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Maryland Oral Health Reforms: Progress in the Face of Tragedy

Maryland Oral Health Reforms: Progress in the Face of Tragedy. Maryland Oral Health Summit October 20, 2011 Dr. Harry Goodman Director, Maryland Office of Oral Health. Importance of Oral Health. U.S. Third National Health and Nutrition Examination Survey 1988-1994.

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Maryland Oral Health Reforms: Progress in the Face of Tragedy

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  1. Maryland Oral Health Reforms: Progress in the Face of Tragedy Maryland Oral Health Summit October 20, 2011 Dr. Harry Goodman Director, Maryland Office of Oral Health

  2. Importance of Oral Health U.S. Third National Health and Nutrition Examination Survey 1988-1994

  3. Importance of Oral Health They are “just baby teeth”, but this damage can be permanent….. • Cause permanent damage to their adult successors • Inhibit nutrition and physical development • Keep a child up at night • Affect the child’s ability to concentrate and learn in school

  4. Importance of Oral HealthPictures Tell a Thousand StoriesBut if this doesn’t grab you…

  5. …Will This? The Death of Deamonte Driver • 12-year Maryland boy from PG County • Never complained/no one was looking • Untreated dental infection resulted in 2 brain surgeries, seizures, 1 tooth extracted, and spent 6 weeks in a hospital at a cost of $250,000 • Medicaid cost of simple extraction - <$100 and preventive services - <$60 - $80/year • Died unexpectedly-February 25, 2007 • Lacked access to treatment andeducation and prevention services

  6. “We can't solve problems by using the same kind of thinking we used when we created them.” Albert Einstein “So when a good idea comes, you know, part of my job is to move it around, just see what different people think, get people talking about it, argue with people about it, get ideas moving among that group of 100 people, get different people together to explore different aspects of it quietly, and, you know – just explore things.” Steve Jobs

  7. MARYLAND HISTORY: IN SEARCH OF A DENTAL HOME • Proud history: • Robust Medicaid dental program until the 1970’s • Early implementation of water fluoridation • 99.8% of Maryland residents on public water systems receive fluoridated water (4,839,490 people) – CDC • Ranked #1 in U.S.

  8. MARYLAND HISTORY: IN SEARCH OF A DENTAL HOME • Not so proud history: • Since the 1970’s, nominal emphasis on oral health • Poorly supported Office of Oral Health – continually cut • Only half of Maryland jurisdictions with public health (safety net) dental services • 1997–Medicaid managed care arrived with policy to withdraw State funding from county dental clinics • No partnerships/No oral health advocacy • Late 1990’s, Maryland reported to have lowest access to Medicaid oral health services in U.S.

  9. MARYLAND’S EXPERIENCE: Planting the Seeds (1998 – 2007) • Oral Health Advisory Committee: • Government agencies, organizations from professional dentistry, academia, child advocacy, managed care, and public health • Advocacy efforts • Mostly focused on access to care • Networking • Legislation – State Senator Lawlah • Surveillance • MCHB/Dental School Survey – Dr. Rossetti • HRSA SOCHS Grant • Early 5-year Oral Health Plan

  10. ADVOCACY and PARTNERSHIPS BEGIN: Legislation • Medicaid Reforms (SB 590 - 1998) • Medicaid Utilization Targets • Increased Medicaid Funding • Oral Health Advisory Committee • Dental Loan Assistance Repayment Program (2000) • Pediatric Dental Fellowship Program (2001) • Oral Cancer Prevention Program (2002) • Increased HealthChoice MCO Dental Rates (2003) • Oral Health Safety Net (2007)

  11. DENTAL ACTION COMMITTEE (DAC)Oral Health Access Reforms in the Face of Tragedy • February 2007 – Death of Deamonte Driver • June 2007 - Convened by DHMH Secretary Colmers after death of Deamonte Driver • September 2007 – DAC report • 7 primary recommendations • October 2007 – All DAC recommendations supported by DHMH Secretary and Governor • April 2008 - Governor’s DAC budget initiatives and other DAC-related legislation passed and signed into law

  12. DAC Recommendations and ProgressFocus Mainly on Access to Care • Statewide single Medicaid dental vendor – July 2009 • Maryland Healthy Smiles Program (Medicaid dental program) – DentaQuest • Eased bureaucratic, paperwork, credentialing issues • Over three years, increase dental rates to ADA 50th percentile - 1st year of increase started July 1, 2008 • All preventive, most diagnostic, other procedures • Additional increases delayed due to state budget deficit • Approximately 400 new dentists have joined Maryland Healthy Smiles Program since July 2009 • More pediatric dentists now participate

  13. DAC Recommendations and Progress • Begin to restore dental public health infrastructure • New/expanded dental clinical and school-based/linked public health programs – also dental van • By April 1, 2011, residents in every Maryland jurisdiction now have access to a dental public health program • Deamonte Driver Dental Van Project • Create public health dental hygienist • Legislation passed 2008 • Being implemented in many public health programs • Institute school-based oral health screenings • MDAC Kaiser Foundation grant for pilot project – Sept. 2011

  14. DAC Recommendations and Progress 6.Train general dentists in pediatric dental care • 550 trained 6a. Train pediatricians, family physicians, and nurse practitioners for oral health assessments and apply fluoride varnish • Integrate oral health into routine primary care practice for 9mo – 3 yr olds as part of EPSDT well child visits • Receive Medicaid fluoride varnish reimbursement – 7/2009 • Over 400 trained/Over 30,000 medical claims to date • Oral Health Literacy Campaign • Federal grant thanks to Maryland Congressional Delegation

  15. Oral Health Literacy Campaign – Spring 2012 • Leading the way in oral health literacy taking its cue from the Institute of Medicine (IOM) oral health report • Educate low income families about the importance of oral health and its effects on overall health and well-being • Targets pregnant women and children ages 0-6 • Encourage the public to request and keep dental appointments and be better able to navigate the oral health delivery system • Empower the public to enhance oral health behaviors such as proper oral hygiene practices and nutritional choices at home • Need to evaluate campaign effectiveness • Need to develop strategies and expand to other age groups and health care providers

  16. Maryland Oral Disease Prevention Program 5-Year Cooperative Agreement (2008-2013): Infrastructure Data and Surveillance State Oral Health Plan Partnerships and Coalitions Prevention Activities Policy Development Evaluation Collaborations CDC State-Based Oral Disease Prevention Program

  17. Dentists Participating in Medicaid Maryland: 2009/2010

  18. Maryland Dental Action Coalition (MDAC) • Conversion from government charged Committee (DAC) to an independent Coalition (MDAC) • Funding from: • Office of Oral Health • CDC State State-Based Oral Disease Prevention Cooperative Agreement • DentaQuest Foundation • Many accomplishments • A true partner in every sense of the word

  19. Thanks and Acknowledgements Making Good Music Together – the Value of Partnerships “Being in a band is always a compromise. Provided that the balance is good, what you lose in compromise, you gain by collaboration.” Mike Rutherford (Genesis)

  20. Congratulations! OOH Staffer Ms. Chris Leo, RDH Winner of the Maryland Rural Health Association “2011 Outstanding Rural Health Practitioner Award”

  21. Progress and Recognition… PEW Dental Health “Report Card”: Maryland received an "A" grade and was determined to be the top performer in the country for dental health

  22. …But We’re Not “There” by Any Stretch • Challenges • Maintaining our current momentum • Expanding statewide prevention programs • Providing a dental home for all Marylanders: • Adults and senior citizens • Special needs children and adults • Integration of oral health with overall health system services • Expanding Oral Health Literacy Campaign to other age groups\healthcare workforce • Having a truly oral health literate populace • Countering anti-fluoridation efforts

  23. But Together – We Can Continue Our Progress! Still Awake? (my always inspired boys) hgoodman@dhmh.state.md.us (410) 767-5942

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