Providing Dental Care to Low Income Families

1. CHALLENGE Providing Dental Care to Low Income Families Brenda Diamond, Director Ministry Dental Center Patsy Mbughuni, Senior Planner CAP Services Inc.

2. Culture • Barriers to Dental Care • Effects of Oral Health on Overall Health • History of Ministry Dental Center • Community Benefit AGENDA

3. Culture is defined as learned behavior which has been socially aquired1 1Park K. Social sciences and medicine. Park’s textbook of preventive and social medicine. 17th ed. Jabalpur India; M/ s Banarsidas Bhanot publishers: 2002: pp 459-488. • Number of people with dental Insurance? • Seen a dentist in the last 6 months for preventative care? • Children should be seen at age 2 for their first dental exam? True or False • Believe you have “soft” teeth. • Want to see a dentist but cannot. CULTURE

4. 65% of people who have dental insurance, utilize it annually. • 46% with commercial insurance, have completed a yearly check up (re-care appointment). (Paid at 100%) • On average, 30% of children in Wisconsin covered by Badger Care has seen a dentist in the last year. Children should be seen by age 1. Myths Unveiled

5. There is not such a thing as “soft” teeth. Teeth that break down easily could be a result of diet (sugar drinks), brushing habits, other oral habits such as smoking, chewing tobacco and drug therapy as well as lack of professional dental care. Fluoride and genetics do play a role in the enamel make up of your teeth. • Access to comprehensive dental care continues to be a real problem in the state of Wisconsin. • Based on utilization rates today, studies indicate there will be enough providers to cover the demand for care in the future. Should community demand increase, dental access could be constrained. Myths Unveiled continued

6. 44 percent of American children will suffer from pediatric dental disease before they reach kindergarten. 73 percent of preschoolers and 48 percent of primary school age children have unfilled cavities Only 1.5 percent of 1-year-olds have had a dental office visit compared with 89 percent who have had an office-based physician visit. (Question of value placed on oral health) National Statistics

7. Fear • Embarrassment • Expense of non covered treatment • Work Schedules • Transportation (Reliable) • Mental Health • Limited providers Barriers to Seeking Care

8. Commercial Insurance Co Payments Out of Pocket Costs Maximum benefits reached quickly Non-Insured Initial $200 plus for appointment Tight Budget, no extra cash for care Chronic needs Public Assistance Programs Limited providers Travel Long distance Wait list for care Chronic needs In/Out of Eligibility INSURANCE BARRIERS

9. Smiles and laughter strengthen your immune system, boost your energy, diminish pain, and protect you from the damaging effects of stress and prevent heart disease.  Both are powerful mood changers as they reduce stress hormones, release endorphins and relieve tension. Smiling releases Serotonin into your blood stream so when you smile you release feel good hormones which raise your mood and lift your spirits. OVERALL HEALTH

10. Recent scientific research suggests a very strong correlation between chronic oral infections from periodontal (gum) disease and systemic health.   • Medical conditions may be complicated by bacteria from the mouth. Oral Systemic Connection

11. Cardiovascular disease - Inflammatory response to oral bacteria contributes to cardiovascular disease, heart attacks or strokes. • Pulmonary Disease - People with chronic periodontal disease (10% of the general population and 50% of all seniors) are most affected by pneumonia. Improving the state of poor oral health may reduce the number of pneumonia cases and decrease patient mortality. • Diabetes - 1/3 of all people with diabetes have severe periodontal disease. Untreated, periodontal disease can disrupt diabetic control. Periodontal disease may be considered a complication of diabetes. • Orthopedic Implants - Infections originate from oral bacteria may lead to failure of the prosthesis. Dental evaluation before surgery could decrease the potential risk of infection. • Cancer - Elimination of all dental disease prior to cancer therapy may minimize or prevent the potential complicating effects of chemotherapy. • Fetus Development - Risk of preterm birth was 3 to 8 times greater for mothers with periodontal disease. Medical Conditions

12. Community-wide concern • CAP Services’ community needs assessment 1995 and 1998 identify lack of access to medical and dental care • Head Start dental assessments – no providers • Hospital Emergency Room visits for dental issues • Family Preservation and Support Initiative - Affordable Health Care Task Force 1996- lack of dental care Community Challenged

13. Delta Dental of Wisconsin, Saint Michael’s Hospital, CAP Services • Each partner brought unique resources to the table: • Delta Dental: financial resources • Saint Michael’s Hospital: financial resources and management/organizational medical infrastructure • CAP Services: resource mobilization capacity, outreach to target community. “Mission of CAP Services is to bring about a permanent increase in the ability of low-income individuals to become economically and emotionally self-sufficient.” Partnership Coalesced

14. January 2002 - Open

15. Our Mission is to continually improve the health and well being of people, especially the poor, in the communities we serve. We believe people have the right to quality dental care services that are efficient, effective and accessible. We believe care should be compassionate and delivered in a dignified and respectful manner by a culturally sensitive and highly professional team of people. Ministry Dental Center

16. Ministry Dental Center provides comprehensive general dental care for infant, pediatric, adolescent, adult and geriatric patients. Eligibility:Recipient of Badger Care Benefitsin Portage & Waupaca Co The patient population served is approximately 40% under age 20; 52% patients aged 20-59; and 8% 60 and older. 21% self report disabled. Ethnicity: Caucasian 81%, Hispanic 5%, Asian 1%, Hmong 9%, African American 3%, Bi-racial 1%. Demographics

17. The most prevalent reasons patients present for dental care are: • Diagnostic (Oral evaluations, diagnostic imaging) • Preventive (prophylaxiswhich includes scaling and polishing procedures to remove coronal plaque, calculus and stains; fluoride treatment; nutritional and dental disease counseling; tobacco counseling for the control and prevention of oral disease; oral hygiene instructions and sealant placement) • Restorative (placement of amalgam, resin fillings) • Emergency Treatment of dental pain (Open a tooth to drain infection and/or extraction as necessary) • Limited Endodontics, Periodontics and Prosthodontics (Root Canal Therapy, treatment of gum disease and replacement of missing teeth) SCOPE & COMPLEXITY OF PATIENT’S CARE NEEDS

18. Ministry Dental is staffed by Total of 13.4 FTE.2.80 FTE Dentist. 2.4 FTE Dental Hygienists, 4.6 FTE Dental Assistants, 2.6 FTE Schedulers, and 1.0 Director.HOURS OF OPERATION:Monday 8 a.m. – 5 p.m.Tues-Thursday 8 a.m. - 6 p.m.Friday 8a.m. - 4:30 p.m.

19. Patients Seen in 2013

20. Operational Philosophy Patients First Standardization Organization Lean-eliminate waste OPERATIONAL EFFICIENCY

21. United Way of Portage County • WI Department of Health Services Dental Grant • Delta Dental • Anthony Family Foundation • Frame Memorial Presbyterian Church • Jeregan’s • Manawa Telephone company • Wetherbee Donation • Saint Michael’s Foundation • Central Wisconsin Community Foundation Sustainablity_Filling the GAP *Average Annual Deficit of $460,000

22. COMMUNITY BENEFITS

23. IMPACT TODAY FUTURE IMPACT Decrease decay rates in children Decrease adult dental care needs Increase demand for preventative recare appointments to sustain oral health. Community awareness of the effectives of oral health on overall health Improve overall health in the Community • Children are seen next available appointment starting at age 9m – 1 yr. • Fluoride Varnish • Sealants • Patient Education utilizing teach back techniques • Emergency & Restorative Care • Treatment plans are completed in 90 days • Over 15,000 persons seen • Low income families have dental home

24. Improving oral health in the community involves changing the community culture around oral health. (learned behavior which has been socially acquired) • Way to impact community culture is through outreach and education. • New Moms groups • Pregnancy Fairs • Public nurses – education in-service • Primary care, OB-GYN, Pediatric physician forums on early intervention and education. • Physicians applying fluoride varnish during well baby checks. Community Out Reach

25. Our Mission is to continually improve the health and well being of people, especially the poor, in the communities we serve. We believe people have the right to quality dental care services that are efficient, effective and accessible. We believe care should be compassionate and delivered in a dignified and respectful manner by a culturally sensitive and highly professional team of people. Back to the Mission

26. Making a difference in our community ! Patient Satisfaction

27. Questions Thank you!