HA ‘Innovation Fellow’ Studies Risk-Based Model for Transforming Oral Healthcare

Advantage Dental has teamed up with University of Washington to transform the delivery of dental care in January.

Sharity Ludwig is at the forefront of a movement to transform the way dental care is provided, especially to low-income families and children. Her participation in the first cohort of the OHA Transformation Center's Clinical Innovation Fellows program in 2014 provided some of the skills and networking contacts for that effort.

"I was completely grateful for the opportunity," Ludwig says. "The learning opportunities that came to me because of it, I can't even express. It was exactly what I needed to know at the time."

Ludwig, an expanded-practice dental hygienist and director of community dental programs for Redmond-based Advantage Dental Services, is also the program manager of "PREDICT," the Patient-centered Risk- and Evidence-based Dental Inter-professional Care Team. And she is participating in a quality improvement project in 14 Oregon counties to determine whether these risk-based and evidence-based practices can improve the oral health of low-income pregnant women and children.

The study is a cooperative venture between Advantage Dental Services, LLC, and the University of Washington, funded by the Robert Wood Johnson Foundation (RWJF). Teams across the state will provide dental hygiene services at WIC centers, Head Start schools, etc., where families already come for trusted services – and then encourage them to visit their dental home for routine care, which is now covered by OHP.

"We want to see them in a non-threatening environment and help them understand the dental system," Ludwig says. "We also want to make sure they know that they do have a dental home and that they have dental coverage they may not be aware of, because of all the recent changes in Medicaid."

The actual implementation will begin in January 2016. This fall the project is meeting with all the participating providers and establishing baseline numbers for the study. They're also drawing up metrics – how to measure whether oral health disparities are being reduced. Those measures, Ludwig says, are: "to ensure that the bulk of the population has received a dental service in a calendar year; that those with urgent needs are seen in a timely manner; and that those at high risk receive the appropriate treatment based on risk."

Providers serving members in a county that meet the metrics will receive incentives, she adds.

What's the ultimate goal?

"We're transitioning oral health care into more of a risk-based model," Ludwig says. "Instead of routinely seeing every member every six months because that's what's covered, if someone is low risk we'd see them once a year. If they're high risk, we might see them four times a year. That would allow us to use our resources wisely and provide some care to everybody, but more care to those that have a higher risk and impact the dental care system."

Ludwig started her career as oral health services coordinator in the Klamath County Public Health Department. She worked mostly with pregnant women, encouraging them to get dental care during pregnancy, which can prevent cavities in children's teeth after they're born.

She also spent five years as a hygienist at a federally qualified health center in Klamath County, before starting with Advantage in 2010. She supervises a team of hygienists across the state, and also sees patients one day a month at a Bend clinic.

Advantage is the state's largest OHP dental care organization. It serves about 330,000 Medicaid members in all 16 coordinated care organizations and has a direct contract with the state to serve open card members.

Gary Whithouse prepared this article for the Oregon Health Authority.

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