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Expanding Oral Health Services to Children

  • By: NYSHealth
  • Date: June 2017
  • Priority Area: Special Projects Fund
  • Type: Grant Outcome Reports
  • Category: Grant Outcome Report
  • Grantee Name: Albany Medical Center

Overview

Although preventable, cavities are the most common chronic infectious disease of childhood—roughly six times more prevalent than asthma. The burden of dental caries 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. In 2013, 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 high-risk preschool-age children in areas where access to dental services is limited—throughout New York State. Following an unexpected national policy change that occurred in May 2014, Albany Medical Center shifted the focus of the grant in 2015 to train pediatric primary care providers to adopt the new policy's recommendations.

Grantee: Albany Medical Center

Dates: November 2013 – December 2016

Grant Amount: $ 167,772

Grantee Website: http://www.amc.edu/

Grant ID: 13-01902


Under this grant, the Albany Medical Center worked with WIC sites upstate to co-locate pediatricians at the centers to provide oral health services to Medicaid-eligible pre-school age children. Mothers receiving WIC benefits were able to bring their infants and young children to the on-site pediatrician for a basic dental screening and fluoride varnish application—an important tool in cavity prevention.

In 2014, the U.S. Preventive Services Task Force (USPSTF)—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 the USPSTF directives, releasing guidelines for all pediatricians to perform not only fluoride varnishing but also oral hygiene and dietary counseling as preventive primary care services.

In the wake of this policy shift, NYSHealth and University of Albany saw an opportunity to go beyond WIC sites and reach ever-greater numbers of children. Consequently, Albany Medical Center expanded 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 attendees were representatives of a 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 took this on as an active project in 2016: Clinton, Cortland, Chautauqua, Yates, Albany, Orange, Montgomery, and Lewis. The local health departments are eligible for reimbursement for the academic detailing work through State public health funds.
  • Conducted outreach to major insurer carriers in the public and private sector regarding the 2014 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