A Quality Improvement Director Goes to the Forum...

This week, staff from DentaQuest’s Institute attended the 2017 Institute for Healthcare Improvement (IHI) Forum. During this multi-day conference, healthcare professionals from around the globe meet in Orlando to talk healthcare improvement. While oral healthcare is not a prominent discussion topic, DentaQuest has been attending since 2011. 

At Monday's pre-conference Scientific Symposium, Dr. Natalia Chalmers and Quality Improvement Project Manager Carrie Peltier presented a poster on our Dental Caries Management (DCM) Collaborative results (pictured left). Over 200 posters were submitted for consideration; the Institute’s poster was one of 70 - and the only one on oral health - chosen. Dr. Chalmers commented that the buzz about the importance of good oral health being vital to overall health was inspiring. Many wanted to learn more about the DentaQuest approach.

The general session featured a series of keynotes and 200+ workshops topics covering improvement science, joy in work, leadership, population health, person-centered care, safety, moving from volume to value to name a few. 

This year’s Forum opened from the lens of patient experience. The keynotes challenged care teams to create a bidirectional transfer of knowledge between patient and care team; this is, in fact, an act of caring. Care teams must work to create this space. It truly matters. Keynote Tiffany Christensen commented: we must ask generous questions to know and learn what matters to our patients. Our job is to make sure there is equity. These sentiments very much resonate with the Institute.

Later in the afternoon, we heard from Bryan Stevenson, a social justice advocate. Mr. Stevenson powerfully reminded us that it is our duty to create healthier communities. We must get closer to the poor and to communities that have been marginalized, neglected, and isolated. There is power in proximity. We also need to change the narrative that defines the difference of race. We must stay hopeful, as our hope has to fuel our practice. And lastly, we need to do the things that are uncomfortable. We have to make the choice to do the difficult thing.

General Stanley McChrystal shared his Team of Teams vision. He spoke about organizational change; being at an inflexion point and ready. He talked about ‘shared consciousness,’ meaning to connect on something with purpose and time and focus. “Together we need to project 'this place' where we want to go and make it to fruition.” This requires leadership that composes self-awareness, discipline, decision making, effective communication, connection, constant learning and functional excellence.

Lastly, as is IHI tradition, we heard from Dr. Don Berwick, president emeritus and senior fellow at IHI. Dr. Berwick’s spot-on remarks and reflections on the American healthcare system ring true year after year, and this year was no different. He shared a moving personal story of needing - and using - the healthcare system for his own family. He charged organizations to “snuggle,” meaning outline a clear and common purpose, be all together, or none at all and provide a safe vessel – failures are instructive; it’s OK to try, there can be shared honor, and we must have affection and mutuality. As this culture is what saved his brother.

Healthcare is complex; like the organizations who provide care and coverage. Inter-organizational competition is not the answer; coordination is. And DentaQuest is no different. Leaving this year’s Forum, I couldn’t help but board my plane back to Boston with some puffed feathers … DentaQuest has these pieces. We are prime to be the ‘Leading Voice.’ Improvement work is a social thing. It asks us to reflect, to adjust, to learn from, and to collaborate. It demands that we ask is what we are doing better or more of the same? We want better; we want to improve the oral health for all. That means understanding the system, at the macro, meso and micro levels. All together, or none at all. We must always ask “what do we want to learn over time?” and chart that course.

Cheers to another amazing Forum. Kaiser Permanente sent over 400 staff this year. Won’t you consider joining us next December in Orlando? This stuff matters!

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Cindy Hannon, MSW

Quality Improvement Director 

DentaQuest Institute  

"When you believe in this stuff, it is easy to write!"

Lunch Box oral health education program expands to kids with vision impairment

You may know that our mission is to improve the oral health of all, and starting with young children and health literacy is a great step forward.

Before this school year started, we supported efforts by The Children's Oral Health Institute to grow their national Lessons In A Lunch Box: Healthy Teeth Essentials & Facts About Snacks® program. This expansion enables the program to reach children who have impaired or loss of vision. Everyone needs to care for their mouths in order to have healthy futures, and Lunch Box is ensuring all kids have this chance.

In February, special lunchboxes - now with braille - will be delivered to participating schools along with a volunteer presentation to run the program.

So what is this educational program about healthy teeth and why does it matter? 

The Children's Oral Health Institute, a nonprofit based in Maryland, outlines it clearly:

• Lessons In A Lunch Box: Healthy Teeth Essentials & Facts About Snacks is an educational oral health literacy program developed around a lunch box designed exclusively to teach elementary school children. The lunch box includes a color coordinated carrot case with a rinse cup top designed to store a toothbrush, toothpaste, and dental floss.
• The program is created to help children to begin learning early, throughout grade school, about taking care of their teeth, making good diet choices and careers in dentistry.
• The Children’s Oral Health Institute believes the program and the exclusive lesson guides, including the Code Red: The Oral Health Crisis In Your Classroom booklet, will encourage teachers to incorporate oral health education as a part of classroom instruction.
• The program model is presented is to elementary schools with support from organized dentistry, local dental school faculty, their students and community volunteers. It is important that dentist examine and provide treatment for underserved children.
• Exposing dental students to programs like Lessons In A Lunch Box may help to improve the access to the oral health care challenges we face throughout the country.
• Further, the profession of dental medicine is facing a workforce shortage. According to the 2000 Surgeon General’s Report, by 2020 there will be one dentist for every 100,000 Americans. The program places emphasis on encouraging children to begin considering the dental profession as a career option. 
• The ideal times during the school year to introduce the Lessons In A Lunch Box program are:
• October, National Dental Hygiene Month. This is a good time of the school year to present the program because it allows the teacher approximately 8 school months to refer to the visual and practical lessons offered by lunch box.
• February, National Children’s Dental Health Month (NCDHM). This is another great time because much of the dental community looks forward to participating in initiatives that highlight and support the annual observance of NCDHM when dental and medical professionals focus on efforts to improve the oral health of children.
• Give Kids A Smile® (GKAS) Day. Usually celebrated throughout the country in late January or early February, GKAS is the annual centerpiece NCDHM.
• The cafeteria has proven to be the best location in the school to present the program. Students can comfortably have their lunch box open in front of them while listening to the presenter explain all of the fun and exciting educational features of the delightful container. They learn about the following:
• flossing, brushing and fluoride
• healthy dietary choices and good eating habits
• careers in dentistry

Did you learn anything new here? By partnering and supporting this expansion, we learned a lot about the vision impaired community and successful ways to help all children develop important oral health habits.

‘Action for Dental Health’ in Congress

While we all paid close attention to health care in the Senate last week, the House Energy and Commerce Committee made a critical, yet mostly overlooked step to advance oral health for at-risk populations.

On July 27^th, the Committee unanimously passed HR 2422, or the Action for Dental Health Act of 2017. This bill calls for Congress to authorize additional oral health promotion and disease prevention programs to help at-risk populations struggling to obtain appropriate oral health care.

The bill points out that more than 181 million Americans will not see a dentist, but almost half of people ages 30 and older have some form of gum disease and nearly a quarter of children under age 5 already have cavities. 

As we at DentaQuest well know, caries is the most prevalent chronicdisease among children and can be prevented. What’s more, we see time and again that Americans of all ages are in desperate need of access to oral health care - Missions of Mercy like the one in Wise County, Va., is a great example. Both the Washington Post and The New York Times covered the July event, for which thousands of people come from miles away and lineup for hours and even days just to get access to dental and other services.

If this new legislation passes through Congress, the Centers for Disease Control and Prevention will award grants and collaborate with states, counties, public officials, or other stakeholders to implement a variety of initiatives.

These activities could include oral health programs that:

·         more broadly use portable/mobile dental equipment;

·         facilitate the establishment of dental homes;

·         eliminate geographic, language, cultural, or other barriers to care;

·         reduce the use of emergency departments for dental conditions; and

·         provide dental care to nursing home residents.

It is exciting to see bipartisan support for dental care initiatives that have tremendous impacts on the oral and overall health of patients. This type of work will drastically improve the health of Americans. And it has the ability to address the estimated $2.6 billion in free care that dentists currently deliver, as well as the nearly $2.1 billion spent on dental cases in hospital emergency departments – 80 percent of which could be treated in a dental office for roughly $4 million total, according to the bill.

Bipartisanship like this must continue and we urge legislators to make oral health a critical component of any health reform legislation that passes through this Congress. 

Proud to Reflect on DentaQuest Giving Back, Remain Committed for 2017

The start of a new year is an opportunity to reflect and consider how we fit into the community at large. Through our corporate giving program and the volunteered talents of our staff, we are investing in our neighborhoods, supporting our stakeholders, and creating leadership opportunities for our employees. Here are highlights from 2016 that will help us have even greater impact for 2017:

Community is the Foundation of What We Do

We awarded Corporate Giving funds to safety net dental programs and community organizations that help thousands of at-risk children, families, people with disabilities, and seniors. We were also involved with organizations working to feed the hungry, prepare the next generation workforce, end health disparities and inequity, and help neighbors who are struggling to get through each day.

In 2016, DentaQuest’s Giving Program touched 165 organizations in 26 states. And that is in addition to the millions of dollars in investments made by our DentaQuest Foundation and our DentaQuest Institute to community change makers who are working for better policies, financing, and care with a goal of improving the oral health of all. All this matters because oral health really is fundamental to living a healthy life and important to academic and economic success.

Missions of Mercy Dental Clinics

While our 24 million members have access to quality dental care, there are millions more who are uninsured or underinsured and fall through the cracks at the worst of times. Many of them depend on the arrival of the Mission of Mercy, a multi-day free clinic staffed by volunteers, for essential dental care services. Working with local dental societies and our local staff volunteers, DentaQuest supported 21 free care clinics in 18 states.

Consider that, on average, each Mission of Mercy clinic serves 1,500 to 2,000 patients; the dental clinics that we supported provided over $15,000,000 in services and helped nearly 30,000 individuals who have great needs and few other options.

Stand Together in Times of Crisis

Our employee-directed Corporate Giving Committee directed financial support to communities that suffered in 2016: areas recovering from Hurricane Matthew in Florida and South Carolina, the once-in-a-century floods in Louisiana, flooded areas of rural West Virginia, the destructive wildfires (and tornado) in Tennessee. Support was also sent to Orlando after it suffered a violent shooting and to a help those in need after a five-alarm fire in Cambridge, Mass.

Throughout the year, we provided toothbrushes to schools, after school programs, and community health fairs serving at-risk children in high need neighborhoods. And through our matched giving program, our employees made additional contributions to charities close to their hearts.

Sweat Equity 

For us, giving is a combination of equity and sweat. Our employees look forward to attending local events that support the community and are willing volunteers at health fairs, walks for a cause, and dental care clinics.

During our annual Mission Month (mid-September to mid-October), we roll up our sleeves and leave the office to conquer high-impact projects tailored to the need of the community. This year, it was to feed families at Ronald McDonald Houses, paint and update schools and community centers, remove invasive plants from local rivers, and reclaim and replant city gardens.

We participated in 35 events in 11 states. A remarkable 67 percent of our employees participated in a Mission Month project, contributing over 3,612 volunteer hours, valued at $93,912.

Some go even further. Our Living the Mission Awards honor employees who go above and beyond for their sustained volunteer contributions to a charitable organization outside of Mission Month or company-sponsored events. Congrats again to those awardees!

What's Next?

Looking back on what we’ve accomplished in 2016, it is with pride that we can say we live our mission every day.  We truly are the dental company with vision, and heart. Looking forward, we will aim higher, find ways to give more of ourselves to those around us, and ultimately stay true to our mission - improving the oral health of all.

Engaging Grassroots with Grassmiddles to Facilitate Changes in Oral Health Equity

Why should grassroots and grassmiddles engage for oral health care? “If you want to go fast, go alone. If you want to go far, go together.” – African proverb

It’s been a busy spring for our team as we just wrapped up six meetings in six states (in just three weeks!). During the months of April and May, DentaQuest Foundation convened partners in the six states of our Grassroots Engagement Initiative, which launched last year in Arizona, California, Florida, Michigan, Pennsylvania, and Virginia.

The grassroots strategy aims to amplify the voice of those most impacted by oral health disparities –people who are living with tooth and mouth pain, limited access to dental services or affordable coverage, and other barriers to obtaining good oral health.

These meetings brought together those working at the state level (like oral health coalitions) – also known as the “grassmiddles” – with local-level community advocacy organizations – the “grassroots” groups.

DentaQuest Foundation’s grassmiddle partners have been working in oral health for many years and have a deep understanding of the policy environment in their states, often in addition to clinical knowledge or experience. Grassroots organizations, meanwhile, understand the needs of their communities and are experts at organizing and mobilizing community members to create change around issues like the environment, racial justice, jobs and more.

Why the Grassroots Engagement Initiative? Within it, these stakeholders learn from each other’s respective expertise. Together, they can take aligned action to improve oral health while also respecting and including the voices of those most impacted by oral health disparities.

These kinds of partnerships only serve to strengthen the effort of a larger national movement by getting everyone to agree on the priorities and join together where action is needed to improve oral health.

Illustrating the power of partnership

One of the Grassroots Engagement Initiative grantees in California is SCOPE (Strategic Concepts in Organizing and Policy Education) helped bring grassroots and grassmiddle partners to agreement on oral health change efforts.

SCOPE is a group that first emerged in the early ‘90s in the midst of the Los Angeles uprising following the Rodney King verdict. Staff from SCOPE facilitated what’s called “power mapping” at each of the six state meetings.

 “Power mapping” asks:

•  what are the major issues in a state (for example, in Arizona: lack of adult dental coverage in Medicaid, lack of access to quality oral health care in Native American and other poor communities, and a weak social safety net);
• who are the decision makers that could potentially influence those issues (for example, Governor Ducey and the Arizona legislature); and finally,
• who else might be potential allies or challengers.

Participants then map out where all of these factors and people stand on the issue. Finally, they strategize on what’s needed to shift these dynamics in a way that positively impacts oral health in the state. Ultimately, the resulting power map should be used to track progress by revisiting it periodically to see how opinions have shifted.

At each state meeting, SCOPE helped participants reach consensus on a draft power map to begin using and measuring against. The agreement resulted from peer-to-peer learning, as well as collaboration across grassmiddles and grassroots experience.

Why does this matter? How will oral health equity improve?

Power mapping can be an excellent complement to the state’s oral health plan, which is goal-oriented and shows where the state wants to go. In fact, the power map and community level actors can help inform how to get there – an element that is improved with grassroots and grassmiddles on the same page.

Ultimately, it’s crucial that efforts to create change are in line with one another when facing a problem as significant as poor oral health. These state meetings seek to encourage all of us to see ways in which we can work together, and bring our respective strengths to the table, as we work for a healthier America. 

Beyond Your Mouth: The Social Determinants of Oral Health

April is minority health month, and there’s no better time to focus on dental health—which so profoundly affects the overall health of minorities. As the commemorative month comes to a close, consider the importance of improving the oral health of all (our mission lived each day).

“Oral health implies much more than healthy teeth. The mouth is both a cause and a reflection of individual and population health and well-being,” states a study published in BMC Oral Health. This notion reflects the fact that many of the determinants of dental health go way beyond medical factors—they are behavioral, cultural, social, and economic as well.

For example, tooth decay is a major dental health issue for the United States. And the food we eat plays an important role in this. Foods rich in sugar and carbohydrates help to form plaque acid that attacks tooth enamel. But those who live in food deserts with no access to healthy, nutrient rich food, may be forced to rely heavily on these foods in their diet.

Education also plays an important role in tooth decay. 

According to the Centers for Disease Control and Prevention (CDC):

• Adults aged 35–44 years with less than a high school education experience untreated tooth decay nearly three times that of adults with at least some college education.

• In addition, adults aged 35–44 years with less than a high school education experience destructive periodontal (gum) disease nearly three times that of adults with at least some college education.

Access to fluoride is also key. 

Prior to World War II, Americans were plagued by toothache and tooth loss.  But in 1948 the National Institute of Dental and Craniofacial Research was formed and researchers began demonstrating the effectiveness of fluoride in preventing tooth decay. 

According to a Surgeon General’s report, “Community water fluoridation remains one of the great achievements of public health in the twentieth century—an inexpensive means of improving oral health that benefits all residents of a community, young and old, rich and poor alike.”

While community water fluoridation is highly recommended by nearly all public health, medical and dental organizations, some may still lack this important program. (Check your community’s status in this CDC fluoride finder.)

Dental insurance inequalities also contribute to health disparities, as preventive oral care including check-ups and regular dental cleanings are crucial. That is one reason we created the unique PreventistrySM approach, which not only fully covers most preventive services, but also helps highlight for network dentists those members at higher-risk of tooth decay.

This year’s minority health month theme is Accelerating Health Equity for the Nation. Long past just recognizing health inequalities, this theme calls us to improve our work toward health equity, in part by focusing specifically on the social determinants. 

As you continue to think about this theme—hopefully long past April—don’t forget about the intertwined importance of oral health.