National Oral Health Expenses Oral Health Care for People with - PowerPoint PPT Presentation

3/8/2018 Disclosures • The speaker has nothing to disclose Paul Glassman DDS, MA, MBA Professor and Director of Community Oral Health University of the Pacific School of Dentistry San Francisco, CA pglassman@pacific.edu Pacific Center for Special Care at the University of the Pacific Arthur A. Dugoni School of Dentistry National Oral Health Expenses Oral Health Care for People with Developmental Disabilities U.S. National Dental Expenditures 2000 - 2025 ($ Billions) $250 350% • Ability to access and have $200 300% dental care in a dental office 250% $150 • Complex health history 200% Dental Services (DS) DS % of 2000 Level (321%) • Ability to apply prevention $100 150% procedures 100% $50 50% $0 0% Source: CMS National Health Expenditure NHE Historical and projections, http://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/NationalHealthAccountsHistorical.html http://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/NationalHealthAccountsProjected.html Pacific Center for Special Care at the University of the Pacific Arthur A. Dugoni School of Dentistry Pacific Center for Special Care at the University of the Pacific Arthur A. Dugoni School of Dentistry 1

3/8/2018 Health Spending by Condition Medical Expenditure Panel Survey - Top 25, 2013 $110,000 $100,000 $90,000 $80,000 $70,000 (Millions) $60,000 $50,000 $40,000 $30,000 $20,000 $10,000 $0 General Health: MEPS: Expenditures by Medical Condition 2013, Table 3 http://meps.ahrq.gov/data_stats/tables_compendia_hh_interactive.jsp?_SERVICE=MEPSSocket0&_PROGRAM=MEPSPGM.TC.SAS&File=HCFY2013&Table=HCFY2013%5FCNDXP%5FC&_Debug= Dental Health: MEPS: Expenditures per Person by Health Care Service 2012, Table 3 http://meps.ahrq.gov/mepsweb/data_stats/tables_compendia_hh_interactive.jsp?_SERVICE=MEPSSocket0&_PROGRAM=MEPSPGM.TC.SAS&File=HCFY2013&Table=HCFY2013%5FPLEXP%5FB&VAR1=AGE& VAR2=SEX&VAR3=RACETH5C&VAR4=INSURCOV&VAR5=POVCAT13&VAR6=REGION&VAR7=HEALTH&VARO1=4+17+44+64&VARO2=1&VARO3=1&VARO4=1&VARO5=1&VARO6=1&VARO7=1&_Debug= Pacific Center for Special Care at the University of the Pacific Arthur A. Dugoni School of Dentistry Pacific Center for Special Care at the University of the Pacific Arthur A. Dugoni School of Dentistry Center for Health Care Strategies. Examining Oral Health Care Utilization and Expenditures for Low-Income Adults. November 2017. https://www.chcs.org/media/FOM-Oral-Health_111617.pdf Pacific Center for Special Care at the University of the Pacific Arthur A. Dugoni School of Dentistry Pacific Center for Special Care at the University of the Pacific Arthur A. Dugoni School of Dentistry 2

3/8/2018 Disruptive Innovation Disruptive Innovation • Companies tend to innovate faster than their customers’ needs evolve • Their products or services become too sophisticated, too expensive, and too complicated for many customers in their market. • Historically the greatest profitability has been achieved by charging the highest prices to their most demanding and sophisticated customers at the top of the market. Pacific Center for Special Care at the University of the Pacific Arthur A. Dugoni School of Dentistry Pacific Center for Special Care at the University of the Pacific Arthur A. Dugoni School of Dentistry Disruptive Innovation • However, by doing so, companies unwittingly open the door to “disruptive innovations” at the bottom of the market. • An innovation that is disruptive allows a whole new population of consumers at the bottom of a market access to a product or service that was historically only accessible to consumers with a lot of money or a lot of skill. J. Am. College Dentists. 2016(83)2. Disruptive Innovation and the Oral Health System. Pacific Center for Special Care at the University of the Pacific Arthur A. Dugoni School of Dentistry Pacific Center for Special Care at the University of the Pacific Arthur A. Dugoni School of Dentistry 3

3/8/2018 Total Health: How Long and How Well We Live Care for Chronic Oral Diseases Behaviors Health Care Delivery (alcohol, tobacco, (procedures) diet, exercise, Acute Care/ preventive dental Environment, procedures?) Surgical Public Health 10% Intervention 20% 40% 30% Chronic Disease Genetics Management McGinnis JM & Foege WH. Actual Causes of Death in the United States. JAMA 1993; 270(18):2207-12 (Nov 10). McGinnis JM, Williams-Russo P, Knickman JR. The case for more active policy attention to health promotion. Health Affairs 2002; 21(2):78-93 (Mar). Pacific Center for Special Care at the University of the Pacific Arthur A. Dugoni School of Dentistry Pacific Center for Special Care at the University of the Pacific Arthur A. Dugoni School of Dentistry Overcoming Obstacles Program Overcoming Obstacles to Oral Health • Collaborators – Pacific School of Dentistry – Apple Tree Dental – California Dental Association – California Dental Hygiene Association – American Dental Association Elder Care Committees – California Association of Health Facilities – American Health Care Association Pacific Center for Special Care at the University of the Pacific Arthur A. Dugoni School of Dentistry Pacific Center for Special Care at the University of the Pacific Arthur A. Dugoni School of Dentistry 4

3/8/2018 The Obstacles to Oral Health The Pyramid Training Model • Informational obstacles – Not sure what to do – Or, do not understand the importance of doing it Oral health • Physical obstacles professionals – Can’t physically perform needed procedures Social service professionals, • Behavioral obstacles nurses, facility managers, etc. – Resistive to performing procedures • Organizational obstacles Parents, caregivers, direct care staff, individuals with special needs – Systems within an institutional setting Pacific Center for Special Care at the University of the Pacific Arthur A. Dugoni School of Dentistry Pacific Center for Special Care at the University of the Pacific Arthur A. Dugoni School of Dentistry Solving Informational Obstacles Solving Informational Obstacles Special Toothbrushes • Recognize the difference between a healthy and an unhealthy mouth Surround Brush Pacific Center for Special Care at the University of the Pacific Arthur A. Dugoni School of Dentistry Pacific Center for Special Care at the University of the Pacific Arthur A. Dugoni School of Dentistry 5

3/8/2018 Adapted Oral Solving Informational Obstacles Hygiene Instruments • Understanding – replacement, storage, of oral hygiene equipment – and infection control Pacific Center for Special Care at the University of the Pacific Arthur A. Dugoni School of Dentistry Pacific Center for Special Care at the University of the Pacific Arthur A. Dugoni School of Dentistry Solving Physical Obstacles Mouth rests Open Wide Prop Pacific Center for Special Care at the University of the Pacific Arthur A. Dugoni School of Dentistry Pacific Center for Special Care at the University of the Pacific Arthur A. Dugoni School of Dentistry 6

3/8/2018 Solving Behavioral Obstacles • Structuring the environment • Involving the individual • Using reinforcers • Shaping • Generalization • Desensitization Pacific Center for Special Care at the University of the Pacific Arthur A. Dugoni School of Dentistry Pacific Center for Special Care at the University of the Pacific Arthur A. Dugoni School of Dentistry Pacific Center for Special Care at the University of the Pacific Arthur A. Dugoni School of Dentistry Pacific Center for Special Care at the University of the Pacific Arthur A. Dugoni School of Dentistry 7

3/8/2018 Pacific Center for Special Care at the University of the Pacific Arthur A. Dugoni School of Dentistry Pacific Center for Special Care at the University of the Pacific Arthur A. Dugoni School of Dentistry Silver Diamine The Declining Role for the Dental Drill Fluoride Varnish Fluoride Pacific Center for Special Care at the University of the Pacific Arthur A. Dugoni School of Dentistry Pacific Center for Special Care at the University of the Pacific Arthur A. Dugoni School of Dentistry 8

3/8/2018 Sealing Caries Science of caries and chronic disease management Pacific Center for Special Care at the University of the Pacific Arthur A. Dugoni School of Dentistry Pacific Center for Special Care at the University of the Pacific Arthur A. Dugoni School of Dentistry The CA Health Workforce Pilot Project Science of caries and chronic disease management Community- based telehealth enabled teams Pacific Center for Special Care at the University of the Pacific Arthur A. Dugoni School of Dentistry Pacific Center for Special Care at the University of the Pacific Arthur A. Dugoni School of Dentistry 9

3/8/2018 The CA Health Workforce Pilot The CA Health Workforce Project Pilot Project 1. RDAs, RDHs, and RDHAPs will make the decision about which radiographs to take, if any, to facilitate an initial oral evaluation by a dentist. 2. RDAs, RDHs, and RDHAPs will place “Interim Therapeutic Restorations” (ITR) Pacific Center for Special Care at the University of the Pacific Arthur A. Dugoni School of Dentistry Pacific Center for Special Care at the University of the Pacific Arthur A. Dugoni School of Dentistry Pacific Center for Special Care at the University of the Pacific Arthur A. Dugoni School of Dentistry Pacific Center for Special Care at the University of the Pacific Arthur A. Dugoni School of Dentistry 10