Hub and Spokes Route Dental Care to Destinations in Need

Krysia Gabenski Featured News

By Krysia Gabenski, CDA Strategic Communications Specialist
From the Spring 2015 Journal of the Colorado Dental Association

According to a February Colorado Health Institute (CHI) report, eight of Colorado’s 64 counties are “dental deserts,” meaning they are without a licensed dentist, a Federally Qualified Health Center (FQHC) or a Community-Based Dental Clinic (CBDC). It’s important, however, to point out that these eight counties only account for 1% of the total state population. But nonetheless, the need for access to quality dental care for this underserved population is real and urgent. That’s why the CDA, through its new Community Dental Health Program (CDHP), has stepped up to lead this effort to improve access-to-care issues statewide.

A Collaborative Effort
The CDHP will build partnerships between underserved communities and dentists to improve oral health and access to care. The program will customize a sustainable hub-and-spoke model in various communities. The hub is the location where the participating dentist spends the bulk of his/her time. Depending on the needs of each community, that could be the dentist’s primary practice or a hospital, a CBDC or an FQHC. Ideally, once a hub is created, dentists will establish spokes in adjacent communities where preventive oral hygiene instruction and treatment can be provided. In some communities not covered by a full-time dentist, registered dental hygienists, who in Colorado may legally work without the supervision of a dentist, can step in to help in partnership with the hub dentist. Collaboration between dentists and dental hygienists is paramount to the program’s success.

Identifying the Need    
Data and many criteria are taken into account when evaluating and selecting hub and spoke locations. For sustained success, the location must serve as a geographic, commercial and health base for the region to provide the foundation needed to anchor hub-and-spoke practices. The community should express some interest in offering dental services and be willing to invest in dental practices through cost-sharing and facility co-location. Once these initial criteria are met, the CDHP helps build partnerships with local hospitals, primary care practices and other community health and social anchors to enlist the support of key community leaders and institutions.

One such location that meets the criteria is Springfield, Colo., in Baca County. Based on the CDHP’s research, Springfield has high populations of Medicaid beneficiaries, residents in assisted living/nursing home facilities and sparse access to dental care. These statistics made for the perfect location to launch a pilot program. Because of the extreme transportation expense to access dental care, many residents of Springfield and the surrounding area forego routine dental checkups, leading to bigger oral health problems. Enter Dr. Carol Morrow, chair of the CDHP. As a dentist with practices in Walsh, Colo., and Johnson City, Kan., Dr. Morrow knows the rural dental landscape well. Her solution to the access-to-care problem in Springfield? She will travel to them.

With her primary practice in Walsh serving as the hub of this model, Dr. Morrow will travel a couple days per week to a Springfield medical clinic. In addition to working with patients, Dr. Morrow will train medical clinic staff to do dental screenings for a full integration of medical and dental care in the area. When Dr. Morrow is practicing in her Walsh and Kansas locations, patients in Springfield with extreme emergency cases and access to transportation may travel to her. For routine treatment, patients can make an appointment on a day she’s scheduled to be in Springfield.

Waiting in the wings is a project in Holyoke, Colo. A local hospital will open its doors to dentists who will address the oral health needs of those in Phillips County and the surrounding areas.

Making Medicaid Work
Finding a permanent solution to the access-to-care problem will take more than just matching a dentist or dental hygienist with a region that needs assistance. Reaching the Medicaid population is an important part of equation, too. Common criticisms are that dentists are unwilling to treat Medicaid beneficiaries and that this population has very little access to oral healthcare. These criticisms aren’t always accurate. According to the CHI report, from 2012-2014, there has been a 17% jump in dentists who treat Medicaid patients. That’s a promising statistic that correlates with the addition of an adult Medicaid dental benefit and the CDA’s Take 5 efforts, but the work is not finished. Medicaid patients in many areas of the state still lack access to a dentist. It comes down to this: If every dentist in the state were to take five Medicaid patients, the effect on access-to-care issues in the underserved population would be immense. As more dentists sign up to serve this population, more access to dental care across the state is achieved, which will eliminate criticisms and calls for new models of care to solve access needs.

Funding Long-term Success
As with any new initiative, raising enough money to establish and sustain the CDHP is critical. Initial outreach has drummed up some support for the CDHP, with DentaQuest donating $10,000 to help offset some of the costs involved in setting up the pilot program in Springfield. Additional funding will come in the form of matching programs, where organizations like the Department of Local Affairs might match the funds local governments are able to allocate in support of increased access to dental care in their communities.

A solution to access-to-care issues in Colorado involves more than just increasing the number of dentists. Colorado has one dentist for every 2,022 residents—well within the parameters of one dentist to every 1,500 to 3,000 residents set by the American Dental Association as a measure to ensure balanced access to care and sustainability for dental practices. It’s about connecting dentists to communities that have patients in need of oral healthcare to create long-term relationships and sustainable practices.

If you have an interest in meeting needs in underserved communities in Colorado, contact Dr. Carol Morrow, chair of the Community Dental Health Program, at