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State Oral Health Plan and Prevention Agenda Update Jayanth Kumar, DDS, MPH Director, Bureau of Dental Health New York State Department of Health 1.

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Presentation on theme: "State Oral Health Plan and Prevention Agenda Update Jayanth Kumar, DDS, MPH Director, Bureau of Dental Health New York State Department of Health 1."— Presentation transcript:

1 State Oral Health Plan and Prevention Agenda Update Jayanth Kumar, DDS, MPH Director, Bureau of Dental Health New York State Department of Health 1

2 2 Framework for Comprehensive State Oral Health Plans Knowledge for Evidence-Based Decision Making What should be done? Setting Optimal National and State Objectives: (data-driven) What can be done? Planning Feasible Strategies (capacity-driven) What is achieved? Implementing Effective Strategies (outcome-driven) What could be done? Determining Possible Strategies (science-driven) Data: societal influences, current capacity, environmental analysis Surveillance Data: unmet needs, service and data gaps Data: proven prevention and best processes Data: process, outcome, impact evaluations Data: disease burden, target populations, and implementation barriers

3 Setting State Objectives Increase awareness of the importance of oral health to overall health and well- being. Reduce the prevalence of tooth decay. Increase acceptance and adoption of effective preventive interventions. Reduce disparities in access to effective preventive and dental treatment services. 3

4 A Framework for Public Health Action: The Health Impact Pyramid Education & Counseling Clinical interventions Long lasting protective interventions Change the context to make individual’s default decisions healthy Socioeconomic factors 4 Increasing population impact Increasing individual effort needed Chairside guide Campaigns Evidence-based practice School Dental Sealant Program Fluoridation Insurance coverage

5 Prevalence of caries, untreated caries and dental sealant, and New York State 3 rd Grade Survey.

6 Dental insurance, fluoride tablet use and dental visit, and New York State 3 rd Grade Survey

7 Figure 9a. Trends in tooth loss. Percentage of persons (ages 65 and older) who have lost all natural permanent teeth. New York State BRFSS, 1999 to

8 State Target and Disparities, Survey

9

10 Childhood Caries in NYS: Emergency Department and Ambulatory Surgery Facility Visits

11 Percent with at Least One Dental Visit and One Preventive Dental Visit, NYS Medicaid Program 2011

12 Trends in Dental Visit in Children by Income Groups 12 Source: ADA

13 Trends in Dental Visits 13 Source: ADA

14 Clinical Preventive Services 14 More than half (56%) of children and adolescents did not visit the dentist during the preceding year in 2009, and 86% of children and adolescents did not receive a dental sealant or a topical fluoride application during the preceding year in More than two thirds (69%) of 5–19 year-olds did not have a dental sealant during 2005–2010 (7).

15 Challenges Improving public perception utilization of effective preventive measures Insurance coverage diversity and flexibility of the dental workforce, & uneven distribution of dental professionals measurement and tracking of oral diseases, risk factors, the dental workforce and utilization of dental services. Addressing the high cost of dental education and the debt burden 15

16 Goals Goal 1: Integrate oral health into systems, policies and programs which improve overall health. Goal 2: Prevent oral diseases and address risk factors through evidence-based interventions. Goal 3: Eliminate oral health disparities and improve access to high quality, comprehensive, continuous oral health services for all New Yorkers. Goal 4: Strengthen systems which improve the oral health of people with special health needs. Goal 5: Increase knowledge sharing statewide to enhance the adoption of best practices, replicate proven efforts, and improve community oral health literacy. Goal 6: Increase capacity, diversity, and flexibility of the workforce to meet the needs of all New Yorkers. Goal 7: Maintain and enhance the existing surveillance system to measure key indicators and for tracking progress. 16

17 Strategies Bring together stakeholders periodically and develop a statewide agenda for action Explore opportunities to form regional partnerships Strengthen the oral health surveillance system Encourage educational and training programs to update competencies and standards 17

18 People with special health needs: Objectives Identify successful reimbursement strategies Increase inter-professional collaboration Implement changes in the surveillance system to enable data collection Identify Centers of Excellence for providing oral health care Assess the number of dental providers serving people with special health care needs Address waiting times for appointment Train caregivers Develop research activities that address the oral health issues 18

19 Prevention Agenda Goal #5: Reduce the prevalence of dental caries among NYS children. Objective 5-1: By December 31, 2017, reduce the prevalence of tooth decay among NYS children by at least 10%. Objective 5-2: By December 31, 2017, increase the proportion of NYS children who have protective dental sealants by at least 10%. Objective 5-3: By December 31, 2017, increase the proportion of NYS children who receive regular dental care by at least 10%. Objective 5-4: By December 31, 2017, increase the percentage of NYS population receiving fluoridated water by 10%. Objective 5-5: By December 31, 2017, strengthen systems to improve the oral health of people with special health needs.

20 Surveillance & Epidemiology State Oral Health Program Achieving targets Population- based Programs Health Systems Interventions Community- Clinical Linkages 20

21 21

22 Fluoridation in New York State Prevention Agenda Target 78.5% Population served: 12.9 m (71.4%) Fluoridating Systems: 123

23 Fluoridation: Defend and Promote Monitoring the fluoride level Training Upgrading equipment & technical assistance Evaluation 23

24 24

25 Prevalence of Caries by Subgroups

26 The best kick-off question: Do you and your family typically drink bottled water or tap water? Addressing common risk factors in dental offices

27 School policies and programs School dental screening School dental programs 27

28 ECC Learning Collaborative Partnered with DentaQuest Institute for their Phase III ECC Learning Collaborative Enrolled four teams from WNY Developing New York State faculty to replicate the collaborative Goals 1. Reduce % of patients with new cavitation by 50% 2. Reduce % of patients complaining of pain by 30% 3. Reduce % of patients with referral for operating room treatment and sedation by 50% Ends on February 28, 2015 Planning expansion strategies

29 HRSA Maternal and Child Health Initiative Learning Collaborative Integration into MCH programs Education & Training Reimbursement for primary care providers Collaboration with Perinatal Networks Community linkage Perinatal Care Standards in Medicaid 29 PERFORMANCE MEASURE 12 A) Percent of women who had a dental visit during pregnancy and B) Percent of infants and children, ages 1 to 6 years, who had a preventive dental visit in the last year

30 Policy and Guidance Reimbursement for smoking cessation counseling (SCC) must meet the following criteria: SCC must be provided face-to-face by either a dentist or by a dental hygienist that is supervised by the dentist. SCC must be billed by either an office- based dental practitioner or by an Article 28 clinic that employs a dentist. Dental practitioners can only provide individual SCC services, which must be greater than three minutes in duration, NO group sessions are allowed. Dental claims for SCC must include the CDT procedure code D1320 (tobacco counseling for the control and prevention of oral disease).

31 Health Workforce Shortage Creating incentives to locate practices in shortage areas Loan repayment Practice support Innovative workforce solutions Virtual dental home Teledentistry 31

32 SUMMARY State Oral Health Programs Achieve the Vision of Healthy People in Healthy Communities Build consensus, develop a common agenda, and mobilize for action Build and foster partnerships Collaborate and promote integration Leverage resources Support communities Measure progress and review policies and programs 32

33 Thank You 33

34 Eliminate health disparities State Oral Health Program Salience Improve the quality of life Promote oral health as integral to overall health Promote optimum oral health for all 34

35 Collecting, Analyzing & Providing Data State Oral Health Program Supporting communities Education & Training Program Support Grants, Technical Assistance, Guidance Building Partnerships, Coalitions, Networks 35

36 Federal Funding CDC, HRSA State Oral Health Program Leveraging resources State Funds Foundations Establishing Collaborations 36

37 People with special health needs Objective 4.a: By 2017, identify successful reimbursement strategies for providers and hospitals that address the additional time and resources needed to treat people with special health needs. Objective 4.b: By 2017, ensure that systems developed to increase interprofessional collaboration and inform consumers about dental care address the challenges faced by people with special health needs. 37

38 Objective 4.c: By 2017, implement changes in the surveillance system to enable data collection on oral health and access to dental care for people with special health needs. Objective 4.d.: By 2017, identify Centers of Excellence for providing oral health care to people with special health needs. Objective 4.e: By 2017, assess the number of dental providers serving people with special health care needs and determine how many are needed to serve people with special health needs. 38

39 Objective 4.e: By 2017, develop and implement strategies to ensure that waiting times for routine appointments are no longer than one month, and dental emergencies are addressed within 24 hours for patients with special health needs. Objective 4.f.: By 2020, ensure that all health care workers employed to assist people with special health care needs are trained in their daily oral health care. Objective 4.g: By 2017, develop research activities that address the oral health issues of people with special health care needs. 39


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