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NNOHA Conference, November 8th, 2016
Cavity Free at Three: Colorado’s innovative model integrating
oral health in prenatal care.
Cavity Free at Three GoalsMission
Eliminate early childhood caries in Colorado’s children
What We DoCavity Free at Three teaches medical and dental providers how to deliver preventive oral health services for young children and pregnant women.
The American Dental Association (ADA), the American Academy of Periodontology (AAP), the American Congress of Obstetricians and Gynecologists (ACOG) and other professional organizations recommend dental care during pregnancy
Treatment Guidelines
Association between periodontal disease and preterm birth, gestational diabetes, and low birth weight (Corbella et al., 2016; Guimaraes et al., 2012; Ha et al., 2014; Xiong et al., 2009.)
Goal to decrease or delay the transmission of cavity-causing bacteria to babies by taking care of the mother (Weintraub et al, 2010; Douglass et al, 2008; Berkowitz, 2006).
Pregnancy not a contraindication for dental treatment. Routine dental care, radiographs, restorations safe at anytime during pregnancy (Hartnett et al., 2016; National Consensus Statement, 2011; Rainchuso et al., 2013; Kurien et al., 2013)
Prenatal Oral Health Research
Long-term AIM
By September 2019, increase by 15% over the state baseline the percent of women who have received oral health care, defined by prophylaxis, during pregnancy.
Medical ProvidersEducate the patient on the link between oral health and health of their baby
Reassure safety to patients and dental professionals
Conduct oral health screening (less than 1 minute!)
Refer to a dentist and encourage dental home
Prenatal Cavity Free at Three Model
Prenatal Cavity Free at Three ModelDental ProvidersSee women at anytime during pregnancy
Standard of care with a few pharmacological considerations (i.e. pregnancy is not a reason to alter treatment plan)
Educate the client on oral health practices
Pre-Post Training Data
Oral Health Services for Pregnant women increased from reported 24.8 % to reported 29.9% after Cavity
Free at Three training
● Serving Denver Metro
since 1989
● 23 Health Centers (and growing)
● In 2015
▪ 40,000 medical patients
▪ 7,900 dental patients
● 51% Medicaid, 39% uninsured
Metro Community Provider Network (MCPN)
MCPN Timeline Integrating Oral Health in Prenatal Care
The mouth is connected to the body?
Co-location
Medical Dental Integration
Medical Dental Total Integration
Evolution of Integration Models
Co-Location
FQHC with medical and dental services in the same building
Part of the same organization, but not “integrated”
Unified EHR system - medical and dental can communicate
Options to refer/prioritize high need patients
Medical/Dental Integration (MDI) ModelsModel 1● Dental hygienist works within medical clinic (in peds pod and OB pod)
● Participates in morning huddles and is able to identify patients that need to be seen
● Screening, fluoride varnish (if necessary), caries risk assessment are done
● Schedule patient into dental clinic
Model 2● Dental hygienist has entire hygiene operatory within medical clinic
● Able to screen and provide preventive services in medical clinic before referring to dental clinic
● Set up like a direct access dental hygiene clinic
Who is trained? ● All dental hygienists
○ Beginning to implement with all new dentists
● Medical providers/staff in clinics with MDI
What resources are used? ● Cavity Free at Three brochures
● MCH brochures
● Cavity Free at Three goal setting sheets
● MDI Toolkit - developed for MCPN staff
Cavity Free at Three
Dental Codes used in Dental Clinic
Dental Codes used in Medical clinic
D1XXX DSCRN*
D1110 D0190
D4XXX
D4910
D4341/D4342
*Screening/Dummy code not currently trackable
DataYear Total #
Pregnant Patients
Total # Receiving
Dental Services
Percentage (%)
2013 1201 205 17.1%
2014 1289 210 16.3%
2015 1461 354 24.2%
Practical Implementation Tips
The nuances of working as a dental provider in a medical clinic ● Sensitivity of appointments● Teamwork and flow with medical team● Patient barriers - time availability and stress of OB
appointments● Communication and referral systems● Billing/front desk systems
○ Insurance codes per encounter or per day?○ Ways to identify uninsured patients so that billing for
these encounters gets funneled to grant funding
Limitations● No baseline data pre-2012 for comparison.
● Data pulled by claims data, dummy codes not trackable
● Some pregnant patients receiving care elsewhere
● Financial sustainability
Sustainability
● Buy-In from medical and dental providers
▪ Local trainings, focus groups, newsletters, etc.
● Protocols and scalability
● Billing procedures
● Grants
● Data
▪ Data drives organizations
▪ Utilize data to leverage grant opportunities and show success of programs
▪ Analyze data to improve current programs
Sustainability
Contact Information
Colorado Department of Public Health and Environment
Oral Health Unit
cavityfreeatthree.org
To send an email, click on the “Contact Us” tab
Cavity Free at Three FundersThanks to our funders for their support: Caring for Colorado Foundation; The Colorado Health Foundation; The Colorado Trust; Delta Dental of Colorado Foundation; Kaiser Permanente; Rose Community Foundation, Health Resources and Services Administration (HRSA)
A special thanks to Metro Community Provider Network
“This project was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS), Grant Number: H47MC28479. Information/content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government”
