Remarks to the National Network for Oral Health Access
U.S. Department of Health & Human Services
HRSA Press Office: (301) 443-3376
by HRSA Administrator Mary K. Wakefield
October 24, 2011
I appreciate the opportunity to be here today to help mark the 20th anniversary of the founding of the National Network for Oral Health Access. The Health Resources and Services Administration considers your organization among our most valued partners.
Your mission – to improve the oral health of underserved populations and contribute to overall health through leadership, advocacy and support to oral health providers in safety-net systems – is one that we at HRSA are proud to share.
Both you and we want patient-centered dental care that is comprehensive in scope, coordinated across settings and over time, and accessible to all.
Throughout your existence, your organization has been a leader in moving the field of oral health care forward. I know that the President, Dr. John McFarland, is stepping down after 20 years. Dr. McFarland was instrumental in founding the National Network for Oral Health Access and in championing the expansion of oral health care in health centers. At the same time, your first executive director, Colleen Lampron, recently left the association after six years. We greatly appreciate their contributions.
Looking forward, I am gratified that you remain in good and, from our vantage point, familiar hands. Your Interim Executive Director, Barbara Bailey, was a long-time HRSA employee, working in three regional offices as well as at the Bureau of Primary Health Care in Rockville. We look forward to working closely with Barbara and her successor and continuing the partnership between our two organizations.
Well, this morning I want to offer HRSA’s vision for what’s ahead and what we’re doing to shape the future during what I believe is a transformational era in American health care and the health of the American people.
Each generation of health care professionals faces its own challenges and opportunities – but I frankly can’t remember a time more interesting, more important or more exciting than this one. It’s a rarity when we have opportunities to make tremendous progress in providing access to quality health care.
Through the Recovery Act and, especially, the Affordable Care Act, we have important resources necessary to help improve health care – including oral health – for all of the nation’s safety-net populations.
While it’s not the subject of a lot of editorials, the ACA sharply focuses on and strengthens the availability of primary care services.
For example, the Act recognized the importance of increasing access to primary care by creating the largest expansion of HRSA-funded community health centers in the program’s history. As most of you know, it invests significantly through 2015 for the operation, expansion, and construction of HRSA-supported health centers across the nation.
Other parts of the Affordable Care Act invest in training in primary prevention; in the adoption of electronic health records and other health information technology; and in recruiting and retaining faculty that can transmit new, team-based concepts to students who, we hope, will come to see seamless interprofessional coordinated care as the norm.
In the meantime, the growing ability of health centers to “treat the whole patient” in one place at one time is a very encouraging sign for those of us who want to promote and implement more comprehensive team-based health care.
And health centers’ internal structures make them uniquely well-structured to fully implement patient-centered health homes – which certainly should include oral health services.
Because health centers employ a diverse group of health professionals, they are strongly positioned to use interdisciplinary teams to their fullest by redistributing care responsibilities to the teams’ most appropriate, most capable, and most available members. I’ll come back in a minute to the subject of team-based care.
In addition to investing dollars in the delivery of services at HRSA we’ve also devoted resources that inform policy makers and which can be used to help guide the way forward.
While HRSA and NNOHA know just how integral good oral health is to sound overall health, unfortunately, too few others do.
Advancing Oral Health in America, a HRSA-funded Institute of Medicine report released earlier this year, is the latest expert publication to report that decay and other oral diseases may be associated with adverse pregnancy outcomes, respiratory disease, cardiovascular disease and diabetes. However, consumers and, in fact, many health care professionals remain unaware of the risk factors and preventive approaches for many oral diseases. They don’t fully appreciate how oral health affects overall health and well-being.
That’s a knowledge gap that we can ill afford.
To help address this shortcoming, the IOM report proposes that HHS design an oral health initiative which has clearly articulated goals, is coordinated effectively, adequately funded and has high-level accountability. In addition, the IOM stresses three key areas needed for successfully maintaining oral health as a priority issue: strong leadership; sustained interest; and the involvement of multiple stakeholders from both the public and private sectors.
A second IOM report funded by HRSA, titled Improving Access to Oral Health Care for Vulnerable and Underserved Populations, confirmed that millions of Americans are not receiving needed dental care services because of enduring barriers that limit their access to oral health care.
That report, which the IOM released this past summer, found that 33 million people live in areas with shortages of dental health professionals. In 2008, 4.6 million children did not obtain needed dental care because their families could not afford it. And in 2006, only 38 percent of retirees had dental coverage, which is not covered by Medicare. Children, senior citizens, minorities, and other vulnerable populations are affected disproportionately by these barriers – making these disparities in oral health care wholly unacceptable.
Dental insurance coverage largely determines access to oral health care as well as predicts those who will seek it. But many people don’t have dental coverage. And even when they do, they frequently do not receive needed services because of transportation barriers or a lack of providers who accept public insurance.
The IOM recommends changing funding and reimbursement for dental care; expanding the oral health work force by training doctors, nurses, and other non-dental medical professionals to recognize risk for oral diseases; and revamping regulatory, educational, and administrative practices.
Moving forward, the two IOM reports and their recommendations will guide us at HHS and help us do our part to contribute to a sustained and comprehensive effort that provides ready access to oral health services.
At HRSA, we are fully committed to supporting health centers and their oral health programs through training and technical assistance accompanied by a sharp focus on quality. HRSA is fully committed to an integrated system of care that includes oral health. After all, oral health is the second most prevalent issue for health center patients.
By way of illustration, HRSA has in previous years offered Oral Health Service Expansion funding opportunities to increase access to oral health services at existing health centers. Since 2002, there have been 102 awards totaling $56.4 million. In FY 2009, HRSA awarded $8.7 million to support expanded oral health services at 40 health centers. We also routinely provide technical assistance to health centers to help them sustain these services.
HRSA’s commitment also is reflected in our participation in the HHS Oral Health Coordinating Committee – as well as the HHS Oral Health Initiative, which I co-chair with Dr. Howard Koh, the Assistant Secretary of Health. The Oral Health Initiative launched in April of last year focuses on integrating oral health into primary care. It involves eight HHS components and includes nine initiatives to advance oral health care.
In particular, we see increased opportunities to improve oral health care for children, an opportunity that results from the leadership of many champions – President Obama, HHS Secretary Kathleen Sebelius, the Congress and others.
The work you do gives us great potential to model the integration of medical and dental care – starting with kids. Health centers deliver oral health care to about 3.8 million patients annually; many in that number, of course, are children.
And now, we have a great opportunity to improve oral health care for children through a renewed investment in school-based health centers.
In July, thanks to a provision in the Affordable Care Act, HRSA awarded $95 million in grants to 278 school-based health center programs to expand sites and services at schools nationwide. Of those awards, 146 went to centers to support their oral health activities. Awardees will use the funds for construction, renovation, and to purchase equipment. The July funds are the first installment of an eventual $200 million investment in School-Based Health Centers.
The July investment is in addition to HRSA’s funding last month of a pilot program – the School-Based Comprehensive Oral Health Services Demonstration – to examine best practice models for the integration of comprehensive oral health services into 12 school-based health centers. These centers, however, are clinics that do not receive Section 330 funding. Funds for the pilot grants came from HRSA’s Maternal and Child Health Bureau, not our Bureau of Primary Health Care.
Even though those grants went to clinics outside the community health center system, I would encourage our school-based health center grantees to follow that demonstration and consider the lessons that we learn from the MCHB investment. Our MCHB staff can keep you up-to-date with progress in those demonstrations.
In addition, HRSA supports the National Maternal and Child Oral Health Resource Center, which helps states and communities increase access to oral health preventive and clinical services.
Title V funds also can be used to develop useful resources, like fact sheets for parents and medical and dental providers caring for children with special health care needs. Moreover, Title V supports perinatal expert work groups that bring together professional and federal partners to develop oral health recommendations for mothers and their children.
Finally, the MCHB Targeted Oral Health Service Systems program funds 20 states to strengthen the oral health program infrastructure and improve systems of care through innovative partnerships.
Circling back to an earlier comment, the emerging era of care coordination is especially relevant to improvements in oral health care. There is an interest in both the public and private sectors to support the integration of oral health into primary care – through education and practice.
Both of the recent IOM reports serve as benchmarks for a broader discussion on oral health and coordination of those services across the health care workforce. Some of the reports’ individual recommendations speak to the concept of interdisciplinary training and integrating primary medicine and oral health care.
For example, Recommendation 4 from Advancing Oral Health in America proposes HHS investments in workforce innovations to improve oral health, including first, undertaking work in core competency development, education and training to allow for the use of all health care professionals in oral health care; and second, developing interprofessional, team-based approaches to prevent and treat oral diseases.
And the IOM report on Improving Access to Oral Health Care for Vulnerable and Underserved Populations recommends that HRSA convene key stakeholders to develop a core set of oral health competencies for non-dental health care professionals.
A companion recommendation provides that accrediting bodies should integrate agreed-upon core competencies into their requirements for accreditation, and that all certification for health care professionals should include a demonstration of competence in oral health.
Put simply: To be as successful as we can be in improving access to oral health care and its quality, we need to increase the number, distribution and types of providers. We need a workforce suited to task. HRSA, for its part, is proceeding accordingly.
We cannot address all the oral health care needs across this country with dental providers alone; there needs to be a team effort. If you can get primary care providers to engage – if you can get 3 million nurses to include an oral exam as part of a physical assessment, for instance – the impact truly would be huge.
Couple those providers with your own ranks, which are the biggest oral health contingent HRSA supports. About 3,000 dentists work at health centers, along with more than 1,100 dental hygienists, and about 5,400 dental support staff. That’s a little over 7 percent of the 132,000 health care providers and support staff that work in health centers across the nation.
And I know you’re busy. The 3.8 million oral health patients served at health centers in 2010 was up by about 22 percent (an increase of 680,000 patients) since the start of 2009.
HRSA’s Bureau of Clinician Recruitment and Services has also been offering primary care dentists and dental hygienists currently serving in the Corps training opportunities, through a new web resource for NHSC members and alumni, called PrimaryCareforall.org. NHSC providers in the Loan Repayment and Scholarship programs can access accredited webinars on topics ranging from Infant Oral Health to Risk Management for Dental Providers. The Corps also offers a CEU workshop at its conferences for LRP awardees, titled The Mouth and Body Connection: Why Oral Health is Important in Primary Care.
In addition, the NHSC works with professional organizations such as the American Dental Association and the National Dental Association to ensure their members are aware of the opportunities available through the NHSC by sharing information in newsletters, at conferences and through one-on-one discussions.
From our Bureau of Health Professions, HRSA in FY 2010 awarded $31 million in grants to train general, pediatric, and public health dentists and dental hygienists. These awards were among 119 oral health training awards BHPr made (totaling $45 million) during the fiscal year.
HRSA’s oral health workforce programs broadly support students, residents and practitioners. Title VII programs support over 2,400 dental and dental hygiene students from disadvantaged backgrounds through loans and scholarships.
In our HIV/AIDS work, the Ryan White HIV/AIDS Dental Reimbursement program and Community-Based Dental Partnership programs train dental students, dental hygiene students and residents. More than 15,000 students and residents were trained to provide oral health services to over 45,000 individuals living with HIV in FY 2010.
And our cooperative agreement with NNOHA includes $550,000 to provide training and technical assistance to help HRSA’s primary care service delivery programs improve access to high-quality oral health services. Your organization will use the funds to develop new learning resources and support oral health workforce activities. And you’ve already developed guidance for health centers to integrate dental and medical care, including an action guide outlining promising practices in medical-dental integration.
In summary, while we clearly continue to have challenges, I think that, as we look forward, there is also ample reason for optimism.
We can glimpse a future in which access to oral health care services and oral health instruction for all primary care providers becomes routine.
It is a future in which colleagues across the health professions recognize, screen and assess the need for oral health care in the individual patients they see.
And it is a future in which HRSA and the National Network for Oral Health Access add to the record of success that we’ve enjoyed to date. Our work through many avenues has us proceeding together down a path that improves access to oral health care.
We have a shared commitment to shaping a new era in oral health care. Even as we recognize that we need to redouble our efforts going forward, we know that – as we do – the health of all Americans will be far better for it.