New York State Health Foundation

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Albany Medical Center

  • Project Title: New York Oral Health Pediatric Primary Care Provider Training
  • Priority Area: Special Projects Fund
  • Grant Amount: $167,772
  • Date Awarded: November 13, 2013
  • Region: Statewide
  • Region: Capital Region
  • Website: http://www.amc.edu/
  • Grant Status: Complete

Overview

Although preventable, cavities are the most common chronic infectious disease of childhood, of which the burden falls disproportionately on underprivileged, minority, or special needs children. Nationally, 25–35% of children in low-income families have never seen a dentist by the age of five. Consequently, dental decay is often treated in emergency departments and ambulatory surgery settings. NYSHealth initially awarded the Albany Medical Center Pediatric Group (Albany Medical Center) a grant to expand the Women, Infants, and Children (WIC) Smiles program—a pediatric oral health program that provides preventive services to Medicaid-eligible preschool-age children in areas where access to dental services is limited. Albany Medical Center set out to expand the program at WIC sites in upstate New York, where mothers receiving WIC benefits could also bring their young children to the on-site pediatrician for a basic dental cleaning and fluoride varnish—an important tool in cavity prevention.

Grantee: Albany Medical Center

Dates: November 2013 – December 2016

Grant Amount: $167,772

Grantee Website: http://www.amc.edu/

Grant ID: 13-01902


During the grant project, however, unexpected national policy changes occurred that Albany Medical Center recognized as an opportunity to move beyond WIC sites and have an even greater impact on children’s oral health in New York State. First, the U.S. Preventive Services Task Force—an authority on prevention and evidence-based medicine—released recommendations that primary care providers apply fluoride varnish to the teeth of all infants and children up to the age of five. The American Academy of Pediatrics then endorsed these recommendations, releasing guidelines for all pediatricians to perform not only fluoride varnishing but also oral hygiene and dietary counseling as preventive primary care services. As a result, pediatricians across all payers—not just those accepting Medicaid—can provide the varnish and other preventive services to their patients and be reimbursed.

Consequently, Albany Medical Center worked with NYSHealth to expand the original scope of its grant to make a statewide push for a wider standard of care for children’s oral health and provide professional training to pediatric primary care providers in adopting the new recommendations. Specifically, Albany Medical Center targeted practices that serve the highest-risk children (although not exclusively); served as an expert and mentor for local health department staff trainings; provided pediatric primary care sites with an implementation toolkit; aligned activities with similar work done by various stakeholders; and conducted outreach to major insurers regarding the impact of the new policy on claims processing.

Outcomes and Lessons Learned:

  • Trained more than 500 pediatric primary care providers and more than 160 direct child care providers on integrating the new standards for children’s oral health care and counseling. Many were representatives of larger pediatric practices and residency training sites, administrators, and others in positions of influence over practice behavior;
  • Collaborated with the New York State Department of Health and New York State Association of County Health Officials to launch a Fluoride Varnish in Primary Care initiative and train the local county health departments to perform academic detailing for local pediatric providers on oral health preventive and fluoride varnish services in the medical home;
  • Trained local health department representatives from 24 counties on how to properly integrate the new care standards into their sites. Eight counties—Clinton, Cortland, Chautauqua, Yates, Albany, Orange, Montgomery, and Lewis—took this on as an active project in 2016. The local health departments are eligible for reimbursement for the academic detailing work through State public health funds; and
  • Conducted outreach to major insurers in the public and private sector regarding the updated fluoride varnish recommendations. All major insurance carriers in New York State are now reimbursing for fluoride varnish in medical homes for children at rates comparable to that of State Medicaid.

Albany Medical Center encountered some resistance from pediatric primary care providers who simply did not view oral health as their purview or felt unable to overcome the barriers of time, training, and billing to begin offering of fluoride varnish. However, now that fluoride varnish is a national standard of care, pediatric offices must provide these services.

Co-Funding and Additional Funds Leveraged: N/A