Dental Public Health Activities: Descriptive Summaries
Mountain Health Alliance
The five-county region, which includes counties in Maryland, West Virginia, and Pennsylvania, have a very high poverty rate and high rates of adult oral health decay. In Allegany County, Allegany Health Right (AHR) has operated a dental program for low income people for over 11 years. Part of that program involves an Emergency Department (ED) Diversion program with the local hospital in Allegany County, in which patients presenting in the ED with dental pain are given a list of resources to contact for help. AHR employs a Community Health Worker (CHW) to do outreach and a Dental Case Manager to help patients find the care they need. To address this pressing problem on a larger scale, area agencies that work with low income populations (including Allegany Health Right) as well as area hospitals, health departments, Federally Qualified Health Centers, and other health care providers collaborated and established the Mountain Health Alliance (MHA) in 2011, under the auspices of the Western Maryland Area Health Education Center (WMAHEC). The MHA is dedicated to increasing access to affordable, comprehensive, quality healthcare for all in the tri-state, five-county region and currently is funded through a Health Resources and Services Administration (HRSA), Federal Office of Rural Health Policy grant, (D06H27794).
Over the course of its existence, the AHR Dental Access Program has provided dental care, at no cost to the patient, in excess of $2.1 million, with AHR paying over $807,000 via grant funding and dental practitioners donating over $1.3 million. Over 2,400 people have received services. Under the ED Diversion Program, from its inception in FY2013 to FY 2014, the Western Maryland Health System saw a 25% decrease in ED visits by patients seeking help with dental issues. In FY2012 the ED saw 1,519 emergency dental patients; by FY2014, that number had decreased to 1,144.
In striving to meet the region’s most pressing problems, the MHA partners focus on assisting low income adults in finding the oral health care they need, and educating local providers as to the benefits of integrating oral health screenings into the primary care setting. MHA has established an ED referral/deferral program with two area hospitals, through which patients seeking dental assistance in the ED are asked to sign a release form allowing the hospital to send their patient contact information to the MHA’s CHWs for follow-up. Once the release form is sent to MHA via HIPAA compliant fax to email, the CHWs contact the patients and help them find the dental care they need through local Health Department dental clinics (there are three in the region and a fourth under construction) or through private dental practitioners who volunteer to provide services to MHA referrals at a reduced hourly rate. The majority of dentists approached by MHA about taking referrals have agreed to provide services at an hourly rate of $150, rather than charging by procedure. This has allowed MHA and AHR to greatly stretch direct service dollars. The dentists have all been approached by MHA staff, and agreed to the parameters of the program as suggested by MHA. No actual contracts have been signed; this is most likely a reflection of the rural area in which the MHA operates. All agreements with private practice dentists have been verbal. The CHWs develop relationships with the patients to encourage them to engage in healthier lifestyles and to improve their overall oral health. Again, the patients receive these dental services at no cost to them. In addition to the ED program, MHA also receives referrals for dental care from the FQHCs in its area, and through a variety of other sources. Finally, the MHA through the Western Maryland Area Health Education Center (AHEC) has provided Continuing Medical Education (CME) and training courses for hospital-affiliated primary care providers (PCPs), Federally Qualified Health Center PCPs, and other PCPs on the integration of oral health exams into the primary care setting.
The project described is supported by the Health Resources and Services Administration, Grant # D06RH27794 (MHA) and Grant # D04RH23556
The Western Maryland Area Health Education Center (AHEC) is one of the regional AHEC centers of the University of Maryland AHEC program – which is supported by Health Resources and Services Administration, Grant # U77HP03056Body of report
Under the original AHR ED Diversion program, consumers presenting at the ED with dental pain were given a list of dental resources to contact. However, recently the MHA approached the hospitals in Mineral and Garrett counties about creating a patient information release form that, when signed by the patient, would allow the ED to send the patient’s contact information directly to MHA’s Community Health Workers. The CHWs then contact the patient directly. While new, it is hoped that this approach will increase the number of people actually receiving oral health treatment who sought assistance through the ED. AHR and Allegany County’s hospital is considering adopting this approach.
Contact Person(s) for Inquiries:
Susan Stewart, Executive Director, Western Maryland Area Health Education Center,39 Baltimore Street, Suite 201, Cumberland, MD 21502, Telephone: 301-777-9150, Email: firstname.lastname@example.org
Sandi Rowland, Executive Director, Allegany Health Right, 153 Baltimore Street, #3, Cumberland, MD, 21502, Telephone: 301-777-7749, Email: email@example.com