P0785 - A Statewide Medical Dental Integration Initiative

Background: Wisconsin has a significant gap to improve access to pediatric oral health care. Only 1 in 5 Wisconsin Medicaid eligible children ages 0-5 years received preventive dental services, in 2018. By the time children in Head Start are 5 years old, half have developed caries. Dental hygienists can now practice in medical clinics without the direct supervision of a dentist due to the 2017 Wisconsin ACT 20 legislation. As 80,000 children ages 0-5 enrolled in Wisconsin Medicaid in 2018 had a medical visit, but no dental visit, a medical dental integration model offers the opportunity to leverage medical visits to incorporate oral health care.

Methodology: Utilizing a modified version of the Institute for Healthcare Improvement’s Breakthrough Collaborative Model, the Wisconsin Medical Dental Integration (WI-MDI) project aims to: 1) Expand access to preventive oral health services; 2) Reduce the prevalence of caries experience and untreated dental caries; and 3) Develop a financially sustainable model for integrated oral health care that redefines how preventive oral health care is provided to children. This three-year project started in January 2019 with the creation of an Advisory Council composed of representatives from multiple healthcare systems, federally qualified health centers, professional associations, and state agencies. The WI-MDI driver diagram (Figure 1) was created to assist clinic teams in implementing system changes required to integrate oral health into primary care. Data is collected in Life QI, an online quality improvement platform used to assist with project oversight to both track and analyze improvement data.

Discussion: Six Advisory Council meetings have occurred to date with the partnership growing over time (N=15-20 partners). Clinical team’s readiness to implement the MDI model was assessed through their identification of readiness to proceed with each of the drivers (Figure 2). A yearlong Learning Collaborative started in October 2019, with two learning sessions to date, and five monthly Collaborative calls addressing primary drivers clinics were not ready on yet (yellow/red colors). Three federally qualified health clinics (FQHCs) are currently participating with dental hygienists integrated into their medical teams. Participants engagement has been enhanced through a complementary stipend from a dental partner.

Conclusion: Recruitment of healthcare systems to engage in this Project has taken longer than anticipated, however, intentions to adopt the model remain high. System changes necessary to incorporate a new provider into primary care delivery revealed several key barriers: incorporating dental documentation into existing medical records, updating billing systems to bill dental codes, investment of hiring new staff, and greater challenges for large systems’ acceptance compared with FQHCs. Due to COVID-19 pandemic, modifications have been made to now include virtual monthly team calls to help systems overcome these barriers with plans to start Learning Collaborative Wave 2 in March 2021.