Access to dental care in North Dakota Collaborative strategies to reduce barriers to care

Why don’t patients visit the dentist? Fear Cost Transportation Low knowledge of value of oral health Not experiencing pain Cultural factors Language barriers Lack of available workforce

Keys to expanding access to care Education Prevention Outreach

Who Are We Treating? 25% of the population has 80% of the dental disease SOURCE: Healthy People 2010, Oral Health Review, CDC

Half of ND Medicaid recipients reside in our four urban centers Fully-staffed public health dental clinics Supported by state oral health programs, private practice Medicaid providers SOURCE: ND Department of Human Services Medicaid Access Monitoring Plan 2016

Medicaid-specific provider barriers Reimbursement rate below cost of services N.D. = 60% of usual fees Claims admin complexity, delayed payment 2015 MMIS Medicaid transition Lack of patient compliance Rate of failed appointments = 30-50% Despite these barriers, ND exceeds national averages in percentage of dentists enrolled in Medicaid plus Medicaid fee reimbursement

Improving Access to Care Collaborative Partnerships Access to Care Safety Net Clinics Dental Homes Private Practices

Solutions? Improve dental Medicaid with adequate funding, reduced administrative burden, and vigorous dentist recruitment. Expand and support non-profit safety-net clinics through grant partnerships, loan repayment programs. Maximize dental hygiene and assistant workforce through expanded training programs, community outreach, and case management. Engage with tribal communities to improve IHS dentistry, maximize prevention, reduce credentialing barriers, and facilitate contracting with dental community.

Current Efforts

Improve Dental Medicaid Recruit more providers 75 dentists pledged to see more Medicaid patients through 2015 “Take Five More” initiative Work to close reimbursement gap Reimbursement fees closer to market-based rates likely to improve participation Quarterly Medicaid Advisory Committee meetings w/DHS Medicaid officials Regular communication aimed at improving Medicaid administration

Maximize Current Workforce Seek in-state program for expanded restorative functions training Expand school-based outreach 3,124 kids in 42 schools received sealants in 2015-2016 through Seal!ND Encourage case management 3 DAs completing Community Dental Health Coordinator certification Support ER Diversion programs Volunteer in mobile outreach, programs Ronald McDonald CareMobile, Donated Dental Services, more

Expand, Support Non-Profit Safety Net Clinics Recruit workforce, volunteer dentists, support outreach for 6 existing non-profit dental public health clinics Maintain quarterly survey of ND dentists to match volunteers with non-profits Promote loan repayment, student exchange programs

North Dakota led nation in net in-migration of dentists from 2011-2016 Contributing factors were state loan repayment programs, WICHE Professional Student Exchange Program

Engage with Tribal Communities Providing local dentist support for IHS clinics Recruited 4 dentists to Spirit Lake Clinic in 2016, filled need until FT dentist hired Facilitating outreach on reservations Supporting tribes that elect “638” status

Future Focus

Improve Dental Medicaid Continue fee reimbursement efforts Collaborate with Governor’s office, DHS to improve MMIS claims system, evaluate risk-based managed care organization (MCO) 18 states currently utilize dental MCO’s

Maximize Current Workforce Utilize in-state training program for expanded hygienist, assistant duties per NDBODE rules Integrate case management in all dental public health programs Utilize $6.8 million ND Dental Foundation endowment for outreach, education programs Further expand school-based outreach

Maximize Current Workforce Establish ER Diversion programs in Bismarck, Minot and Grand Forks Obtain grant, launch teledentistry pilot program Obtain funding to support expanded distance-learning program for dental assistants

Expand, Support Non-Profit Safety Net Clinics Continued workforce support through recruitment, grant support, volunteerism Emphasize loan repayment programs, WICHE Professional Student Exchange Program Support integration of CDHCs

Engage With Tribal Communities Provide staffing support for IHS clinics as needed Facilitate expanded outreach through mobile clinics, school-based programs Provide support for tribes that elect “638” status to contract directly for dentists, establish third-party billing Support use of CDHCs to assist in outreach, education

Collaboration – The ND Way Explore, implement Medicaid Managed Care Organization Contracting Integrate case management at public health clinics Funding, support distance-learning, expanded functions programs Teledentistry

North Dakota solutions Let’s work together to implement North Dakota solutions for good oral health Brent Holman, DDS Executive Director, NDDA ndda@midconetwork.com 701-223-8870