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2007 National Primary Oral Health Care Conference

San Diego ,CA

Session Title: Family Health Center of Marshfield, Inc.

Oral Health Expansion Program

Presented by:Greg Nycz, Director

Tuesday, December 11th 11:00 - 11:30 a.m.

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Presentation Overview

Part One – A Four Part Strategy• What we have largely achieved to date

– Phase I: Piloting a dental clinic and getting noticed

– Phase II:1) Replicating and further developing the model in

other communities2) Creating a dental clinic “picket fence” around the

pilot site and3) Fully integrating dental into the electronic medical

record

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Presentation Overview

Part One – A Four Part Strategy, continued

• Future Plans– Phase III:

A second dental school in Wisconsin to address workforce needs and enable Phase IV

– Phase IV: Full deployment of dental capacity and the realization of our Community Health Center vision: 100% access/0 disparities

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Presentation Overview

Part Two – How we got this far and future

strategies• The importance of creating a vision for a

preferred future and establishing a grand design or road map to get you there

• The role of advocacy and community engagement

• The critical nature of dual accountabilities to:– Our patients and communities– The taxpayers

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OUR FIRST FACILITYTHE LADYSMITH DENTAL CENTER

OPENED JULY 2003

8,840 square feet

17 operatories

6 dentists

8 hygienists

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Ladysmith Dental Center Operatory

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Ladysmith Dental CenterWaiting Room

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OUR SECOND FACILITYTHE NEWLY REMODELED OWEN DENTAL CENTER

OPENED IN JULY 2005

2,472 square feet

5 operatories

2 dentists

3 hygienists

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OUR THIRD FACILITYTHE CHIPPEWA FALLS DENTAL CENTER

OPENED JUNE 18, 2007

17,700 square feet

29 operatories

9 dentists (3 posted positions)

6 hygienists

Special space and equipment to serve the developmentally disabled

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OUR FOURTH FACILITYTHE PARK FALLS DENTAL CENTER

OPENING FEBRUARY 2008

9,100 square feet

15 operatories

4 dentists

5 hygienists

Special space and equipment to serve the developmentally disabled

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Making a difference: Delta Dental grant will help build the system

Delta Dental of Wisconsin approved a $500,000 grant, payable over two years, to help build the integrated record model envisioned by Marshfield Clinic and Family Health Center. The implications of this project extend well beyond northwestern Wisconsin, however. Establishment of a standardized, scalable system for electronic health records is a national interest, driven in part by the administrative simplification provisions of the Health Insurance Portability and Accountability Act (HIPAA). The Marshfield initiative recognizes this and could become the model for a much broader system.

Ref: Delta Dental of Wisconsin – Advancing solutions for great oral health

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CURRENT AND ESTIMATED FUTURE DENTAL ACCESS

FY07 FY081 FY091 FY101 Total Patients 12,504 24,516 31,326 40,860 Medicaid 6,640 14,710 18,800 24,000 Sliding -Fee 1,863 3,653 4,668 6,088 Commercial/Self Pay 4,001 6,153 7,858 10,772 Dentists (FTE) 9 18 23 30

1Projection based on Ladysmith 2007 experience, inflated by FTE estimates. 53.1% Medicaid for 2007 , estimate 60% for future years. 14.9% sliding -fee for 2007 -2010.

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Part Two – How we got this far and future strategies

The importance of a vision and a road map.

“If you don’t know where you are going, any road will take you there.”

Lewis CarrolAlice in Wonderland

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Solving Wisconsin’s Oral Health Crisis A Vision for Wisconsin: A Model for the Nation

Prepared for Secretary Kevin Hayden

March 20, 2007

Prepared by: Greg Nycz, Director

Family Health Center of Marshfield, Inc. 1000 North Oak Avenue

Marshfield, WI 54449 715-387-9137

and Barbara Snell, CEO

Access Community Health Centers 3434 East Washington Ave

Madison, WI 53704 608-443-5515

Table of Contents Acknowledgements Executive Summary Introduction 1 The Case for Change 3 The Need for a Ne w Delivery System and Training Model 14 The Wisconsin Demonstration – A Model for the Nation 20 Moving Forward – the Balance Needed 27 A New Dental School and Student Pipeline Infrastructure 28 A Simulated Community Health Center Expansion Program And Its’ Impact on Dental Access in Wisconsin 29 Bibliography 32 Figures, Tables, Appendix A

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The role of advocacy and community engagement

• Giving voice to the silent epidemic– I’ll beg for you– The power of personal stories

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The role of advocacy and community engagement

“A long time ago I learned one thing about most people from home who walked into my office and about those people who don’t. Most who don’t are those with the biggest problems like the woman I met in Rhinelander who because she was on Medicaid could not find a single dentist to remove the braces from her son’s teeth. She finally gave up and held her son down while her husband removed the braces with a pair of pliers. People like her cannot afford to come to us to plead their case. They struggle in the shadows of their neighborhood trying to hang on, trying to get through the day, happy if they don’t find themselves farther behind at a day’s end than they were at the beginning.”

Reference: Prologue (2nd paragraph), Raising Hell for Justice, The Washington Battles of a Heartland Progressive, written by David R. Obey, 2007

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The role of advocacy and community engagement

• The importance of value “the Ladysmith Dental Center”– Opportunity knocked– A natural disaster struck– A strategy right out of a line from the movie

“My Blue Heaven” was born

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The role of advocacy and community engagement

• Community readiness and support

The Model:

1. Local public health advocates raise community awareness about the problem

2. Convene local leaders interested in resolving the problem

3. Review available approaches to problem resolution

4. If our model wins out, consider what your community can do to help us help you.

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The role of advocacy and community engagement

Every community is different: The Chippewa Falls story

They followed the model:1. Identified the need2. Brought leaders together3. Reviewed options4. Wanted us

Then they:1. Created Chippewa County Dental Foundation2. Got a $500,000 Commerce Department grant as well as other

funds3. Purchased land (half donated)4. Built the dental center to our specifications and leased it to us

They share our vision and are a strong long-term partner

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The role of advocacy and community engagement

The importance of ground breakings, ribbon cuttings, and patient origin maps

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Ladysmith Dental Center Ribbon CuttingAugust 2003

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Senator Decker laying the cornerstone brick at theLadysmith Dental Center

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CHIPPEWA FALLS DENTAL CENTER GROUNDBREAKING – MAY 19, 2006

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CHIPPEWA FALLS DENTAL CENTERRIBBON CUTTING CEREMONY

AUGUST 16, 2007

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Park Falls Dental Center Check Presentation – August 15, 2007

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The importance of dual accountabilities to those in need we seek to serve and to those who pay (HRSA, Medicaid) as well as those who ultimately foot the bill (taxpayer).

• Competing interests vie for limited oral health investments

• Organized dentistry “just pay us fairly and we will solve the problem”

• Free clinics, hospital sponsored Medicaid-only clinics, mobile dental safety net clinics all overwhelmed with patients and in need of funds

• Community Health Centers offer a comprehensive solution under a new model – group practice integrated with medicine and the promise of leaving no one behind

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The Need for a Comprehensive Strategy

The problem goes well beyond access to dental services for Medicaid and BadgerCare

Consider: 1) no general dental benefit under Medicare and 2) many more low-income uninsured for dental than

medical care.

Solution: Implement a sliding-fee based on ability to pay for low-income residents without insurance (an essential component of the community health center model)

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The Need for a Comprehensive Strategy

If you build it, they will come, but they come because of oral pain.

If we want to address oral health disparities, we must address health literacy issues and modify the help seeking behavior of those who currently do not understand the value of preventive dental care.

Solution: Integrate dental and medical clinical and administrative information systems and provide decision support to physicians to counsel and refer to the dental service. Promote dental and medical home concept.

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To Get to the Finish Line for Our State We Need to Get to the Finish Line Somewhere in Our State

• Demonstrate we can greatly expand access• Enlist medicine (with decision support) to

address health literacy and refer to dentistry (registry model)

• Champion prevention, maximize community water fluoridation and bring down per capita costs to sustainable levels

• Serve the patients and the taxpayers

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The Role of Community Governance

For 16 years Edward Stroinski from Thorp, Wisconsin, gave generously of

his time in volunteer Board service to Family Health Center of Marshfield,

Inc. His goal, like those of his colleagues on the Board, was simple, “to

help people” and to ke ep Family Health Center’s mission of improving

access to primary care strong. In 2001, under Ed’s leadership, the Board

and staff developed a strategic plan. A cornerstone of that plan was that

we must act to provide quality oral health care to those in need.

This facility in Ladysmith, Wisconsin, represents the first step taken in that

process. This plaque recognizes Ed’s leadership as President of the Board

and the important role your community board volunteers played in

recognizing and acting on a pressing community need for access to quality

dental services.