SMILES Dental Project

Spanning Miles In Linking Everyone to Services

Mountain Family Health CentersGarry Millard, DDSgmillard@mountainfamily.org

• Community Health Center serving 16,000 pts• Dental services currently in 2 locations/6 chairs• Target population is low income students• Previous sealant program identified very high unmet

need, and over 50% Medicaid eligible• Serving rural communities in W. Colorado• High cost resort area• Over 50% of patients

prefer Spanish• Transportation barriers

MFHC Overview

Pitkin Lake

Chaffee

Pueblo

Moffat

Rio Blanco

Garfield

MesaDelta

Montrose

San Miguel

Dolores

Montezuma

Routt Jackson

Grand

Eagle Summit

Gunnison

OurayHinsdale

Saguache

MineralRio Grande

San Juan

Archuleta Conejos Costilla

AlamosaHuerfano

Larimer

BoulderGilpin

Clear Creek

Park

Fremont

Custer

Weld

Morgan

DenverAdams

Arapahoe

Douglas

Elbert

El Paso

LoganSedgwick

Phillips

Washington

Lincoln

Kit Carson

Cheyenne

Crowley Kiowa

Otero

Bent

Las Animas BacaLa Plata

Yuma

Prowers

Salud FamilyHealthCentersPlanning

PlannedImplementationMarch2017Summit

CommunityCareClinic

MountainFamilyHealthCenter

Tri-CountyHealthNetwork

DentalAid

SMILES Dental ProjectSMILES Grantees/Pioneers

Barriers/Learning & Partners

• 5 Main barriers to implementing SMILES:– 1. Challenging transition from existing oral

health programs– 2. School districts reluctant to be “early

adopters”; concerned w/ student privacy– 3. Minimal data collection with existing

programs– 4. Staffing challenges– 5. Billing challenges

Barriers/Learning & Partners

• 5 Main barriers to implementing SMILES:– 1. Challenging transition from existing oral

health programs:• Difficult to establish glide path from current

programs to new models, while serving the community need

• Important to have unified leadership within implementing agency and with community partners

• Schools comfortable with status quo

Barriers/Learning & Partners

• 5 Main barriers to implementing SMILES:– 2. School districts reluctant to be “early

adopters”—Biggest surprise• Schools short staffed and underfunded• School district cannot afford legal help• Legal help unfamiliar with new model• Sense of mistrust with unknown program• Took nearly one year to get MOU’s signed

Barriers/Learning & Partners

• 5 Main barriers to implementing SMILES:– 3. Minimal data collection with existing

programs• When applying for grant, unmet dental

need data is limited• Data underestimates true unmet need,

since non-participants (uninsured) have higher decay rate

Barriers/Learning & Partners

• 5 Main barriers to implementing SMILES:– 4. Staffing challenges

• Difficult to find staff to work in remote areas

• SMILES work schedule follows school schedule

• “Backfill” staff (filling in for SMILES team) not needed during school breaks

Barriers/Learning & Partners

• 5 Main barriers to implementing SMILES:– 5. Billing challenges

• Need innovative Billing Manager • Billing uninsured patients (Nominal fee per

procedure or per visit)• Need long-term mindset (big upfront costs

to hire and train staff, and buy equipment).

Implementation

• We plan on opening a total of 4 school based SMILES locations.

• We have decided to start at the School Based Health Center we already operate because the Dental Hygienist already has a relationship with the school

Implementation Challenges

• The schools generally do not want us sharing their internet connection, because it will increase their cost.

• We are planning on setting up our own wireless network, and will transmit data atnight when there is less data traffic (via HotSpot)

Implementation Challenges

• School districts very concerned with patient privacy (FERPA)

• If school agrees to transmit your data on their internet connection, they are by definition a “Business Partner”, and you must sign a BAA ( Business Associate Agreement)

SMILES Project Advice

• Have one SMILES admin day per week for 2 years to be able to plan and implement program

• Involve the existing oral health programs from the beginning, and see if they are supportive

• Present student/school benefits to School Board/District Nurse early in process.

• Be sure to only choose sites that have a locking room for your equipment, or you will have to transport it in all kinds of weather.

SMILES Project Advice

• Be sure to get state board of dentistry involved from the beginning

• Focus state board on this cost-effective model to meet unmet dental need in underserved communities, without adding independent dental therapists

• Tell reluctant dentists that this model could help them expand their practice at a lower cost than satellite clinics.

• Be patient with older dentists who are unfamiliar with newer techniques and materials

SMILES Project Advice

• Don’t let outspoken and unaware dentists talk you out of doing what is right for the underserved among us

• You do NOT need permission from local dentists, if your state law has adopted the expanded scope for DH’s to

place ITR and take needed radiographs