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

2. 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

3. Keys to expanding access to care
Education
Prevention
Outreach

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

5. 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

6. 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

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

8. 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.

9. Current Efforts

10. 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

11. 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 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

12. 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

13. 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

14. 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

15. Future Focus

16. 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

17. 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

18. 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

19. 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

20. 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

21. 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

22. North Dakota solutions
Let’s work together to implement
North Dakota solutions
for good oral health
Brent Holman, DDS
Executive Director, NDDA