Oral Health Integration in Well Child Care: Collaboration of Group Health Cooperative, Washington Dental Service, and WD

1. Oral Health Integration in Well Child Care A Collaboration of Group Health Cooperative, Washington Dental Service and WDS Foundation

2. Group Health Cooperative Overview • Large integrated healthcare system • Combines delivery system with coverage • Contracted network • 25 ambulatory and specialty medical centers in WA and northern ID • 1100 medical staff • 640,000 patients • Electronic medical records system

3. Desired Outcomes • Full integration of oral health preventive services as routine part of well child care • Demonstrate the role of primary care providers in caries prevention in large integrated healthcare organizations • Patient and provider acceptance and satisfaction • Seamless business processes • Evaluate ROI • Improved oral health status of young children

4. Oral Health Key Objectives Incorporate oral health prevention elements into well child visits at Group Health • Oral cavity exam • Remineralization with fluoride varnish • Anticipatory guidance • Oral health promotion information • Referrals for dental care if indicated

5. Approach (3 year pilot) • Recruit six pilot clinics throughout western Washington • Incorporate oral health services during well child visits for children 6 months to 3 years • Develop business model for reimbursement with Washington Dental Service • Negotiate billing procedures with Medicaid. • Assess readiness to disseminate practices to all clinics

6. Defining Clinical Workflow • Defining content of care • Establishing roles for clinical team members • Establishing workflow • Building electronic tools to integrate care elements into health record

7. Business Process Changes • Capture of dental insurance information • Establish patient cost-shares at point of service • Develop process for uninsured patients • Develop coding and documentation capability in the electronic record

8. Partners and Roles GH Primary Care Division: • Delivery of service • Reporting and billing of services rendered • Quality improvement cycles to optimize delivery WDS • Insurance reimbursement for services to WDS enrollees WDS Foundation • Training of providers and staff • Funding of oral health services for GHC members not enrolled in WDS or Medicaid • Funding for planning and implementation

9. Staff Satisfaction Survey Results: July 2009 * n = 123

10. Patient Satisfaction Survey Results: 2009 • Over half of the children have private dental insurance coverage • 9% had no dental insurance • The majority of children had not yet been to a dentist • 67% of children in the survey had not yet been to a dentist • The majority of parents indicated they they highly value the oral health services • 91 % want their child to have the remaining recommended fluoride varnish applications • 93% would recommend the fluoride varnish to other parents of young children • Parents expressed very high satisfaction with the full range of oral health services they received. • 89% were satisfied to extremely satisfied with the information they received before the varnish was applied to the child’s teeth • 93% were satisfied to extremely satisfied with how well the staff were able to keep the child comfortable during the varnish application

11. Outcome assessment • Full integration of oral health preventive services as routine part of well child care • Demonstrate the role of primary care providers in caries prevention in large integrated healthcare organizations • Patient and provider acceptance and satisfaction • Seamless business processes • Evaluate ROI • Improved oral health status of young children?

12. Funding WDS Foundation Group Health Foundation

13. Thank you Group Health: David Grossman, MD, MPH grossman.d@ghc.org WDS Foundation: Dianne Riter, MPH driter@deltadentalwa.com

14. Winning strategies • Referral dentist network in place before implementation; success of WDSF sponorship of ABCD program in Washington • Link to existing workflows and cognitive maps; e.g. immunization • Use and integrate electronic tools to pre-order and pre-fill EMR • Standardize team roles and expectations • MA applies varnish before immunizations • Standardize patient education and integrate into existing health promotion materials • Measure outcomes and provide feedback