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5/3/17
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Silver Diamine Fluoride in the “Real World”
Sharity Ludwig, EPDH, MS
Presenter Disclosure
www.AdvantageDental.comAdvantage Dental proprietary information
The following personal financial relationships with commercial interests relevant to this presentation
existed during the past 12 months:
Sharity Ludwig is the Director of Community Dental Programs for Advantage Dental
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Advantage Dental Overview
www.AdvantageDental.comAdvantage Dental proprietary information
Founded in 1994 by a group of dentists concerned with lack of dental care in rural Oregon.
} Mission: To provide dental leadership, service and access to care for our communities in a professional, entrepreneurial, and sustainable manner.
} Commitment: Do everything possible to ensure that no member of any community Advantage serves suffers the ravage of tooth decay or suffers from dental caused pain which inhibits their daily life.
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Impact Across the Lifespan
Child
Adult
Older Adult
Douglas County 1990’s Douglas County 2016
www.AdvantageDental.comAdvantage Dental proprietary information
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Goal of Treatment: Oral Health Over a Lifetime!!
Objective:1. Caries Risk Assessment 100% of assigned members2. Prioritize care based on risk
Areas of Interest
www.AdvantageDental.comAdvantage Dental proprietary information
} Increase preventive visits for pregnant women and children} Decrease bacterial transmission
between mother and child} Four fluoride varnishes by 30
months} Decrease hospital OR cases
} Costly} Reduce exposure to sedation
} Decrease hospital ED visits for dental concerns} Doesn’t address the root cause
} Decrease unnecessary drug use (opioids & antibiotics)
} Control infection and decrease disease burden for chronic disease patients
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Meeting People Where They Are With Service and Science
} Dental Office Barriers (traditional service)} Inconvenient} Transportation Barriers} Trauma inducing for
some individuals
} Dental Outreach (non-traditional in the community)} Risk assess
} Pregnant women} Women, Infant,
Children (WIC)} Head Start } Schools } Medical offices} Residential facilities
} Trusted Community Partners
Core Concepts of Delivery System
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Community Outreach Increase children’s and pregnant women’s utilization with efficiency through community-based dental care in Oregon.
Expanded Practice Dental Hygienists and Community Liaisons
Utilizing dental auxiliaries at the top of their licenses. Local relationship-building.
Evidence-Based Care American Association of Pediatric Dentistry (AAPD) risk guidelines.Evidence-based care algorithms based on risk programmed into Electronic Dental Record (EDR). Appropriate utilization of resources.
Central Case Management Virtual connectivity for seamless linkage to necessary dentist care.
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Connecting the Community
www.AdvantageDental.comAdvantage Dental proprietary information
Patientseenincommunitysetting
Clinicalfindingsand
riskassessmententeredinElectronic
HealthRecord
Electronicnotificationsentto
PrimaryCareDentistand
CaseManagement
Communitybased
preventionandtreatment
provided
CaseManagementassistsintriagingto
care
Communityteams
engagedifnecessary
Risk-based Clinical Algorithm
www.AdvantageDental.comAdvantage Dental proprietary information
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Community Risk-based Treatment Recommendations
www.AdvantageDental.comAdvantage Dental proprietary information
Virtually Connected Interdisciplinary Care Team
www.AdvantageDental.comAdvantage Dental proprietary information
Primary Care Dentist
Regional Community
Teams
Centralized Case
ManagementCommunity
Entities
Risk-Based Care
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Aligning Reimbursement
Global BudgetingBudgeting
Capitation or Discounted Fee for Service for PCDsStaff model salary for clinics and community teams
Compensation
Pay for performance based on disparities metrics for whole team
Pay for Performance
What is Global Budgeting?} Medicaid pays the company to administer the
program and provide services for thousands of clients.
} Medicaid rate varies by age of client and which program they are in.
} Company creates a global budget based on its mission statement and goals
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Global BudgetingOregon Health Authority
16 CCOs
Quality Improve Metrics at CCO Level and CCO Withhold
Provider CarePCDs
SpecialistsCommunity EPDHs
DCO Withhold
Dental Care Organization
Advantage Dental
Administration & Profit
Case Management Services
Compensation• Providers have the opportunity to invest in the
company and become unit holders• Providers can own and operate their own practices. • PCDs receive capitated payments with bench marks
for performance in order to receive their withhold (utilization not production).
• Specialists are paid discounted fee for service for services referred to them.
• Centralized Case Management team provides support for all providers.
• Centralized Community Team of Regional Managers and Expanded Practice Hygienists provide support for all providers.
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Advantage Dental Services, LLC
Withhold
Eligible to all OHP network
providers
DHS Dental Assessment
within 30 days
Sealants on molars of 6-
9 & 10-14
PREDICT Incentive
Clinical community team
Incentive based on Intervention county assigned
Regional Manager
Community Liaison
Expanded Practice Permit
Dental Hygienist
Centralized administration
team
Incentive Based on performance of ALL 7 intervention counties
Case Management
All other Administrative employees not called out in
other two groups
Dental Home
Incentive based on individual provider
performance within the Intervention County
Primary Care Dentist
Advantage Dental Clinics
Withhold Goals
www.AdvantageDental.comAdvantage Dental proprietary information
} Sealants } Foster children} The percentage of OHP recipients that get at least one
visit of any kind per year } Patient satisfaction } Emergency department visits} Production –(Cap versus Encounter Data)} Fee for service referrals } Silver fluoride per 1,000} Risk assessment per 1,000} Children age six and under treated in the hospital.
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SharityLudwig,EPDH,MSEmail:[email protected]
Anyintelligentfoolcanmakethingsbiggerandmorecomplex...Ittakesatouchofgenius- andalotofcouragetomoveintheoppositedirection.-- AlbertEinstein
