Michigan Community Dental Clinics, Inc.Dental Care for the Under-served

Medicaid Eligible and the Low Income Uninsured

The Dental Clinics North “Social Entrepreneur” Model adapted for

the State of Michigan

Gregory P. Heintschel, DDS Dental Director

_______ Patti Ulrich

Director of Community Programs

and Outreach

MCDC Mission StatementWhy we exist …Our Mission is to increase access to oral

healthcare and provide health education to Medicaid recipients and to low-income uninsured persons in Michigan.

Our care is delivered in a fashion that upholds and respects the dignity of those served, with the ultimate goal of improving their quality of life with improved health and wellbeing.

Our focus is on those we serve.We are changing lives – one life at a time.

MCDC Vision Statement What we hope to accomplish …

Our vision is a healthy Michigan population, who assume responsibility for their own wellness, with our staff’s guidance and proper intervention.

This is accomplished by providing appropriate oral healthcare, delivered efficiently and with assured quality, to meet the needs of those who seek care.

MCDC Action StatementHow we succeed

We assist in the development of dental clinics and other dental models to increase access to oral healthcare for those on Medicaid and the Low-income Uninsured.

We also provide the Staff and Management Services that allow the clinics to maximize efficiency and productivity, thereby leveraging limited resources for the greater good.

What is Dental Clinics North?A partnership of 6 LHDs that serve 21 Cos from M-55 to the

Mackinac Bridge

Created and operated by NW Michigan Community Health Agency – Charlevoix (DCN is a division of NWMCHA) Health Dept for CHX, Emmet, Antrim, and Otsego counties

5 other LHDs partner with NWMCHA to coordinate care with other LPH programs – WIC, etc. To be the LHD presence for the dental clinic(s) in their service area

Ten Clinics located in TC, Manistee, Cadillac, West Branch, Mancelona, East Jordan, Gaylord, Alpena, Petoskey, Cheboygan - with Manistee joining in Jan ‘08

34 Dentists, 22 RDHs, 61 dental assistants

Central Staff of seven dedicated to Dental with backup from more in Finance and IT

Dental Clinics North ProgramsCurrent Programs:

Ten Clinics serving 21 rural northern lower MI counties 25,000 clients served with over 50,000 visits annually Electronically connected with Electronic patient record using

the DXOne version of Dentrix (as of October 1, 2004) The Northern Dental Plan Training Program for University of Michigan Dental Students

Hospital care provided in 3 regional hospitals For children < 4 with severe dental disease (ECC) or medical

necessity For those Developmentally Disabled (DD) Adults who cannot be

treated in the clinic settingPrograms on the “Drawing Board”

Nursing Home Program for the 85% of residents who are covered by Medicaid and cannot access care

Expansion of the Hospital Program to more hospitals Newly Created MI Community Dental Clinics, Inc, (MCDC) to

increase access to care throughout MI New clinic buildings for our Gaylord and Manistee operations

Coordinated Prevention & Education Programs Work!

The Northern Dental Plan (NDP)A Reduced Fee Program for Uninsured AdultsImplemented April 1, 2004

Eligible Adults - up to 200% of the Poverty Level

Using a fee schedule that covers DCN’s costsAll area Dentists can participate – if willing to

accept the fee schedule Comprehensive dental services available at more

affordable feesAllows access to care for those not eligible for

Medicaid (the working poor and retirees subsisting on SS alone)

Patients will pay for services as they are rendered using cash, check, money order or credit card

The Northern Dental PlanA Reduced Fee Program for Uninsured AdultsHow it works…

Interested patients contact our Clinics to join the plan – cost is $50 per person to enroll

In return for the $50, the patient receives a Comprehensive Oral Exam w FMX & TXT Plan

In addition, the patient now has access to our reduced fee schedule, which is ~ 35-40% below UCR

Those persons on Medicaid can receive services not covered by Medicaid at these fees without enrolling in the plan

We allocate 15-20% of our schedule to accommodate the NDP patient pool.

Funds in Excess of Costs will be used toContinually expand, update, repair and replace

dental equipment and clinic infrastructureCreate a Dental Assistance Fund dedicated to

supporting the cost of care in our clinicsUsing the NDP fee schedule….

Provide essential services not covered by Medicaid Provide services to low-income uninsured adults Have patients pay a portion of the cost, with the Fund

paying the balance.

Quality Assurance1. Patient Satisfaction Surveys

2. Director of Quality Assurance at DCN David Murphy, DDS – UMSD, 1969

25 yrs of dental practice experience 5 yrs teaching clinical dentistry at UMSD as a clinical assistant

professor Currently teaching at Kalamazoo Valley CC dental hygiene program,

and resides in Otsego, MI. Electronic Chart reviews to determine

Appropriateness of Care Before and after quality effects of txt, using digital x-ray images Consistency of Care and billing practices Rx prescribing practices

3. Group practice Working with other professionals in a group encourages

conformity and assures quality of care. Continual peer pressure to provide optimal care. Outliers from the norm are easily identified and corrected.

Dental Clinics North

Providing Access to Comprehensive Dentistry

delivered in an

Efficient Fashionwith

Outcomes that are of Assured Quality and Appropriateness of Care

Michigan Community Dental Clinics, Inc(MCDC)

A Vehicle to allow the efficient Dental Clinics North practice model to become the Norm to increase Access to Dental Care for Medicaid and Low-income Uninsured via

Public Health Dental Clinics throughout Michigan

Mission StatementProvide the Management Services that allow LPH Depts. in Michigan to increase access to Oral Healthcare to persons who are Medicaid eligible and the low-income uninsured.

Michigan Community Dental ClinicsWhy do it?

There is a need to “Normalize” the DCN clinic model, so that LPH dental clinics can operate without loosing money – a private-sector approach to public healthcare delivery. Assures continued funding for all LHD dental clinics in MI. Allows LHD dental clinics to increase the level of dental care for more people.

To expand the dental clinic network and take further advantage of the economies of scale.

To share the expertise and path to success of DCN with others.

To be able to attract and retain dental professionals… This model creates a viable career alternative to owning a private practice.

To significantly increase the access to care for more folks in need. Both adults and children on Medicaid currently have difficulty accessing

dental care. Most adults under 200% of the Federal Poverty level have poor access to

dental services.

Because it’s the right thing to do.

Michigan Community Dental Clinics, Inc

A 501C(3) non-profit Dental Services Corporation Provides Dental Services on behalf of Local Health Depts. Services include:

Design of new clinic facilities or remodel of existing facilities

Providing specifications for equipment and supplies

Management of the Clinic Facilities by: Providing the Electronic Patient Record using Dentrix® Enterprise

software Billing Medicaid for services rendered, collecting fees, paying op costs Hiring all clinic personnel Direction for operation of all clinics to equal the Dental Clinics North model

Assisting LHDs with integration of Oral Health Education and Prevention programs with WIC, Head Start and other services

Allows for expanded economies of scale with administrative costs distributed over more clinics

What does MCDC look like?

Michigan Community Dental Clinics, Inc. (MCDC)

DCN Admin Staff

Affiliated Groups of Dental Clinics(Anchor LHD)

Dental Clinics North

(NWMCHA)

Dental Clinics of Southwest MI(Van Buren / Cass DHD)

Thumb Area Dental Clinics

(St. Clair Co HD)

Dental Clinics Mid-Michigan( Mid MI HD).

Detroit Community

Dental Clinics(DHD)

Host Health Departments(where clinics reside)

Current, Planned, & Proposed ClinicsDental Clinics North

Petoskey East Jordan Mancelona Gaylord Cheboygan Alpena West Branch Cadillac Manistee Traverse City Marquette (1/1/08)

Mid MI Dental Clinics Stanton (6/08) Big Rapids (6/08) Hart (6/08) Mt. Pleasant (08)

Dental Clinics of SW MI Hartford Dowagiac Three Rivers (12/1/07) Berrien Springs (09) Coldwater (08) Hillsdale (1/01/08) (Kalamazoo in ’08 ??)

Thumb Area Dental Clinics Port Huron (5/01/08) Caro (09) Algonac (09)

Detroit Community Dental Clinics Children’s Hospital (CHM) (08) Herman Keiffer (08) Samaritan Center (08)

Board of Directors includes:

Gerald Chase, MPH, ChairJeffrey Elliott, BBAJames Young, JD

Patrick Shannon, JD, MPH, EdDDaniel Briskie, DDS, MS

Daniel Sarya, DDS, MPH, MSLonnie Stevens

MCDC Management TeamExecutive Director: Tom Veryser, DDS, MHSADental Director: Greg Heintschel, DDSOperations Director: Sandy Kilmer Human Resources Director: Sindy KaraptianOral Health Promotion & Community Services

Coordinator: Patti Ulrich, RDHQuality Assurance Director: David Murphy, DDSMCDC contracts with NWMCHA for accounting

services

Michigan Community Dental ClinicsIn general terms, How will it work?

Groups of Dental Clinics that are owned and operated by Local Health Depts. (LHDs) will contract for dental services with MCDC Dental Clinics North Dental Clinics of SW Michigan Dental Clinics of Mid Michigan Dental Clinics SE MI/Thumb Detroit Community Dental Clinics

The Model Each Dental Clinic and equipment is owned by or partnered with a LHD MCDC provides dental services on behalf of LHDs, will bill and collect

fees, pay all bills on behalf of LHDs LHDs will provide the cash required for the Medicaid Match for the SPA

fees. MCDC will pay rent for the space and equipment . MCDC will compensate the LHD for Outreach and other LHD services

that coordinate with oral health services or prevention.

The MCDC Model allows…

LHD to separate dental staff from other LHD staff and provide unique Staffing reimbursement for the Dental Network Staff that rewards performance and controls cost.

LHDs to provide dental services to persons-in-need, without the cost or “hassle” of managing the clinic.

Regionalization of network clinics to address local issues locally with local health department recognition for doing so.

For increased leverage in purchasing supplies and services via coordination by MCDC.

A cost-efficient method of expanding access to dental services to the underserved throughout Michigan.

A method to create a Fund to support the cost of uninsured care in other regions of the State.

Empowerment of individual clinics to provide care in an efficient fashion, and for the employees to be rewarded for extraordinary performance.

DCN Nursing Home InitiativeBased upon information obtained in a survey by the

Michigan Department of Community Health only 63% of Michigan dentists provide nursing home services in their office.

Only 16% of all dentists provide for care in the nursing home. Currently 46,826 residents, 35,119 on Medicaid.

Medicaid paid 567,622 in dental services for the elderly in 2006, and 56% of that was payment to mobile services.

Leaving only 249,753 paid on behalf of the elderly by 4500 active licensed dentists in the state.

Resulting in only $16.16 spent per resident annually, and only $55.50 per dentist.

ConsequenceHuge Unmet Need For The Medicaid

Nursing Home Resident!

DCN Nursing Home Initiative as a Proposal. What We Provide.

Annual in house exam by a dentistAll dental equipment and materialsEase of referral to DCN clinicsIn-service training at no expense to homeIndividual consultations for residents on oral

healthcare issuesBilling, scheduling, and other administrative

functionsReduced set up fees for careAccess to the Dental Assistance Fund (DAF)

Our proposal to facilities requires2 year agreement for servicesminimum 500 residents to initiate$75 per resident “dental director” first year fee$50 annual “dental director” per resident adequate facility (beauty shop)dedicated aid for assistance and transportationconsent for treatmenthealth historyIT support through a broad band connectiondedicated but minimal storage for supplies

What Outcomes We ExpectHelp facilities meet federal care mandatesReduced transportation fees for residentsReduced staffing costsIncreased consciousness of oral hygieneHealthier residentsImproved quality of life for residentsMarketing advantage to the facility

Pilot Program: Meadow Brook, Bellaire, MI

36% of resident population seenAvg. 50 min per appointment.4% of residents seen at accelerated re-care70% of hygienists salary for direct care and 30%

for admin, education, and in-service training.50% of residents referred for further treatment

A unique model funded by local tax dollars

Northern Dental Clinics entered into an agreement with the Lelanau County Commission on Aging to provide diagnostic and preventative treatment to county residents age 60 and above at 200% of poverty or below.

Each eligible resident will receive a voucher valid for a initial exam, full x-rays, and a prophylaxis, a complete treatment plan, opportunity for the DAF, and entrance into the NDC clinics through the NDP.

County may pay for additional services upon review.