Presentation Overview

1. 2007 National Primary Oral Health Care ConferenceSan Diego ,CASession Title: Family Health Center of Marshfield, Inc. Oral Health Expansion ProgramPresented by:Greg Nycz, DirectorTuesday, December 11th 11:00 - 11:30 a.m.

4. 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: • Replicating and further developing the model in other communities • Creating a dental clinic “picket fence” around the pilot site and • Fully integrating dental into the electronic medical record

5. 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

6. 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

7. OUR FIRST FACILITYTHE LADYSMITH DENTAL CENTEROPENED JULY 2003 8,840 square feet 17 operatories 6 dentists 8 hygienists

8. Ladysmith Dental Center Operatory

9. Ladysmith Dental CenterWaiting Room

10. OUR SECOND FACILITYTHE NEWLY REMODELED OWEN DENTAL CENTEROPENED IN JULY 2005 2,472 square feet 5 operatories 2 dentists 3 hygienists

11. OUR THIRD FACILITYTHE CHIPPEWA FALLS DENTAL CENTEROPENED 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

12. OUR FOURTH FACILITYTHE PARK FALLS DENTAL CENTEROPENING FEBRUARY 2008 9,100 square feet 15 operatories 4 dentists 5 hygienists Special space and equipment to serve the developmentally disabled

14. 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

19. 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 Carrol Alice in Wonderland

21. The role of advocacy and community engagement • Giving voice to the silent epidemic • I’ll beg for you • The power of personal stories

22. 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

23. 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

24. The role of advocacy and community engagement • Community readiness and support The Model: • Local public health advocates raise community awareness about the problem • Convene local leaders interested in resolving the problem • Review available approaches to problem resolution • If our model wins out, consider what your community can do to help us help you.

25. The role of advocacy and community engagement Every community is different: The Chippewa Falls story They followed the model: • Identified the need • Brought leaders together • Reviewed options • Wanted us Then they: • Created Chippewa County Dental Foundation • Got a $500,000 Commerce Department grant as well as other funds • Purchased land (half donated) • Built the dental center to our specifications and leased it to us They share our vision and are a strong long-term partner

26. The role of advocacy and community engagement The importance of ground breakings, ribbon cuttings, and patient origin maps

27. Ladysmith Dental Center Ribbon CuttingAugust 2003

28. Senator Decker laying the cornerstone brick at theLadysmith Dental Center

29. CHIPPEWA FALLS DENTAL CENTER GROUNDBREAKING – MAY 19, 2006

31. CHIPPEWA FALLS DENTAL CENTERRIBBON CUTTING CEREMONYAUGUST 16, 2007

32. Park Falls Dental Center Check Presentation – August 15, 2007

34. 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

35. The Need for a Comprehensive Strategy The problem goes well beyond access to dental services for Medicaid and BadgerCare Consider: • no general dental benefit under Medicare and • 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)

36. 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.

37. 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

40. The Role of Community Governance