november 20, 2015 hosted by:. dr. nikki stone, kentucky oral health coalition chair
TRANSCRIPT
2015 KENTUCKY ORAL HEALTH SUMMIT:RECONNECT, EVALUATE, AND LOOK FORWARDNovember 20, 2015
Hosted by:
WELCOME!
Dr. Nikki Stone,
Kentucky Oral Health Coalition Chair
STAND UP IF YOU ARE A….
Are you a dentist?
Are you a nurse?
Are you an K-12 educator?
Are you affiliated with a university?
Are you a social worker?
Are you representing a Managed Care Organization?
Are you a KOHC member?
Other?
2015 KENTUCKY ORAL HEALTH SUMMIT PURPOSE:
To bring advocates for improved oral health together in
Kentucky for information
sharing, learning, networking, and
public policy prioritization.
SUMMIT OBJECTIVES:
Shared understanding of Kentucky’s oral health policy initiatives and landscape.
Improved collaboration and communication among oral health advocates.
Shared agreement on policy solutions to improve access to care.
AGENDA• Keynote by Dr.
Michael Glick
• State of the State of Oral Health in Kentucky
• Oral Health Champion Awards and Lunch
• Panel moderated by Bill Goodman
• Visioning and strategy session
• Optional – Annual Meeting
WHAT IS THE KOHC? The Kentucky Oral Health Coalition (KOHC) is a group of concerned citizens, advocates, and professionals working together to improve oral health across Kentucky.
HISTORY OF KENTUCKY COALITION EFFORTS
2001 Kentucky Dental Health Coalition (KDHC) Priorities:
Legislative
Public Awareness & Education
Dental Service Delivery Models
Dental Education Initiatives
2010 Kentucky Oral Health Coalition (KOHC) Priorities:
Oral Health Literacy
School-Based Oral Health
Access to Care
KOHC’S VISION OF IMPACT
KOHC’s Vision of Impact is to engage PARTNERS across the state to create a collaborative oral health literacy campaign designed to:
Educate PARENTS Activate POLICY-MAKERS Inspire Health PROFESSIONALS Engage the PUBLIC
to create optimal oral health for all Kentuckians.
OUR ASKS OF YOU FOR TODAY
Participate in social media - #KySmileTeam
Stay for the whole day – we need your expertise
Take your own breaks
Read the Medical News Paper – open it up to the middle – there is an oral health supplement!
Populate the Bright Spots Map
Visit sponsors booths
Become a member of the Kentucky Oral Health Coalition (KOHC)
Network and meet someone new
THANKS TO THE SPONSORS OF THIS EVENT!
THANKS ALSO TO
• KOHC Planning Group
• KOHC Executive Committee
• KOHC members
“CHAMPION”
“a person who fights for or defends any person or cause”
dictionary.reference.com/browse/champion?s=t
A SKEPTIC’S GUIDE TO THE ORAL-SYSTEMIC HEALTH CONNECTIONDr. Michael Glick, Professor and William M. Feagans Chair at the School of Dental Medicine, University of Buffalo
QUESTIONS?
THE STATE OF ORAL HEALTH IN KENTUCKY – DATA, PROGRAMS AND FUTURE
Dr. Julie McKee, State Dental Director
Lisa Lee, Commissioner of Department of Medicaid Services
Kentucky Oral Health Program Overview
Dr. Julie Watts McKeeDental Director
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Core Mission:To assure oral health for Kentucky.
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Statistics: Decay Rates: 2011-2012
10% U.S. Children with decayKentucky rate: currently unknown
2001-200419.5% of 2-5 year olds in U.S. with untreated
decay2001
42.8% of Kentucky children with untreated decay
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Statistics: Access and Utilization46% of all Medicaid/KCHIP children
One dental service60% of 6-9 year olds received services
40% of all received a preventive service54% of 6-9 year olds received preventiveOral Health Service by a non-dentist provider
PhysiciansHealth Departments
Nurses Hygienists
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Statistics: Preventive ServicesFluoride Varnish
200440% reduction in smooth surface decay. Last year: 22,000 in local health deparmentsSmiling Schools: 17,000 this year
Public Health Hygiene7 sites30,000 services4,600 patients
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Statistics: Behavioral Risk Factor Surveillance SystemHigh rate of extractions
7th highest in adults with an extractionDental Visits
42nd in the nation (not good)60% of adults with a dental visit
7th in edentulism in senior Kentuckians.This is an improvement over the years
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Statistics: Dental WorkforceDeloitte Report
Rural areas need dentistsJefferson County needs 150 more dentists
Maldistribution435,000 newly covered mouthsFew new providers13 new dentist license in Appalachia
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Statistics: Water FluoridationReduces decay between 40 and 50%99.8% of Kentuckians have optimally
fluoridated drinking water. Highest covered state
Washington, DC at 100%New regulations
0.7 Parts Per Million
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Key Stakeholders: Health DepartmentsSpecific Funding VarnishSealantsHygiene ProgramsSpecial ProjectsMedicaid Reimbursements
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Key Stakeholders: Dental SchoolsUniversity of Kentucky
OutreachVarnish SuppliesSpecial Projects
University of LouisvilleSpecial Projects
Collaboration is evident
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Key Stakeholders: AppalachiaSmiling Schools
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Key Stakeholders: Boards and Associations Kentucky Board of DentistryKentucky Dental Association
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Key Stakeholders: Water PlantsRegulatory Responsibility
MonitoringReporting
Technical Assistance
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Emerging Issues: Data CollectionUniversity of Kentucky
Prevalence StudyEarly Learners
Delta DentalPrevalence Study
Third and Sixth GradersUniversity of Louisville
On-Going Surveillance System
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Emerging Issues: PH HygienistsSeven Pilot Programs
Start up fundingLooking for two more
Electronic Health RecordsDental is the Canary
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Emerging Issues: Increased Decay Rates in Early ChildhoodPermanent Teeth Decay Rates (Nationally)
Dropping SlowlyPrimary Teeth Decay Rates (Nationally)
Slight, but significant increaseKentucky?
We’ll see
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Emerging Issues: TeledentistryOral Health
Interested in developing networkInvolves dental schoolsInvolves private dentists
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Emerging Issues: Workforce DistributionPossible maldistribution?Medicaid ExpansionLeads to delay or avoidance of care
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Emerging Issues: Community Dental Health WorkersCommunity Dental Health Coordinator
Reduces careReduces impactProven in other areas of patient navigation
and education
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Emerging Issues: Adult DenturesSignificant Increase in Medicaid ExtractionsPent Up Dental Need in Expansion PatientsDentures
EmployabilityBetter Nutrition
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Program Cost Effectiveness:Community Water Fluoridation
Annual per-person cost savings$16-$19 a year
KentuckySaves $69 Million a year
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Program Cost Effectiveness:Fluoride Varnish
20% reduction shown in Kentucky projectsVaries on the studied parameters
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Program Cost EffectivenessSealants
Evidence Based ProcedureAfter two years
$53Oregon
1313% in 20 years$125 cost of filling-avoided
If avoided, PH RDH has avoided $987,164
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The Future of Oral HealthNationally
Provider numbers StableDecreasingIncreasing
StateKeep on striving for the best oral health status
for all Kentuckians
KENTUCKYCabinet for Health and Family Services
Kentucky Department for Medicaid Services
Lisa D. Lee, Commissioner
November 20, 2015
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Medicaid at a Glance
• 1.3 Million Members• Managed Care Delivery System• ACA Changes Medicaid Expansion State Based Exchange – kynect Streamlined Eligibility and Enrollment
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Medicaid Enrollment 2012-2015
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Expansion Demographics• Average age = 38• Evenly distributed between males and
females• Under 138% of Federal Poverty Level -
$16,105 per year• Health Status
– High Cholesterol– Diabetes– COPD– Asthma– Depression
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Overview of Selected Preventive ServicesRelative Increases in number of Medicaid screenings
Pre-Expansion (2013) vs. Post-Expansion (2014)
Tobacco U
se Counse
ling &
Inte
rventions
Adult Diabete
s Scre
ening
Gestational D
iabetes S
creening in
Pregnancy
Breast
Cancer S
creening
Colorecta
l Cance
r Scre
ening
Cervica
l Cance
r Scre
ening
Prosta
te Cance
r Scre
ening
LDL-C
holestero
l Scre
ening
Preventive D
ental S
ervice
s
Alcohol M
isuse
Screening &
Counselin
g
Annual Welln
ess/Physic
al Exa
ms0%
20%40%60%80%
100%120%140%160%180%200%
Smoking
Obesity-Metabolic
CancerCardio-
vascular
DentalMH
Drug & Alcohol
OverallExams
*Based Medicaid Claims Data
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Adult Preventive Dental Visits
2013
2014
2013 2014
73,739
159,739
Preventive Dental Services
117%
85,779More Received
Preventive Services
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Medicaid Paid Dental Services by Category
SFY2009 SFY2010 SFY2011 SFY2012 SFY2013 SFY2014 SFY2015
Category Total Spend Total Spend Total Spend Total Spend Total Spend Total Spend Total Spend
Checkup/oral Evaluation $9,588,344 $11,421,513 $12,565,091 $8,993,894 $10,353,870 $11,976,471 $13,723,578
Dentures $110,174 $99,388 $115,992 $62,763 $41,709 $41,652 $44,361
Extractions $17,088,917 $17,493,869 $18,369,086 $12,633,457 $13,500,062 $17,770,223 $23,581,249
Gum Treatment/Gingivectomy/Debridement $3,188,629 $3,351,197 $3,687,230 $2,134,566 $1,682,975 $2,280,412 $4,094,162
Other $19,775,079 $23,614,684 $24,614,556 $15,597,318 $18,345,909 $22,543,234 $27,478,381
Preventive/Sealants/Cleanings $15,785,138 $19,698,002 $21,470,772 $16,909,144 $21,974,170 $23,190,664 $24,041,463
Prosthesis $17,163 $15,962 $15,857 $8,991 $4,137 $2,344 $777
Pulp Cap/Root Canal $4,278,946 $4,252,226 $4,077,407 $2,860,812 $3,083,581 $2,944,465 $2,929,443
Restoration/Crowns $5,026,268 $5,578,092 $6,009,033 $4,317,920 $5,228,747 $5,717,563 $6,240,392
Restoration/fillings $27,551,645 $30,243,809 $30,301,185 $22,684,698 $26,453,088 $28,352,284 $33,621,099
Space Maintainers/Retainers $796,420 $872,668 $907,706 $653,071 $776,400 $714,259 $617,649
Xrays/Bitewings/Panoramics $10,569,464 $12,563,327 $12,886,825 $9,487,499 $11,618,814 $13,514,228 $16,224,307
Grand Total $113,776,187 $129,204,737 $135,020,739 $96,344,131 $113,063,462 $129,047,799 $152,596,860
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Number of Medicaid Members Receiving Dental Services
SFY Distinct Member Count (Under Age 19 Only)
2010 244,113
2011 262,074
2012 247,055
2013 261,082
2014 274,411
2015 282,171
SFY Distinct Member Count (All Ages)
2010 333,573
2011 351,982
2012 327,451
2013 343,297
2014 402,518
2015 470,380
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SFY 2007 SFY 2008
Distinct Members Rcving Dental Service
172,589 191,725
Distinct Members Enrolled During Timeframe
466,939 482,659
Percent Utilizing 37% 40%
What Happened When Kentucky Raised Dental Rates for Children by 30%?
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Summary
• Dental Health is Important to Physical Health• Not Everyone has Dental Insurance• Medicaid Covers 1.3 Million Members• Medicaid Expansion Covers 427,000 People• Medicaid Paid $152 Million in Dental Claims in
SFY2015• Raising Dental Reimbursement Rates Did Not
Appear to Result in a Large Increase in Utilization for Children
• Policy Changes Impact Services
QUESTIONS?
LUNCHA lunch buffet will by served at the adjacent room. Please grab your lunch and we will move into the awards session.
2015 ORAL HEALTH CHAMPIONS
PANEL DISCUSSION: ENVISIONING ORAL HEALTH IN KENTUCKY BEYOND 2015
Moderated by Bill Goodman, KET
DR. MICHAEL GLICKDR. NIKKI STONEREPRESENTATIVE TOM BURCHEVA STONEBios located in the Program
*Senate Republicans on the Health and Welfare Committee were not available on this date to participate on the panel
PUTTING A KENTUCKY ROAD MAP TOGETHER, TOGETHER:BUILDING ON WHAT WORKS AND MOVING FORWARD IN KENTUCKYFacilitated by: Lacey McNary
OBJECTIVES FOR THIS SESSION Work collaboratively to draft a roadmap for Kentucky to
move the needle forward in oral health in the next two – five years.
Share thoughts, ideas, proposals, and counterproposals.
Prioritize ideas.
“This is the task before us, to design the systems and platforms for coordinated effort.” Clay Shirkey
DIRECTIONS FOR SESSION1. On your table, you will see a poster, markers, and post it notes.2. Our goal for the remainder of the time we are together is to work
together to identify goals and if possible actions for each priority area listed down the side.
3. For each priority area, you will work individually first to write down goals and activities on the sticky notes that YOU would like to contribute. When you are done post them on the poster at your table.
4. When all people at your table have put their sticky notes on the poster, begin to work TOGETHER to determine what your table wants to contribute to this exercise.
5. Since there are so many areas – the side of the room closest to the sponsors tables starts at the top and the other side of the room starts at the bottom.
6. You will have an hour to work. Each table works at their own pace. It is okay if you do not finish the whole poster – get as far as you can together. Try to move as quickly as possible.
ONE REPRESENTATIVE FROM EACH TABLE TO GO HANG THE CHART ON THE WALL AND RETURN TO YOUR SEAT
Quickly. Please.
NOW WHAT?Stop by the posters and have a discussion with a colleague before you leave
We will transcribe and share themes.
CLOSING• Thank you to all
• Stop by the bright spots maps and posters
• Become a member – staff will be with an Ipad to assist you
• CEUs
• Invite to Annual Meeting
KOHC ANNUAL BUSINESS MEETING
MAIN BUSINESS TODAY
Updates on accomplishments
Bylaws changes
Vote on new steering committee members
2015 ACCOMPLISHMENTS
Communications – Mahak Kalra
Membership – Mahak Kalra
Funding – Nikki Stone
Workgroups
SOCIAL MEDIA
Growth since last meeting:
• Facebook Likes: from 249 to 805
• Twitter Followers: from 159 to 480
• Pinterest: from 22 to 88 followers
Goals for 2015:
• 500 Facebook likes
• 300 + Twitter Followers
• 75 Pinterest Followers
COMMUNICATIONS
Goals for upcoming year:
• Grow KOHC List Serve to 400 Individuals
• Continue listerve messages
• Regularly update website with current oral health related happenings in the events section.
Accomplishments since last annual meeting:
• KOHC List Serve Distribution list of 482
• Monthly messages
• KOHC Blog Posts
MEETINGS AND EVENTS
Accomplishments since last annual meeting:
• Attended 6 Kentucky Meetings to Promote KOHC
• Represented KOHC at 6 National and Regional Meetings
Goals for upcoming year:
• Continue to grow and expand the Oral Health network within our state
• Continue to expand Kentucky Oral Health Coalition’s presence in the national scene
ORAL HEALTH LITERACY WORKGROUP
1. Promote Smiles for Life Curriculum2. Provide technical support for oral health literacy training
sessions for parents across Kentucky3. Expand the oral health network at the national, state,
and local level
SCHOOL BASED ORAL HEALTH WORKGROUP
1. Enhance the kindergarten oral health screening process, awareness, and data collection.
2. Encourage schools to promote oral health prevention. 3. Support expanded role of hygienists.
ACCESS TO ORAL HEALTH WORKGROUP1. Promote collaboration between managed care
organizations and oral health advocates2. Increase reimbursement for dentists 3. Encourage dental professionals to become Medicaid
providers
KOHC VOTES
PROCESS REMINDER
Only dues paying members can vote. If you are unclear about your status, let us know.
Only one vote per organizational member.
We will have 3 votes today.
VOTE 1: BY-LAW CHANGE: STEERING COMMITTEE TERMS
An officer term will be from 1 year to 2 year terms.
VOTE 2: BY-LAW CHANGE: STEERING COMMITTEE COMPOSITION
We will eliminate the current positions: Vice Chair, Secretary, and Treasurer.
The Executive committee will now comprise of Past Chair, Chair, and three Workgroup Chairs.
VOTE 3: BY-LAW CHANGE: STEERING COMMITTEE MEMBERSHIP
CURRENT SLATE
Chair – _______________
Access to Care - Stacy Trowbridge
Oral Health Literacy - Dr Laura Hancock Jones
School Based Oral Health - Eva Stone
NOMINATIONS?
MEMBERS DISCUSSION:
Do we need to include by-laws to allow / disallow corporate
representation on the steering committee?
This would include serving as Chair or Chairs of the 3 workgroups.
2016 AND BEYOND
Oral Health 2020 proposal – Nikki Stone
Surveillance Project - Mahak Kalra
2016 Legislative Session – what is on the horizon?
The three components of the proposal include:
1. ENGAGING, SUPPORTING, AND CONNECTING WITH 5 REGIONAL ORAL HEALTH COALITIONS ACROSS THE STATE TO GROW AND STRENGTHEN THE NETWORK AROUND THE COMMON GOALS.
DELTA DENTAL OF KENTUCKY CHILDREN’S ORAL HEALTH SURVEILLANCE
WHO? Kentucky Youth Advocates will oversee the 18-month project.
WHAT? The surveillance model has two basic components: 1) direct observation to a child’s mouth and 2) parent questionnaire that provides consent, dental and medical insurance information, and other general information about the child. project is intended to screen 3rd and 6th graders.
WHERE? 60 target schools across the state to participate in the surveillance project.
WHY? We know what gets measured often leads to change. The most recent
children’s oral health surveillance in Kentucky was completed in 2001. Provide a landscape of the oral health status of Ky’s 3rd and 6th
population.
2. CREATING AN INTERACTIVE AND CROWD-SOURCED KENTUCKY ORAL HEALTH BRIGHT SPOTS MAP TO HIGHLIGHT CHAMPIONS, BEST PRACTICES, DATA, STORIES, AND INNOVATION.
3. BUILDING CONSENSUS AROUND A COLLECTIVE STATEWIDE POLICY AGENDA AND IMPLEMENTING AN ADVOCACY CAMPAIGN TO REACH TARGETS.
THANKS!
Group Picture?