FirstHealth of the Carolinas initiated its dental health program in 1997 when the community identified oral health as the most pressing need in local school-aged children, especially the nearly 10,000 children eligible for public assistance such as Medicaid, Health Choice or the free and reduced school lunch program.
With guidance from local dentists, state dental personnel, local school administrators, health department providers and parents, FirstHealth made the decision to open three public health centers in private practice settings one each in Hoke, Montgomery, and Moore counties.
With support from The Duke Endowment and The Kate B. Reynolds Charitable Trust, the first center was opened in October of 1998, with the other two centers following in January and October of 1999. The response to the centers has been overwhelming, with an even larger demand than previously estimated.
The three centers currently serve 5,583 medically underserved children, just over half of the estimated eligible. Nearly three-fourths have never seen a dentist or have not been to a dental clinic for over a year. The payor mix overall for the program is currently 85% insured and 15% uninsured.
As of May 2001, the dental health program has assisted 241 patients with securing health care coverage through public assistance. In this third year of implementation, Medicaid and Health Choice account for nearly 90% of the program's operating expenses. Local placement of the centers has contributed to the impressive appointment compliance rate with a low 13% "no show rate," as compared to the national rate of 50%.
Since the first clinic's opening in 1998, over 21,000 sealants have been placed to protect posterior teeth from decay, one fourth of the children have moved to preventive maintenance recall status, and 17% exhibit no new decay at recall examinations. School-based dental screenings have documented a 50% decrease in the percent of children with decay and a 15% increase of sealants in fifth graders in just three years.
Satisfaction surveys completed in the first few months of 2001 were overwhelmingly positive. Once the child's treatment plan is completed, a survey is sent to his or her home for parents to respond on their satisfaction level with the center and its staff.
The overall score was 4.6, on a scale of 1 (very poor) to 5 (very good), describing a high level of satisfaction in the areas of perceived quality of service, staff interaction and waiting time.
One of the dental program's assets is the "public health-minded" leadership of Sharon Harrell, DDS, MPH, FAGD, Director of the dental health program. The former dental director of a county health department, Dr. Harrell provides the program with leadership, clinical skills, public health practice, group screening experience, preventive program planning and commitment to serve those largely underserved.
Her experience and initiative has guided the program through implementation to a successful and sustainable, yet focused, effort. Dionne Colbert, MS, DDS, manages the centers in Hoke and Montgomery Counties and is currently working toward her Masters of Public Health degree. Margaret Burgin, DDS, is a recent graduate of the University of North Carolina and works predominately at the center in Moore County.
The program not only provides care to eligible children, but also case management. Outreach workers call patients to ensure they will keep appointments or maintain treatment regimens.
"The key," according to Lisa Hartsock, Project Director of Community Voices North Carolina, "is understanding our communities, even in finding the right personnel. We need people who not only do great dentistry but understand our population, their culture, and their needs."
Through assistance from the W.K. Kellogg Foundation's Community Voices initiative, FirstHealth has broadened its efforts in the areas of dental health to hopefully impact access to care not only locally, but also throughout North Carolina and across the nation.
In May 2000, FirstHealth was honored to participate in the release of the first-ever Surgeon General's report on oral Health, which included a nationally televised press conference and a satellite media tour.
Dr. Harrell has been instrumental in leading an effort advocating for the Board of Dental Examiners to allow reciprocity, in order to alleviate the dentist shortage in the state.
FirstHealth has been active in efforts to inform key decision-makers through service to the North Carolina Institute of Medicine's Task Force on Dental Care Access, delegation to the National Dental Association, and participation on a national task force to reduce the numbers of oral and pharyngeal cancers.
Policy changes have occurred through these efforts, including an improved benefit package to include essential dental procedures for Health Choice. Efforts continue toward advocating for the expansion of the role of hygienists and for enhanced public assistance reimbursement.
First Health would like to see increases in the state Medicaid reimbursement for dental practices. Hartsock also estimates the program is only seeing 50% of the children who are in need of care.
"Due to time constraints and low reimbursements, many kids could not get in to see the dentist. We haven't met the children's needs, so we can't expand to adults."
The site is also advocating changes in the dental practices of the state where they address the shortage of dentists. Currently, North Carolina has no reciprocity of dental licenses with other states. Even experienced dentists wishing to move to North Carolina must sit through a lengthy two-day exam, a practice that deters many from moving to the state.
Community Voices would like to change current practices on credentialing, that is the recognition of experience of dentists practicing in other states. This would enable North Carolina to recruit more dentists than it currently can.