for Special Care at the University of the Pacific Arthur A. Dugoni School of Dentistry

Space and Equipment

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Pacific Center for Special Care at the University of the Pacific Arthur A. Dugoni School of Dentistry Pacific Center for Special Care at the University of the Pacific Arthur A. Dugoni School of Dentistry Pacific Center for Special Care at the University of the Pacific Arthur A. Dugoni School of Dentistry Pacific Center for Special Care at the University of the Pacific Arthur A. Dugoni School of Dentistry

Radiographs

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Pacific Center for Special Care at the University of the Pacific Arthur A. Dugoni School of Dentistry

Photographs

Pacific Center for Special Care at the University of the Pacific Arthur A. Dugoni School of Dentistry Pacific Center for Special Care at the University of the Pacific Arthur A. Dugoni School of Dentistry Pacific Center for Special Care at the University of the Pacific Arthur A. Dugoni School of Dentistry

Community-based Prevention and Early Intervention Procedures

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Pacific Center for Special Care at the University of the Pacific Arthur A. Dugoni School of Dentistry Pacific Center for Special Care at the University of the Pacific Arthur A. Dugoni School of Dentistry Pacific Center for Special Care at the University of the Pacific Arthur A. Dugoni School of Dentistry

Interim Therapeutic Restoration

Pacific Center for Special Care at the University of the Pacific Arthur A. Dugoni School of Dentistry

Interim Therapeutic Restoration

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Pacific Center for Special Care at the University of the Pacific Arthur A. Dugoni School of Dentistry Pacific Center for Special Care at the University of the Pacific Arthur A. Dugoni School of Dentistry

The Virtual Dental Home Sites

Pacific Center for Special Care at the University of the Pacific Arthur A. Dugoni School of Dentistry

Pacific Center for Special Care at the University of the Pacific School of Dentistry. Report of the Virtual Dental Home Demonstration http://dental.pacific.edu/departments-and-groups/pacific-center-for-special-care/publications

Pacific Center for Special Care at the University of the Pacific Arthur A. Dugoni School of Dentistry

Oral Health Systems for Underserved Populations

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Pacific Center for Special Care at the University of the Pacific Arthur A. Dugoni School of Dentistry

Hub and Spoke System

Pacific Center for Special Care at the University of the Pacific Arthur A. Dugoni School of Dentistry

• Reach people, emphasize prevention, and lower costs
• Majority of people kept and verified healthy on-site

– About 2/3 of children had all needed services completed by dental hygienist

• Continuous presence
• Community organization integration
• Dentist integration

Pacific Center for Special Care at the University of the Pacific Arthur A. Dugoni School of Dentistry

AB 1174

Pacific Center for Special Care at the University of the Pacific Arthur A. Dugoni School of Dentistry

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Pacific Center for Special Care at the University of the Pacific Arthur A. Dugoni School of Dentistry

The ADA House of Delegates passed Resolution 45H-2015, Comprehensive ADA Policy Statement on Teledentistry, in November at ADA 2015 – America’s Dental Meeting.

Pacific Center for Special Care at the University of the Pacific Arthur A. Dugoni School of Dentistry

Denti-Cal Teledentistry Billing

Denti-Cal Bulletin. March, 2016, V32, #4 http://www.denti-cal.ca.gov/provsrvcs/bulletins/Volume_32_Number_04.pdf Pacific Center for Special Care at the University of the Pacific Arthur A. Dugoni School of Dentistry

CPCA Guide Intermittent Clinics Dental Hygiene Billing Telehealth Billing Dentist Contracting

Pacific Center for Special Care at the University of the Pacific Arthur A. Dugoni School of Dentistry

Proof of Concept Legislation/ Regulation Expansion/ Research

2009 2015 2016 + OR, CO, HI, MN, AZ, MO... OR, CO, HI

Virtual Dental Home Timeline

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Pacific Center for Special Care at the University of the Pacific Arthur A. Dugoni School of Dentistry

Science of caries and chronic disease management Community- based telehealth enabled teams Financial Incentives aligned with

• ral health
• utcomes

Pacific Center for Special Care at the University of the Pacific Arthur A. Dugoni School of Dentistry

The Era of Accountability

Pacific Center for Special Care at the University of the Pacific Arthur A. Dugoni School of Dentistry

The Triple Aim

• improving the experience of care
• improving the health of populations
• reducing per capita costs of health care

Pacific Center for Special Care at the University of the Pacific Arthur A. Dugoni School of Dentistry

The Quadruple Aim

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Pacific Center for Special Care at the University of the Pacific Arthur A. Dugoni School of Dentistry

Dental Care in the Future

Pacific Center for Special Care at the University of the Pacific Arthur A. Dugoni School of Dentistry

Dental Care in the Future

Pacific Center for Special Care at the University of the Pacific Arthur A. Dugoni School of Dentistry

Dental Care in the Future

• Dental Practice =

– Geographically distributed – Telehealth enabled – Oral health teams

• Chronic disease management

– using biological, medical, behavioral, and social tools

• Integrated with general health, educational, and

social service systems

• Interacting with the majority of the population
• Focused on oral health outcomes in the

Era of Accountability

Pacific Center for Special Care at the University of the Pacific Arthur A. Dugoni School of Dentistry

People with Developmental Disabilities

• Daily mouth care is essential to avoid

consequences of disease

• Disease repair: primary issue is the ability to

perform procedures without sedation or anesthesia

• Preventive and early intervention care

delivered in community location (residential facility, day program, etc.) is most likely to result in better daily mouth care and better

• ral health

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Pacific Center for Special Care at the University of the Pacific Arthur A. Dugoni School of Dentistry

People with Developmental Disabilities

• Payment – Denti-Cal does not support the

care coordination, education, caregiver support activities needed to maintain an effective community-based system of care.

• Regional Centers can and should supplement

provider payments for these activities ( in addition to focus on general anesthesia)

Pacific Center for Special Care at the University of the Pacific Arthur A. Dugoni School of Dentistry

Regional Center Demonstration Projects

• Provider recruitment and training
• Integrate oral heath activities in community

service locations

– residential facilities – day programs

• Regional Centers pay providers for education,

prevention, care management, early intervention

Paul Glassman DDS, MA, MBA Professor and Director of Community Oral Health University of the Pacific School of Dentistry San Francisco, CA pglassman@pacific.edu