ORAL HEALTH INFRASTRUCTURE ENHANCEMENT FEASIBILITY ANALYSIS

1. ORAL HEALTH INFRASTRUCTURE ENHANCEMENT FEASIBILITY ANALYSIS Project Update to DHCC November 5, 2009 Source: John Snow, Inc. presentation to Steering Committee on August 3, 2009

2. Approach: • Phase I, II - completed • Phase III & IV • Agree on most promising initiatives • Develop detailed business and operational plans (Including identification of partners and collaborators) • Conduct feasibility assessment (Sensitivity analysis and testing assumptions) • Final reporting and presentation (Including written and oral presentation)

3. Guiding Principles • Need for coordinated / systematic approach • Focus on most vulnerable • Pragmatic response that is inclusive of all stakeholders • Builds capacity and strengthens workforce • Involves the private sector overtime • Incorporates patient-centered approach • Aware of provider concerns and business realities

4. Update on Stakeholder Interviews (examples…) • Hospitals in Sussex County • Private dentists in Sussex County • Delaware Dental Society • DIDER Board of Directors • Dental Hygiene Clinic in Wilmington, DelTech • State Medicaid Office • La Red Health Center • Stockley Center • Delaware Healthcare Association

5. Preliminary Key Findings & Draft Recommendations • Multi-Purpose Clinic • Downstate Residency Program • Case Management Program

6. Multi-Purpose Clinic • Support La Red Community Health Center (Designated FQHC) with its on-going efforts to develop primary care dental operations • Once up and running, La Red could work with various stakeholders to implement training activities starting in years 3 or 4 • Community-based residency program in collaboration with Sussex County hospitals • Dental hygienist training site with DelTech hygiene program students residents of Kent and Sussex Counties • Dental assistant training site with Sussex County vocational schools

7. Downstate Residency Program • General Practice Residency sponsored by Sussex County hospital w/ community-based clinical co-sponsor • Bayhealth, Beebe, or Nanticoke Hospital would be primary applicant (Could be collaborative effort between 2 or more hospitals) • La Red CHC would be clinical co-sponsor • Wilmington-based GPR would play supportive role • Sussex / Kent County private dentists and medical doctors would play supportive role

8. Statewide Case Management Program • Work with La Red CHC to case manage existing medical patients to obtain dental care. • Once established, work with the Public Health Clinics, area schools, and other organizations (as appropriate) to case manage children • Coordinate respective outreach within area schools • Collaborate to assist in providing treatment to high need children and facilitating a dental home for ongoing preventive care

9. Next Steps • Wrap-up and Finalize: • detailed business and operational plans (Including identification of partners and collaborators) • feasibility assessment (Sensitivity analysis and testing assumptions) • final report and presentation (DIDER, Steering Committee, & DHCC) (Including written and oral presentation) • Action –Approve contract extension until May 30, 2010 to wrap-up project activities and JSI presentation on recommendations and findings to DIDER Board (Dec) and DHCC (Feb)