2014 Strengthening the Oral Health Safety Net for Pregnant Women and Young Children

Most of us associate Lean and Kaizen with internal business processes however they can also be essential to North Carolina’s oral health safety net. By helping health departments and community health centers improve their business and service through process improvement strategies, the BCBSNC Foundation is helping dental clinics see more people in a more efficient manner.

The Foundation’s Strengthening the Oral Health Safety Net for Pregnant Women and Young Children Collaborative’s goal is to help improve the efficiency and capacity of dental clinics that reach the underserved. Poor oral health can cause serious and even life threatening complications, yet decay is almost 100% preventable. Low income populations are the most at risk for poor oral health and have the least access to oral health care. The Foundation works with dental clinics who have as their mission providing care to low-income populations, helping them to both stay sustainable and gear up to meet the demand for services.

The first phase of this grant program focused on improving practice finance and efficiency for six dental clinics (Catawba, Orange, Macon, and Madison Health Departments as well as ECU Dental School’s Community Service Learning Center in Elizabeth City and Piedmont Health). Staff from these clinics attended a two-day workshop in Hickory in May to develop Quality Improvement projects based on a thorough Practice Assessment and related Enhancement Plan conducted by the NC Office of Rural Health. These clinics continued to improve their processes by turning attention to clinic flow at three-day on-site Kaizens (rapid improvement events) facilitated by NC State’s Industrial Extension staff at each participating clinic in July.

Some of the improvements clinics are embarking on seem basic, but they are dramatically increasing access to care by making themselves more efficient. As an example, the Orange County Health Department clinic has focused on increasing their monthly revenue from under $30,000 to $45,000 through efforts such as improving communication on the dental team, scripting patient interactions to ensure consistency in policy enforcement, standardizing processes to decrease billing errors and reducing their no-show rate through improvements in the confirmation policy and development of a “sooner if possible” patient list.

“Even at the workshop, clinics were identifying low hanging fruit—things that will really make a difference in their accessibility to families with young kids and to their bottom line,” said Katie Eyes, senior program officer at Blue Cross Blue Shield of NC Foundation. “It’s clear that with support of training they’re receiving they are well on the path to improving oral health in their communities. The learning that goes on among the sites and with support of the faculty is the reason that we really believe in the cohort based approach.”

The convener for this work, Center for Public Health Director Greg Randolph, remarked, “I was really struck by the passion and excitement all of the teams showed for examining their business and clinical flow processes and striving to dramatically improve them – I am really looking forward to seeing what these teams accomplish and the impact it has on their communities.”

After the Practice Finance and Efficiency Phase, the six clinics will begin to focus on providing enhanced access and clinical care to pregnant women and young children, the populations in which preventive services have the greatest impact on future health. In collaboration with faculty from UNC School of Dentistry and School of Medicine, they will implement the Baby Oral Health Program (bOHP) in September and the Prenatal Oral Health Program (pOHP) training in January.

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