Appalachian Rural Dental Education Partnership Program (ARDEP) - Phase V

This 2016-2017 proposal completes the implementation of a rural dental education partnership to address oral health needs and partnership network development for the Appalachian region of Kentucky. MSU and the University of Kentucky (UK) are currently in the third year (2015-2016) of a four-year ARC implementation plan for the Appalachian Rural Dental Education Partnership (ARDEP). The long-range goals of ARDEP are: 1. To increase opportunities for Kentuckians from the Appalachian counties to pursue dental education and practice as a career choice. 2. To improve the numbers and distribution of dentists practicing in Kentucky’s Appalachian counties. 3. To improve oral health literacy and demand for care. 4. To develop financially sound oral health models to benefit the economic base of and societal improvements in Appalachia. With an earlier ARC planning grant, a Comprehensive Oral Health Needs Assessment recommended a major oral health initiative to develop regional partnerships and coordinated care networks (public health, safety net organizations, regional medical centers, regional universities and practitioner networks). MSU and UK formed the ARDEP partnership to help address these goals by development of an innovative university dental pipeline model and partnership network across the ARC region. During the ARDEP implementation, major changes have occurred in the state and Appalachian economy and health care in Kentucky. These changes included transition of the Medicaid program to a managed care model and phase-in of the new Affordable Care Act (ACA). This includes changes in Medicaid eligibility and a major Medicaid expansion (initiated in 2014--ongoing). The Shaping Our Appalachian Region (SOAR) initiative was also activated with a series of working groups and reports, including the SOAR Health Work Group and oral health sub-group reports. During 2015, the Kentucky Cabinet for Health and Family Services also designed, with stakeholders from across Kentucky, a new four-year State Health System Innovation Plan (SHSIP). Collaborating with the Cabinet, the ARDEP Project Team has also closely monitored the dental outcomes/trends of these health systems changes in Appalachia and carefully articulated the multi-year ARDEP implementation with these changes and SOAR. Major increases in numbers of insured adults who now have Medicaid dental benefits and economic changes in region have substantially accentuated the needs to transform dental delivery and improve a weak oral health infrastructure. Poor oral health creates major societal health expenses for the ARC region that far exceed the direct costs of dental services (early childhood development, educational outcomes and medical care costs). As part of the SOAR Health Work Group, listening sessions were conducted across the region, with over 1350 citizens attending health related sessions. From this input, children’s oral health was also identified as one of 10 priority health areas. A sub-group was formed which included members of the ARDEP Project Team. This subgroup developed an oral health report that recommended short-term, mid-term and long-term solutions for the 54-county ARC region. The ongoing ARDEP assessments and implementation provided important regional dental information that facilitated the SOAR and state planning and documented the dental outcomes and economic impact of the health systems changes. It also became clear to the ARDEP Project Team that regional primary care organizations and health practitioners do exist in-region who want to improve the coordination of primary care and partner in new and innovative ways. A central strategy, formation of an Appalachian Oral Health Network, emerged. This network will provide an ongoing, regional dental infrastructure, linking dental service and educational partners with information support and to the Kentucky Health Information Exchange (KHIE). As part of State Health Systems Innovation planning, a new Oral Health Delivery Framework was identified to help form the necessary network and information infrastructure. After 2016-2017, the network will also include extension of the ARDEP dental pipeline model to other universities and colleges serving the region, using a tuition based sustainability model. From the ARDEP planning grant and implementation outcomes, three observations remain very clear. First, needs are great and access to dental care continues to be very restricted in the ARC region, particularly for financially disadvantage populations. With Medicaid expansion, all available information indicates the dental access concerns in the region, particularly for adults, have substantially increased. Second, the current dental education pipeline from the ARC counties remains very limited with few residents seeking and earning a DMD degree. Early outcomes indicate the ARDEP dental pipeline model has great potential to improve oral health literacy and interest in dentistry, addressing these regional needs. Third, both supply and demand considerations (care coordination/literacy campaigns) must be addressed with new strategies, or the oral health infrastructure and quality of health, across the region will continue eroding.