The Health Foundation funded two multi-year projects dealing with oral health – the Central Massachusetts Oral Health Initiative (CMOHI) and the Oral Health Initiative of North Central Massachusetts (OHINCM). Both of these projects have been completed and together they had significant impact on oral health in the region and across the state.
As we began funding these projects, we learned that one in four children in Massachusetts had untreated dental decay. In Worcester County 35,000 children and 65,000 adults did not have access to dental care. Chronic oral infections cause school absenteeism and other health problems later in life, including heart disease, diabetes, low birth weight and pre-term births.
The Health Foundation funded planning and pilot grants for these projects in 2000 and 2001 respectively. Their full implementation efforts began in 2002 and continued through 2009.
Total funding for both projects was $5.9 million over the nine years, of that amount $3.6 million went to the CMOHI and $2.3 million to the OHINCM.
Both projects had as their goals:
· To increase access to oral health services for people who were either uninsured or on MassHealth who had substantial difficulty accessing dental care.
· To raise awareness of the importance of oral health, especially among parents of young children.
· To influence legislative and regulatory policy in support of enhanced oral health services.
· To create a model for oral health services that can be replicated and sustained.
The successful outcomes of the CMOHI and OHINCM were the result of these projects joining the advocacy efforts facilitated by Health Care For All’s statewide Oral Health Advocacy Task Force to secure public policy changes. Without the changes in state laws and regulations, much of the increased access to oral health services would not have occurred and would not be sustained. The Task Force worked with Massachusetts legislators to create the Oral Health Caucus in 2005, believed to be the first such caucus in the nation. The Oral Health Caucus has been chaired by Sen. Harriette Chandler and Representatives Kathleen Teahen and John Scibak. Key legislative and regulatory changes that were made included:
· full restoration of MassHealth adult dental benefits;
· the establishment of a third-party administrator to manage the operations of the MassHealth Dental Program;
· allowing dentists to cap their MassHealth caseloads, making it more likely that dentists would agree to serve MassHealth patients; and
· increased MassHealth reimbursement for dental procedures.
CMOHI – At the outset, fewer than 10 dentists in Central Massachusetts were serving MassHealth members. By the conclusion of this initiative, over 200 dentists were available to MassHealth members. In addition, the two federally qualified health centers in Worcester went from providing approximately 2,000 dental visits to more than 4,000 visits annually. Finally, in the Worcester Public Schools during the 2001-2002 school year, 438 second and third grade students received school-based dental services; by the 2008-2009 school year, over 4,500 students from pre-K through sixth grade received dental services through programs administered by Family Health Center and Great Brook Valley Health Center.
OHINCM – estimated that 42,000 individuals were in need of oral health services at the time the project began. By the conclusion of the project, it was estimated that 30,000 individuals (71 percent of those in need) had received direct services or education about oral health. The average number of people served each year as a result of this initiative was estimated at more than 15,000.
CMOHI – At Family Health Center, services nearly doubled from 700 per month in 1999 to 1,281 per month by 2009. At Great Brook Valley Health Center, visits went from 1,122 per month in 2000 to 1,720 in 2009. Over the years that CMOHI was funded, more than 335,000 dental patient visits were provided by the health centers.
OHINCM – Community Health Connections in Fitchburg, Gardner and Leominster and the ACTION mobile dental unit have served in 2009 more than 26,604 patient visits, with a staff of 15 dentists, 17 dental assistants and 2 hygienists.
CMOHI – As changes were made to the MassHealth dental program, dentists found it to be similar to the other insured programs they dealt with in their offices. As a result, with significant recruiting efforts, the number of dentists accepting MassHealth patients went from fewer than 10 in 2000 to almost 200 in 2008.
OHINCM – At the conclusion of this project, 47 area dentists were providing services to MassHealth patients.
CMOHI – Initially, the Worcester Public Schools were providing minimal preventive services – oral health screens and fluoride rinses – in only a few schools. By the conclusion of the project, services were being provided in 26 Worcester schools. In the 2001-2002 school year, 438 students in grades 2 and 3 were served. By the 2008-2009 school year, over 4,500 students from pre-K through sixth grade received services that included oral exams, fluoride varnish and sealants.
A program was also developed for the Webster Schools and administered by Family Health Center. Beginning as a screening, education and prevention program, it has grown into one that currently includes on-site restoration services.
OHINCM – 43 schools that comprise the Winchendon, Gardner, Leominster, Fitchburg and Narragansett School districts offer school-based dental services, administered by Community Health Connections Family Health Centers, that include screening exams, fluoride varnishes, dental sealants and temporary fillings.
CMOHI – In 2003, CMOHI began to develop a post-doctoral one-year dental residency program within the UMass Medical School. This program received full accreditation in 2005 and the first residents began their program training in July 2005. To date, 12 have completed their residency. Importantly, graduate education reimbursements by the federal government sustain the program.
OHINCM – Community Health Connections Family Health Centers and Mt. Wachusett Community College collaborated to establish an accredited dental hygiene program, with MCCC graduating its first class in 2007. By the fall of 2009, 33 had graduated from the program, performing 3,000 patient visits at the CHC as a part of their training. MWCC is continuing the program.
As these results show, the work done by the grantees and other partners has had significant impact on oral health care, particularly in Central Massachusetts and also across the Commonwealth. By working to make systemic changes, everyone involved in this project has ensured that more Massachusetts residents can access the dental care they need, thus reducing their risk for future health problems. Moving forward, the likelihood is that many more children and adults will be able to get the care they need in a more timely way, thus improving their quality of life and reducing medical costs for these individuals.
Consistent with the Health Care and Health Promotion Synergy Initiative projects funded by The Health Foundation, both projects were collaborative efforts that engaged a number of partner organizations to accomplish their goals. These included:
For CMOHI: Commonwealth of Massachusetts Legislature
Family Health Center of Worcester
Great Brook Valley Health Center
Health Care For All
Health Law Advocates
Massachusetts Coalition for Oral Health
Massachusetts Delta Dental Foundation
Massachusetts Dental Society
Massachusetts Department of Public Health
Massachusetts Society for the Prevention of Cruelty to Children
Oral Health Initiative of North Central Massachusetts
Qunisigamond Community College
South Worcester Neighborhood Center
Southbridge Public Schools
Southern Worcester County Oral Health Coalition
Tufts University School of Dental Medicine
UMass Medical School Office of Community Programs* [admin. & fiscal agent]
UMass Memorial Health Care
UMass Memorial Ronald McDonald Care Mobile
United Way of Webster and Dudley
Webster Public Schools
Worcester City Council
Worcester Department of Public Health
Worcester District Dental Society
Worcester District Hygienists’ Association
Worcester District Medical Society
Worcester Public Schools
For OHINCM: Community Health Connections Family Health Center
Fitchburg Public Schools
Gardner Public Schools
Health Alliance Hospital
Joint Coalition on Health of North Central Massachusetts
Leominster Public Schools
Massachusetts Department of Public Health
Montachusett Opportunity Council* [admin. & fiscal agent]
Mount Wachusett Community College
Phillipston Public Schools
Templeton Public Schools
Wachusett District Dental Society
Winchendon Public Schools