ORAL HEALTH AND PRIMARY CARE INTEGRATION FOR PEOPLE … · 2019. 12. 18. · Oral Health for People...
Transcript of ORAL HEALTH AND PRIMARY CARE INTEGRATION FOR PEOPLE … · 2019. 12. 18. · Oral Health for People...
ORAL HEALTH AND PRIMARY CARE INTEGRATION FOR PEOPLE WITH HIVCONNECTING CLIENTS TO ORAL HEALTH SERVICESMission Analytics Group, Inc. under contract with the Health Resources and Services Administration HIV/AIDS Bureau (HRSA HAB)JUNE 6, 2019
1
Disclaimer
Today’s webinar is supported by Mission Analytics Group, Inc. as a part of a contract administered by the Division of Community HIV/AIDS Programs (DCHAP) of the HIV/AIDS Bureau (HAB). The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by the Health Resources and Services Administration (HRSA), the Department of Health and Human Services (HHS) or the U.S. Government.
2
Through the Session, Recipients Can…
Describe components of the integration of primary care and oral health
Learn about strategies and best practices in integrating oral health into primary care practice
Connect with the project team for more information on technical assistance (TA) products and upcoming site visits
3
Presentation Outline
Importance of Oral Health Care for People with HIV
Components of Integration Connecting Clients to Oral Health Services Recipient Experiences:
Hudson River Healthcare Lifelong
Next Steps Q&A 4
4
Oral Health for People with HIV
Oral health is essential for overall health and quality of life Oral health care is especially important for people with HIV Untreated oral disease may lead to infections, weight loss, malnutrition, and
diseases (e.g., diabetes) Oral diseases impact quality of life (e.g., psycho-social problems and limited
career opportunities)
Oral health is one of the top unmet needs for people with HIV who receive services through the Ryan White HIV/AIDS Program
5
Project Goals
Promote the integration of oral health and primary care through the identification and dissemination of best practices
Phase 1 Literature review Site visits with nine RWHAP recipients
Phase 2 Recipient webinar seriesOral Health and Primary Care Integration Toolkit TA site visits with nine recipients/providers
6
Meet the Team
HRSA HAB Project Team LCDR Tanya Grandison, Contracting Officer Representative CAPT Mahyar Mofidi LCDR Sayo Adunola
Mission Analytics Group and expert consultants Ellie Coombs AJ Jones Dr. David Reznik Dr. Steve Abel Carol Tobias Jane Fox
7
Oral Health SettingCoordinate
Primary Care Setting
Assess
Seven Components of Integration
Act3. Educate
4. Intervene
5. Refer
Provide Services1. Ask
2. Examine 6. Support
7. Share
8
Oral Health SettingCoordinate
Primary Care Setting
Assess
Seven Components of Integration
Act3. Educate
4. Intervene
5. Refer
Provide Services1. Ask
2. Examine 6. Support
7. Share
Check out the recording of a May 23 webinar about assessing risk and providing oral health supports in
primary care settings
Models of Oral Health and Primary Care Integration
Referral Based Coordinated, but not Co-Located Co-Located
10
Poll
Which model best represents your site? Referral based Coordinated, but not co-located Co-located Lots of variation Not sure
11
Refer: Build a Referral Network
Virtually all recipients/providers refer out for some procedures What to look for: Insurance compatibility Welcoming stigma-free environment
How to find them: Local and state dental societies/associations Dental and dental hygiene schools Dental service organizations (DSOs) Social service programs that assist low-income individuals Searchable databases
12
Ask Examine Educate Intervene Refer Support Share
Best Practice Ideas
Keep clients with their dentist and consider partnership Formalize agreements Leverage the dependability of RWHAP payment Communicate availability of RWHAP support
13
Ask Examine Educate Intervene Refer Support Share
Support: Address Barriers and Facilitate Oral Health Care Access
Referral coordination and managementMatching clients to oral health providers Scheduling appointments Sending appointment reminders
Supporting appointment adherence Financial/insurance enrollment assistance Arranging transportation and other support services Helping clients overcome fear
Appointment follow-up
14
Best Practice Idea• Use multiple reminder
methods• Stress the importance of
visit compliance
Ask Examine Educate Intervene Refer Support Share
Oral Health Team
Dentist
Dental Hygienist
Dental Assistant
Primary Care Team
PCP
Medical Assistant
HIV Case Manager
Patient Navigation Models
Dental Patient
Navigator
Ask Examine Educate Intervene Refer Support Share
15
Oral Health Team
Dentist
Dental Hygienist
Dental Assistant
Primary Care Team
PCP
Medical Assistant
HIV Case Manager
Patient Navigation Models
Ask Examine Educate Intervene Refer Support Share
16
Oral Health Team
Dentist
Dental Hygienist
Dental Assistant
Primary Care Team
PCP
Medical Assistant
HIV Case Manager
Patient Navigation Models
Ask Examine Educate Intervene Refer Support Share
17
Ask Examine Educate Intervene Refer Support Share
Best Practice Ideas
Identify an oral health point of contact Bring oral health into the care team Offer regular cross-training
18
Share: Exchange Information Across Primary Care and Oral Health Settings
What do dentists need from PCPs?Client health information, including up-to-date labsMedication regimenBarriers to care that could affect dentistry (fear, etc.)
What do PCPs need from dentists?Appointment attendanceClient’s care planPrescribed medicationsRisk factors that may impact primary health
19
Ask Examine Educate Intervene Refer Support Share
Models of Data Exchange20
Integrated EHR and electronic dental record (EDR)
Linked through an electronic bridge
Manual entry or uploads
Ask Examine Educate Intervene Refer Support Share
Best Practice Ideas
Keep it standard; develop referral forms (ideally linked to EHR)
Use your data! Strike a balance between what
you want and what you can get Require treatment plans for
payment
Ask Examine Educate Intervene Refer Support Share
21
Hudson River HealthCareRyan White Dental Program
Lisa Reid, AVP of Care ManagementVanessa Carolina, Genesis Program CoordinatorOskaya Fleming Duran, Dental Care ManagerBrett Wargo, Data Coordinator
22
HRHCare Mission
23
To increase access to comprehensive primary and preventive health care and to improve the health status of our community, especially for the underserved and vulnerable.
Hudson River HealthCare Service Area
24
HRHCare Services & Model
Medicine
• Family Practice Pediatrics Internal MedicineFamily Planning HIV Primary Care SpecialtyGynecology Prenatal and OB
Behavioral Health
Medication Assisted Treatment
Optometry
Dentistry
25
HRHCare Dental Program
25 year history of providing dental care to persons with HIV
Initially funded through RW Part A Utilized Part C and CDC funds to
increase access to care and research and implement best practices
Dental services co-located in 11 of 30 HRHCare Health Centers
26
HRHCare Dental Sites & Services
Spotfire
27
Ryan White Dental Care Team
28
Role of the HIV PCP
29
HIV Specialists provide comprehensive HIV primary care in accordance with the HIV Standards of Care• Quarterly visits• Annual Referrals
• Nutrition• Ophthalmology• Behavioral health• Dental care
Role of the HIV Care Manager
30
Care coordination responsibilities of the HIV Care Manager:• Initial and on-going assessments to
identify barriers to care & referrals for community services
• Insurance application/navigation• Referral management• Coordination of patient care with Dental
Care Manager• Adherence education• Risk reduction
Role of the Dentist
31
Responsibilities of the Dentist:• Cleanings every 6 months• Dental examination • Education • Case conference/QI• Referral to dental specialty care,
if necessary• Treatment adherence
Role of the Dental Care Manager
32
Responsibilities of the Dental Care Manager• Determine RW eligibility• Coordinate dental specialty referrals• Provide dental and adherence
education• Resolve dental care issues• Conduct monthly dental QI/Case
conference and coordination of HIV education for dentists
Role of the Patient
33
Responsibilities of the Patient
• Provide RW eligibility information
• Adherence• Communicate questions and
concerns• Provide feedback/dental survey• Self-management
Electronic Medical Record (EMR)
Dental and Primary Care utilize the same EMR, eClinical Works (eCW)
Offers automated and staff reminder calls through Patient Portal
Provides access to comprehensive patient information
Promotes re-engagement
Templates standardize documentation
34
EMR Integrated Documentation
• Name of HIV Specialist• Date of last HIV monitoring visit• Viral load
Registration form
• Date of last dental visit HIV Annual
• Date of last dental visit Case management assessment
• Date of last dental visitCase conference
• Track percentage of patients who had a dental exam• COGNOS report extracts data from EMR structured data
Quality improvement
35
EMR Structured Data Care Management Assessment
36
EMR Structured Data HIV Annual
37
HRHCare Dental Program Summary
Co-located in HRHC primary care setting
Strong interdisciplinary treatment team component for coordination of care, case conference, QI and training
Integrated electronic medical record
Dental Care Manager: liaison between dental and primary care
38
Thanks to:
The Dental Team Clifford Hames, DDS, Chief Dental Officer Iris Arzu, Informatics Analyst
Contact information: Lisa Reid, LCSW, AVP of Care Management, [email protected] Vanessa Carolina, HIV Program Coordinator, [email protected]
39
LIFELONG DENTAL PROGRAMSEATTLE TGA
D. Mark Baker, Deputy Executive Director
Multiple attempts to create, develop, implement, and maintain an oral health program. Modeled after Boston EMA.
PCP Integration
NeighborCare Health
Whole person health
Relationships with clients
Development41
Each Provider: Signs an MOU with Lifelong for patient referrals and data sharing Contracts with Ryan White for payment
Dentist and Oral Health Providers are selected based on: Capacity and experience serving people with HIV Accepted Insurance with Medicaid Preference Geographic Location Specialty Care Languages spoken
Fee Schedule
Provider Selection42
Data Sharing
Appointments are scheduled through a three-way call. Providers are faxed:
Recent labs Viral Load, CD4 Count
List of medications (at the appointment) Most recent dental visit/dental history Dental fears Demographics Insurance information (if applicable)
Providers confirm monthly appointments and Phase I Treatment data and entered into data system for follow up.
43
Referral Relationship
Referrals come from Case Managers, Self-Referral, and from dental providers
Referrals are managed by a centralized eligibility function and entered into the data system once eligibility is determined
Dental Navigators track attempts to schedule initial appointment through data systems
Missed and kept appointments
44
Barriers
Dental fears Transportation Eligibility Provider preference Funding, caps and limits
45
Funding, Cost, Sustainability
Ryan White Funding Oral Health NMCM
City of Seattle Funding Case Management
Caps/Limits Monitor client level expenses Exception for medically necessary
Provider contract range Monthly monitoring
Fee Schedule
46
THANK YOU
Special thanks to Caila Nickerson, Former LDP Manager
Poll
What components are strengths of your organization? Assess (ask, example) Act (educate, intervene, refer) Coordinate (support, share) It varies Not sure
48
Poll
What components are most challenging for your organization? Assess (ask, example) Act (educate, intervene, refer) Coordinate (support, share) It varies Not sure
49
Next Steps: We Need Your Help!
Nine TA site visits this spring to fall We will work with providers to identify needs and opportunities and
develop an action plan for implementation If you’re a HRSA RWHAP Part C/D recipient interested in receiving
technical assistance for your oral health program, please contact LCDR Tanya Grandison: [email protected]
50
Stay Tuned for the Integration Toolkit51
Questions/Answers and Comments