2. Michigan Community Dental Clinics, Inc
Michigan Community Dental Clinics, Inc. Dental Care for the Under-served Medicaid Eligible and the Low Income Uninsured The Dental Clinics North “Social Entrepreneur” Model adapted for the State of Michigan
Gregory P. Heintschel, DDS
Dental Director
_______
Patti Ulrich
Director of Community Programs
and Outreach 2

3. MCDC Mission Statement Why we exist …
Our Mission is to increase access to oral healthcare and provide health education to Medicaid recipients and to low-income uninsured persons in Michigan.
Our care is delivered in a fashion that upholds and respects the dignity of those served, with the ultimate goal of improving their quality of life with improved health and wellbeing.
Our focus is on those we serve.
We are changing lives – one life at a time. 3

4. MCDC Vision Statement What we hope to accomplish …
Our vision is a healthy Michigan population, who assume responsibility for their own wellness, with our staff’s guidance and proper intervention.
This is accomplished by providing appropriate oral healthcare, delivered efficiently and with assured quality, to meet the needs of those who seek care. 4

5. MCDC Action Statement How we succeed
We assist in the development of dental clinics and other dental models to increase access to oral healthcare for those on Medicaid and the Low-income Uninsured.
We also provide the Staff and Management Services that allow the clinics to maximize efficiency and productivity, thereby leveraging limited resources for the greater good. 5

6. What is Dental Clinics North?
A partnership of 6 LHDs that serve 21 Cos from M-55 to the Mackinac Bridge
Created and operated by NW Michigan Community Health Agency – Charlevoix (DCN is a division of NWMCHA)
Health Dept for CHX, Emmet, Antrim, and Otsego counties
5 other LHDs partner with NWMCHA
to coordinate care with other LPH programs – WIC, etc.
To be the LHD presence for the dental clinic(s) in their service area
Ten Clinics located in TC, Manistee, Cadillac, West Branch, Mancelona, East Jordan, Gaylord, Alpena, Petoskey, Cheboygan - with Manistee joining in Jan ‘08
34 Dentists, 22 RDHs, 61 dental assistants
Central Staff of seven dedicated to Dental with backup from more in Finance and IT 6

7. 7

8. Dental Clinics North Programs
Current Programs:
Ten Clinics serving 21 rural northern lower MI counties
25,000 clients served with over 50,000 visits annually
Electronically connected with Electronic patient record using the DXOne version of Dentrix (as of October 1, 2004)
The Northern Dental Plan
Training Program for University of Michigan Dental Students
Hospital care provided in 3 regional hospitals
For children < 4 with severe dental disease (ECC) or medical necessity
For those Developmentally Disabled (DD) Adults who cannot be treated in the clinic setting
Programs on the “Drawing Board”
Nursing Home Program for the 85% of residents who are covered by Medicaid and cannot access care
Expansion of the Hospital Program to more hospitals
Newly Created MI Community Dental Clinics, Inc, (MCDC) to increase access to care throughout MI
New clinic buildings for our Gaylord and Manistee operations 8

9. Essential Changes that allow DCN to efficiently provide care to the underserved in Northern MI
April, 2004, we initiated the Northern Dental Plan (NDP) to provide access to care for low-income uninsured adults.
October, 2004, we implemented Dentrix Enterprise® - dental practice management computer system
Increased efficiency of scheduling, delivery of care, and billing
Reduction in errors, and electronic patient charts
1st Step toward “paperless” patient records
August, 2005, a new reimbursement program to encourage productivity and control costs – an efficient private sector model for delivery of public health services
DDS and RDH paid a flat per diem + % of production – using the NDP fee schedule as RVU schedule
Assistants and RDH paid a gain-share bonus if achieve daily production goals, based on the cost of their clinic that day
March, 2006, SPA approved by the Feds (CMS) – allowing an increased Medicaid FFS rate for LPH dental clinics in MI
A rate that covers our cost and allows for surplus funds to improve clinic infrastructure and support the cost of un-insured care for the underserved - if the clinics are cost efficient and productive
June, 2006 – Present, adding capacity in many of our current clinics
December, 2006, digital x-rays – both Panoramic and intra-oral
Further reduces daily operating cost, and increases clinic productivity
The next necessary step to becoming “paperless”
December, 2006, MCDC was incorporated as a not-for-profit dental services corp. 9

10. Results from the Changes in Reimbursement Method
Dental Clinics North - July 05 versus July 06
*Income expressed in RVU’s. Actual income may be more or less depending on payer mix. Expense is actual dollars spent. 10

11. Coordinated Prevention & Education Programs Work!11

12. 12

13. The Northern Dental Plan (NDP) A Reduced Fee Program for Uninsured Adults Implemented April 1, 2004
Eligible Adults - up to 200% of the Poverty Level
Using a fee schedule that covers DCN’s costs
All area Dentists can participate – if willing to accept the fee schedule
Comprehensive dental services available at more affordable fees
Allows access to care for those not eligible for Medicaid (the working poor and retirees subsisting on SS alone)
Patients will pay for services as they are rendered using cash, check, money order or credit card 13

14. The Northern Dental Plan A Reduced Fee Program for Uninsured Adults How it works…
Interested patients contact our Clinics to join the plan – cost is $50 per person to enroll
In return for the $50, the patient receives a Comprehensive Oral Exam w FMX & TXT Plan
In addition, the patient now has access to our reduced fee schedule, which is ~ 35-40% below UCR
Those persons on Medicaid can receive services not covered by Medicaid at these fees without enrolling in the plan
We allocate 15-20% of our schedule to accommodate the NDP patient pool. 14

15. Funds in Excess of Costs will be used to
Continually expand, update, repair and replace dental equipment and clinic infrastructure
Create a Dental Assistance Fund dedicated to supporting the cost of care in our clinics
Using the NDP fee schedule….
Provide essential services not covered by Medicaid
Provide services to low-income uninsured adults
Have patients pay a portion of the cost, with the Fund paying the balance. 15

16. New Equipment and Clinic Expansion (18 additional dental chairs ~ 3-4 clinics)
Mancelona –added 2 chairs and now have 2 DDS
Cadillac- added 2 chairs and now have 2 DDS
East Jordan – added 2 chairs and now have 1.5 DDS
Traverse City – adding 3 ops – and will have 3 DDS
West Branch – added 1 op and now have 1.5 DDS
Alpena – added 2 new chairs and now have 2 DDS
Petoskey – added 3 new chairs and have 1.5 DDS
Gaylord – will build new clinic with 8 ops (net gain 4) & will have 3 DDS
Manistee – will build new clinic with 8 ops (net gain 4) and will have 2 DDS
Cheboygan – will re-model/refurbish – 1 DDS
Digital Radiography for all clinics 16

17. Quality Assurance Patient Satisfaction Surveys
2. Director of Quality Assurance at DCN
David Murphy, DDS – UMSD, 1969
25 yrs of dental practice experience
5 yrs teaching clinical dentistry at UMSD as a clinical assistant professor
Currently teaching at Kalamazoo Valley CC dental hygiene program, and resides in Otsego, MI.
Electronic Chart reviews to determine
Appropriateness of Care
Before and after quality effects of txt, using digital x-ray images
Consistency of Care and billing practices
Rx prescribing practices
3. Group practice
Working with other professionals in a group encourages conformity and assures quality of care.
Continual peer pressure to provide optimal care.
Outliers from the norm are easily identified and corrected. 17

18. Dental Clinics North Providing Access to Comprehensive Dentistry
delivered in an
Efficient Fashion
with
Outcomes that are of Assured Quality and Appropriateness of Care 18

19. Michigan Community Dental Clinics, Inc (MCDC)
A Vehicle to allow the efficient Dental Clinics North practice model to become the Norm to increase Access to Dental Care for Medicaid and Low-income Uninsured via
Public Health Dental Clinics throughout Michigan
Mission Statement
Provide the Management Services that allow LPH Depts. in Michigan to increase access to Oral Healthcare to persons who are Medicaid eligible and the low-income uninsured. 19

20. Michigan Community Dental Clinics Why do it?
There is a need to “Normalize” the DCN clinic model, so that LPH dental clinics can operate without loosing money – a private-sector approach to public healthcare delivery.
Assures continued funding for all LHD dental clinics in MI.
Allows LHD dental clinics to increase the level of dental care for more people.
To expand the dental clinic network and take further advantage of the economies of scale.
To share the expertise and path to success of DCN with others.
To be able to attract and retain dental professionals…
This model creates a viable career alternative to owning a private practice.
To significantly increase the access to care for more folks in need.
Both adults and children on Medicaid currently have difficulty accessing dental care.
Most adults under 200% of the Federal Poverty level have poor access to dental services.
Because it’s the right thing to do. 20

21. Michigan Community Dental Clinics, Inc
A 501C(3) non-profit Dental Services Corporation
Provides Dental Services on behalf of Local Health Depts.
Services include:
Design of new clinic facilities or remodel of existing facilities
Providing specifications for equipment and supplies
Management of the Clinic Facilities by:
Providing the Electronic Patient Record using Dentrix® Enterprise software
Billing Medicaid for services rendered, collecting fees, paying op costs
Hiring all clinic personnel
Direction for operation of all clinics to equal the Dental Clinics North model
Assisting LHDs with integration of Oral Health Education and Prevention programs with WIC, Head Start and other services
Allows for expanded economies of scale with administrative costs distributed over more clinics 21

22. What does MCDC look like?
Michigan Community Dental Clinics, Inc.
(MCDC)
DCN Admin Staff
Affiliated Groups of Dental Clinics
(Anchor LHD)
Dental Clinics North
(NWMCHA)
Dental Clinics of Southwest MI
(Van Buren / Cass DHD)
Thumb Area Dental Clinics
(St. Clair Co HD)
Dental Clinics Mid-Michigan
( Mid MI HD).
Detroit Community Dental Clinics
(DHD)
Host Health Departments
(where clinics reside)

23. Current, Planned, & Proposed Clinics
Dental Clinics North
Petoskey
East Jordan
Mancelona
Gaylord
Cheboygan
Alpena
West Branch
Cadillac
Manistee
Traverse City
Marquette (1/1/08)
Mid MI Dental Clinics
Stanton (6/08)
Big Rapids (6/08)
Hart (6/08)
Mt. Pleasant (08)
Dental Clinics of SW MI
Hartford
Dowagiac
Three Rivers (12/1/07)
Berrien Springs (09)
Coldwater (08)
Hillsdale (1/01/08)
(Kalamazoo in ’08 ??)
Thumb Area Dental Clinics
Port Huron (5/01/08)
Caro (09)
Algonac (09)
Detroit Community Dental Clinics
Children’s Hospital (CHM) (08)
Herman Keiffer (08)
Samaritan Center (08) 23

24. Board of Directors includes:
Gerald Chase, MPH, Chair
Jeffrey Elliott, BBA
James Young, JD
Patrick Shannon, JD, MPH, EdD
Daniel Briskie, DDS, MS
Daniel Sarya, DDS, MPH, MS
Lonnie Stevens 24

25. MCDC Management Team Executive Director: Tom Veryser, DDS, MHSA
Dental Director: Greg Heintschel, DDS
Operations Director: Sandy Kilmer
Human Resources Director: Sindy Karaptian
Oral Health Promotion & Community Services Coordinator: Patti Ulrich, RDH
Quality Assurance Director: David Murphy, DDS
MCDC contracts with NWMCHA for accounting services 25

26. Michigan Community Dental Clinics In general terms, How will it work?
Groups of Dental Clinics that are owned and operated by Local Health Depts. (LHDs) will contract for dental services with MCDC
Dental Clinics North
Dental Clinics of SW Michigan
Dental Clinics of Mid Michigan
Dental Clinics SE MI/Thumb
Detroit Community Dental Clinics
The Model
Each Dental Clinic and equipment is owned by or partnered with a LHD
MCDC provides dental services on behalf of LHDs, will bill and collect fees, pay all bills on behalf of LHDs
LHDs will provide the cash required for the Medicaid Match for the SPA fees.
MCDC will pay rent for the space and equipment .
MCDC will compensate the LHD for Outreach and other LHD services that coordinate with oral health services or prevention. 26

27. Duties of the Anchor HDs (VB/Cass HD & NWMCHA, etc.)
Provide a Dental Director, employed by MCDC
To oversee clinical operations and supervise the professional staff (DDS and RDH)
Provide a Clinic Supervisor, employed by MCDC
To oversee and coordinate the auxiliary staff of the Division Clinics
To coordinate purchasing of supplies, equipment, etc.
Purchase and Own or Lease the equipment, instruments and supplies in each clinic
Provide the space for each clinic
Provide Outreach and other LHD services coordinated with dental. 27

28. Duties of the Host HDs (Where the Dental Clinics are located
Provide space for lease to Anchor HD for dental clinics.
Provide Outreach and Health Promotion activities within its service area.
Coordination of other H.D. Functions and Services that impact Oral health.
Provide the funds for IGT drawdown of funds if the Anchor HD has insufficient funds available in any quarter. 28

29. The MCDC Model allows…
LHD to separate dental staff from other LHD staff and provide unique Staffing reimbursement for the Dental Network Staff that rewards performance and controls cost.
LHDs to provide dental services to persons-in-need, without the cost or “hassle” of managing the clinic.
Regionalization of network clinics to address local issues locally with local health department recognition for doing so.
For increased leverage in purchasing supplies and services via coordination by MCDC.
A cost-efficient method of expanding access to dental services to the underserved throughout Michigan.
A method to create a Fund to support the cost of uninsured care in other regions of the State.
Empowerment of individual clinics to provide care in an efficient fashion, and for the employees to be rewarded for extraordinary performance. 29

30. DCN Nursing Home Initiative
Based upon information obtained in a survey by the Michigan Department of Community Health only 63% of Michigan dentists provide nursing home services in their office.
Only 16% of all dentists provide for care in the nursing home. Currently 46,826 residents, 35,119 on Medicaid.
Medicaid paid 567,622 in dental services for the elderly in 2006, and 56% of that was payment to mobile services.
Leaving only 249,753 paid on behalf of the elderly by 4500 active licensed dentists in the state.
Resulting in only $16.16 spent per resident annually, and only $55.50 per dentist.

31. Huge Unmet Need For The Medicaid Nursing Home Resident!
Consequence
Huge Unmet Need For The Medicaid Nursing Home Resident!

32. DCN Nursing Home Initiative as a Proposal. What We Provide.
Annual in house exam by a dentist
All dental equipment and materials
Ease of referral to DCN clinics
In-service training at no expense to home
Individual consultations for residents on oral healthcare issues
Billing, scheduling, and other administrative functions
Reduced set up fees for care
Access to the Dental Assistance Fund (DAF)

33. Our proposal to facilities requires
2 year agreement for services
minimum 500 residents to initiate
$75 per resident “dental director” first year fee
$50 annual “dental director” per resident
adequate facility (beauty shop)
dedicated aid for assistance and transportation
consent for treatment
health history
IT support through a broad band connection
dedicated but minimal storage for supplies

34. What Outcomes We Expect
Help facilities meet federal care mandates
Reduced transportation fees for residents
Reduced staffing costs
Increased consciousness of oral hygiene
Healthier residents
Improved quality of life for residents
Marketing advantage to the facility

35. Pilot Program: Meadow Brook,
Bellaire, MI
36% of resident population seen
Avg. 50 min per appointment.
4% of residents seen at accelerated re-care
70% of hygienists salary for direct care and 30% for admin, education, and in-service training.
50% of residents referred for further treatment

36. A unique model funded by local tax dollars
Northern Dental Clinics entered into an agreement with the Lelanau County Commission on Aging to provide diagnostic and preventative treatment to county residents age 60 and above at 200% of poverty or below.
Each eligible resident will receive a voucher valid for a initial exam, full x-rays, and a prophylaxis, a complete treatment plan, opportunity for the DAF, and entrance into the NDC clinics through the NDP.
County may pay for additional services upon review.