Medical/Dental Innovation Pilot

Nationally and within the state, disparities in access and treatment in oral health are most prominent in vulnerable populations. This trend is particularly evident in Florida’s Medicaid-eligible children. In Florida, untreated decay and dental caries have increased by 15.4% and 6.9% from 2014-15 to 2017-18 among pre-school aged children. Among third grade students, 45.5% have experienced caries and 25.1% have untreated decay with the prevalence being highest for non-Hispanic Black children (34.6%) and for children without any dental insurance (32.8%). In 2019, only 35.5% of Medicaid-eligible children 0-20 received any preventative dental services, an increase of only.5 percentage points from 2015. The key issue for Medicaid in Florida is having enough dental providers, specifically pediatric dental providers, willing to participate in the program. Majority of dentists (78.2%) are not enrolled as Medicaid providers. The lack of access and utilization of dental care has contributed to high rates of dental disease among Florida’s children.

These statistics highlight the value of preventive dental care and the need to treat dental caries at a young age. Embedding a dental hygienist in a pediatric practice can deliver preventive oral health services in a familiar and convenient setting.

The DTA Foundation funding has allowed FIHI to develop and continue its innovative medical dental integration (MDI) model for embedding registered dental hygienists (RDHs), trained as Community Dental Health Coordinators (CDHCs), into pediatric primary care practices. The pilot program, which launched in November of 2018 and officially finished in March 2021, leveraged routine pediatric visits such as well-child visits and back-to-school check-ups to improve dental education and referrals and increase access to oral health preventive services for Medicaid-eligible children in South Florida by providing fluoride varnish treatments to children who are between the age of six months and 6 years old. FIHI partnered with Pediatric Partners in Palm Beach County and carried out the pilot in three sites, Boca Raton, Jupiter, and Palm Beach Gardens, where in total 381 Medicaid-eligible children between ages of 6 month and 6 years old received fluoride varnish treatment anticipatory guidance and referral to a dental home. Through the integration of MDI program, FIHI created a one-stop-shop for families with the goal of reaching children at a much younger age, taking the initial step toward improving oral health outcomes for the population.

In addition to the impact on children and their families, the pilot integrated primary care and oral health services in one setting increasing the efficiency of both medical and oral health professionals. FIHI’s MDI model provided the delivery of three important oral health services in a systematic and sustained matter: oral health assessments, fluoride varnish applications and linkages to a dental home. Within their project setting, medical assistant’s (MA) are responsible for setting up and administering the FV application, and physicians are responsible for conducting the oral health risk assessments; the RDH is responsible for providing guidance and support on these services, for providing anticipatory guidance for interested children and families, and for facilitating warm hand-off dental referrals for families in need of a dental home. The integration of the services allowed for information sharing and consultation in an efficient manner, making it possible to identify underlying causes of disease, engaging patients in disease risk reduction and prevention, and reducing preventable dental conditions that are often treated in the emergency room. FIHI secured support from the Florida Dental Association Board of Trustees, Florida Dental Hygienists’ Association Board of Directors, and the American Academy of Pediatrics-Florida Chapter leaders. The work was guided by the FIHI MDI Advisory Committee, which included Dr. Patricia Braun of Denver Health and Oral Health Colorado; Dr. Phillippe Bilger, Dentist Consultant, Public Health Dental Program, Florida Department of Health; Dr. Tommy Schechtman, Pediatric Partners; and Dr. Cesar Sabates, former FDA President. Furthermore, Dr. Sean Boynes, Director of Interprofessional Practice at the DentaQuest Institute provide MDI expertise and guidance during the implementation phase.

FIHI partnered with Pediatric Partners of South Florida and launched the project in three of their sites located in Boca Raton, Jupiter, and Palm Beach Gardens. Overall project goal: To increase access and utilization of dental care and preventive oral health services among Medicaid-eligible children in Miami-Dade County through piloting an innovative strategy for improved medical/dental integration.

Objective 1: Increased collaboration among key partners including the Florida Dental Hygienists’ Association, Florida Dental Association and American Academy of Pediatrics-Florida Chapter. This was achieved by coordinating interviews and strategy-building meetings with FIHI and Alliance partners including dental schools, pediatric practices, dentists, and dental hygienists in South Florida to engage them in the Miami-Dade County medical/dental innovation (MDI) pilot and to guide the development of a business plan demonstrating the ability of this MDI model to be successful and sustainable in South Florida.

Objective 2: Increased integration of medical and dental care through embedding a dental hygienist into 1-2 pediatric practices in Miami-Dade County. This was achieved by identifying and partnering with a practice transformation consultant to effectively manage practice redesign and medical/dental integration implementation.

Objective 3: Increased access to dental care and preventive oral health services for an estimated 1,000 Medicaid-eligible children in Miami-Dade County across a one-year period. This was achieved by developing a method for collecting and reporting data that integrates medical and dental systems. Through this MDI project, FIHI and Pediatric Partners increased care by serving 381 Medicaid-eligible children. The MDI program increases access by expanding entry points into the dental care system, especially for vulnerable populations that often have greater access to primary care providers than to dental providers. Routine pediatric visits were leveraged to provide oral health screenings, fluoride varnish, oral hygiene education, and to help establish a dental home for pediatric patients. Dental hygienists embedded in the medical practice was trained as Community Dental Health Coordinators (CDHCs), which equipped them with the specialized skills to help underserved communities navigate the oral health care system, increase their access to care, and bridge gaps related to language, culture, geography, poverty, and a lack of understanding of oral hygiene.