Providing Better Oral Care to Underinsured Populations, Case Study Example

Access to dental care for populations with special needs and low income is a complex bio-psychosocial issue affected by financial situation, general health, transportation needs, psychological well-being as well as weather. According to a report given by a U.S. surgeon general in 2002 the poorest oral health was found in individuals living in poverty and the same populations had difficulties accessing dental care with the most significant financial challenges is being falling into the”Medicaid Gap”: whereby one’s income is more than the Medicaid eligibility levels but is   only enough to cater for primary needs like food, shelter, clothing and utilities. In addition many aged people and people with disabilities live on fixed and limited incomes and therefore it is not surprising that, such patients for go dental treatment in most cases (Department of Health and Human Services [U.S.] 2000).

To address the overwhelming dental needs of the underinsured populations in central Florida, the Dental Care Access Foundation inc. was started. It was founded in 2004 as a non profit organization; in May 2002 a committee of concerned members of the dental Society of Orlando began this foundation and quickly gained support from other non-profit organizations like the Primary Care Access Network (PCAN) which joined the dental professionals in 2003 and offered financial support to the foundation.

The foundations role is to provide access to dental care to populations which are not insured and are disadvantaged economically in the Central Florida. DCAF works by providing  a network of professional dentists who have the willingness offer voluntary services to people who are not able get access to dental care in the current state and federal health conditions .Through this foundation ,patients without access to dental care due to financial constraints may get donated dental treatment through the network of dental professional offering volunteer services The patients are screened by the eligibility specialist to determine their eligibility for the cheap dental services and in case of a need for  advanced  treatment, DCAF is in a position to make arrangements for ancillary and in-kind surgical services.  The patients are provided with the services at private dental offices, community based settings as well as at special events.

To increase efficiency of dental agencies in providing care to the needy patients, the foundation coordinates volunteer dentists from the community with the existing agencies in addition to recruiting of licensed volunteer dental professional and support personnel to work in such dental agencies. The foundation also helps in developing future dental care agencies by identifying populations who do not have the current dental service agencies cover(Kadi G &Massotto M. 2002).

Critical Relationships

The organization strongly believes that life can be changed through a smile and this keeps it going. In providing its services the foundation works in conjunction with different dental agencies in the central Florida. Such dental organizations include: the Dental Society of Greater Orlando whose members founded the DCAF, primary Care Access Network (PCAN) which provides uninsured population in Orange County with medical referral services e .the dental care access foundation conducts eligibility interview to indigent patients who need dental services and then refers the patient to the required dental treatment facility. Another one is Hoffner Dental clinic a primary Care Access Network (PCAN) which provides X-rays, extractions, fillings as well as cleaning in case of children. Another agency is the Orange County Dental Research Clinic which offers X-ray services, fillings, extractions partials and full dentures to adult patients on changing scales depending on patients’ income. Others include Osceola County Health Department, Shepherds Hope, Orange County Health Department, Seminole County Health Department and Osceola County Health Department. DECAF s most operating budget s met with in –kind donations .the start up phase was supported by the PCAN and other financial supporters include the Winter Park Health Foundation among other individual donors (Kadi G &Massotto M. 2002).

The foundations focus is to develop more effective and efficient ways to fulfill its mission while protecting and maintaining the integrity of the resources entrusted to them by donors. The foundations strategic planning for its workforce included assessment of future gaps in work and workload analyses, developing competency of existing dental care agencies by coordinating volunteer dentists from the community in Florida and developing models to assist in recruitment of volunteer licensed dentists, as well as offering support to personnel to work in the already established dental agencies. In addition the foundation developed a multi-operational strategy that outlines goals as well as an action plans whose main focus was how the Foundation does its work and how well the systems and structure support this work. The multi-operational operations included the central Florida Dental Outreach, which gave 180 and 190 patients complete dental treatment in the year 2008 and 2009 respectively. The “Give Kids A smile “event held on National Children’s Dental Access Day in collaboration with the Valencia Community Colleges Dental hygiene program, the operation blessing, the Hoffner Free Dental clinic which treated dental emergencies on their donated dental clinic Friday afternoons, Casselberry Free Dental Clinic offering its services on donated Thursdays evenings as well as the Seminole County Smiles a free clinic that served people in the Seminole county.  In addition, through administrative consolidation and management the foundation has only one paid staff and this ensures maximization of the donated resources to ensure delivery of prompt and quality care to patients. The organization also continually promotes an active and close collaboration with its program partners and the financial supporters to ensure they realize future program performance challenges and financial management.

The foundation established criteria for identifying the eligible patients by using the federal guidelines for poverty in order to ensure that only patients who qualify for the services are given attention and hence meet their vision of having a community where everyone has access to dental care.

The staff evaluates the program in accordance with PART, OMB’s Program Assessment Rating Tool used for the formal evaluation of Federal programs. The complete and comprehensive program involves the assessments of three vital programs of this foundation these include: the utilization project and health care cost, Medical Expenditure Panel Survey (MEPS), and the Consumer Assessment of Health Plans study (CAHPS). The review of these programs forms the basis for the foundation to move forward in offering high quality outcomes while linked with associated program costs, as well as meet the ultimate goal of using the data on performance to in form budget decisions (Kadi G &Massotto M. 2002).

Operational Procedure

The communities’ problem is first identified in which case for DCAF the problem was that access to dental care was locked for underinsured populations in central Florida. The second step involved data collection to access the extent of the need, analysis of the data and conduction of a needs assessment. The third step involved determination of priorities to ensure only the eligible patients were given first priority. This involved an interview with eligibility professional and once a patient was found to be eligible an eligibility and referral form was initiated by DCAF or the participating agency.

Program goals, objectives and activities were developed, such activities involved X-rays, fillings, extractions as well as arrangement of in-kind surgical services or ancillary services in case a patient required more advanced treatment. The core objective here was to unlock access to dental care for everybody by offering cheap dental services. The next step involved the identification of available resources including the volunteer dentists, dental clinics and, private dental offices. This step involved identification of the volunteer dentist and sending of an introductory letter to DCAF to the professional which included employee agreement and other documents recurring signing ,the volunteer then send back signed documents to DCAF and received a letter from DCAF confirming receipt of the documents. Dental appointment would then be made with the participating dental volunteer and the patient would come at the appointed time and using the eligibility form as a “ticket” get treatment after treatment the eligibility form is signed by the volunteer dentist and returned to DCAF for processing. The ongoing phase would be monitored continually to evaluate its efficiency in providing the care (Brupt LS. 2001).

References

Brupt LS. (2001). Where is my patient? A plan to decrease broken appointments in a predominantly Medicaid clinic. Spec Care Dent . 21:126–8

Department of Health and Human Services [U.S.]. (2000). Oral health in America: a report of the Surgeon General. Rockville: National Institutes of Health.

Kadi G &Massotto M. (2002) Handling broken appointments, low case acceptance, and high stress through patient education. Dent Today . 21:132.