Oral Health Integration in Well Child Care A Collaboration of Group Health Cooperative, Washington Dental Service and WDS Foundation

Group Health Cooperative Overview n Large integrated healthcare system  Combines delivery system with coverage  Contracted network  25 ambulatory and specialty medical centers in WA and northern ID  1100 medical staff  640,000 patients  Electronic medical records system

Desired Outcomes  Full integration of oral health preventive services as routine part of well child care  Demonstrate the role of primary care providers in caries prevention in large integrated healthcare organizations  Patient and provider acceptance and satisfaction  Seamless business processes  Evaluate ROI  Improved oral health status of young children

Oral Health Key Objectives Incorporate oral health prevention elements into well child visits at Group Health  Oral cavity exam  Remineralization with fluoride varnish  Anticipatory guidance  Oral health promotion information  Referrals for dental care if indicated

Approach (3 year pilot) 1. Recruit six pilot clinics throughout western Washington 2. Incorporate oral health services during well child visits for children 6 months to 3 years 3. Develop business model for reimbursement with Washington Dental Service 4. Negotiate billing procedures with Medicaid. 5. Assess readiness to disseminate practices to all clinics

Defining Clinical Workflow n Defining content of care n Establishing roles for clinical team members n Establishing workflow n Building electronic tools to integrate care elements into health record

Business Process Changes n Capture of dental insurance information n Establish patient cost-shares at point of service n Develop process for uninsured patients n Develop coding and documentation capability in the electronic record

Partners and Roles GH Primary Care Division:  Delivery of service  Reporting and billing of services rendered  Quality improvement cycles to optimize delivery WDS  Insurance reimbursement for services to WDS enrollees WDS Foundation  Training of providers and staff  Funding of oral health services for GHC members not enrolled in WDS or Medicaid  Funding for planning and implementation

Staff Satisfaction Survey Results: July 2009 * n = 123

Patient Satisfaction Survey Results: 2009 n Over half of the children have private dental insurance coverage  9% had no dental insurance n The majority of children had not yet been to a dentist  67% of children in the survey had not yet been to a dentist n The majority of parents indicated they they highly value the oral health services  91 % want their child to have the remaining recommended fluoride varnish applications  93% would recommend the fluoride varnish to other parents of young children n Parents expressed very high satisfaction with the full range of oral health services they received.  89% were satisfied to extremely satisfied with the information they received before the varnish was applied to the child’s teeth  93% were satisfied to extremely satisfied with how well the staff were able to keep the child comfortable during the varnish application

Outcome assessment Full integration of oral health preventive services as routine part of well child care Demonstrate the role of primary care providers in caries prevention in large integrated healthcare organizations Patient and provider acceptance and satisfaction Seamless business processes Evaluate ROI ? Improved oral health status of young children?

Funding WDS Foundation Group Health Foundation

Thank you n Group Health: David Grossman, MD, MPH n WDS Foundation: Dianne Riter, MPH

Winning strategies n Referral dentist network in place before implementation; success of WDSF sponorship of ABCD program in Washington n Link to existing workflows and cognitive maps; e.g. immunization n Use and integrate electronic tools to pre-order and pre-fill EMR n Standardize team roles and expectations n MA applies varnish before immunizations n Standardize patient education and integrate into existing health promotion materials n Measure outcomes and provide feedback