Winter 2017-18

12 New Mexico Dental Journal, Winter 2018 State of the Workforce | continued 2018 The project was then piloted in three unique settings: urban, rural, and Native American populations. This phase allowed for gathering data and testing the model in real world settings. It was a dynamic process with modifications to both the curriculum and outcome expectations; but it demonstrated that in many ways the CDHC was more than the sum of its parts. There was recognition that CDHCs might come in more than one “flavor” and that existing team members might add CDHC skills to enhance practices in all kinds of settings. The NMDA recognized early that the CDHC model had great potential for our state. Our large Medicaid population and cultural diversity create an ideal environment for case management. Our diffuse rural population will benefit from the provision of some preventive and diagnostic services in the field and the improved efficiency with which services can be provided when visiting the dental office. In 2012, New Mexico became the first state to certify CDHCs. Central New Mexico Community College (CNM, formerly TVI) became the first brick-and-mortar school following the pilot project to license the curriculum. They have just graduated their second class and have served as a model for nearly a dozen other programs throughout the United States. From the patient’s perspective, the CDHC meets them with additional understanding of language and cultural issues that patients face. They provide education on preventive care and hygiene, but may counsel on lifestyle choices that complicate oral health. They may provide some diagnostic services in cooperation with a supervising dentist that could include charting, radiographs, photographs, and models, perhaps remotely by teledentistry. CDHCs can provide sealants as part of a dentist’s treatment plan or prophys and perio treatment, if also licensed as a hygienist . They help schedule visits to facilitate efficient treatment and reduce non-productive “screening” appointments. They may even arrange transportation or childcare. The CDHC could be school-based, hospital-based, clinic-based, or some combination. Many practices note a significant reduction in “no-shows” with the addition of a CDHC on the dental team. From the dentist’s perspective, the CDHC reduces overhead, by allowing more efficiently scheduled appointments and pre-screening to improve productivity. By reducing wasted time, they allow the cost of providing services to be reduced and make Medicaid a more viable practice option. As noted, they reduce no-shows and make sure that patients have complied with pre-operative requirements including pre-medications. They can take on more pre- and post-treatment counseling freeing the dentist and hygienist for more productive activities. CDHCs provide outreach to the community, which generate referrals and improve community goodwill. They can work in-office, or might live in the location of a practice’s satellite office, preparing a full and productive schedule and assisting the dentist as needed. From the community’s perspective, the CDHC brings a culturally-competent oral health specialist to frequently underserved populations. They save money by diverting dental problems to dental practices, rather than costly ineffective emergency room visits. They raise the dental IQ of children and their parents and spread awareness about the importance of oral health to overall health. In some communities, they may be a dental emergency resource. Under-funded coverage, whether Medicaid or a commercial plan, challenges dental practices economically in both competitive urban settings or rural low population density settings. The CDHC impacts the economic equation favorably on both the supply and the demand side. By reducing costly no-shows and increasing the productivity and efficiency of 8% 0% GROWTH 2015-17: DENTISTS vs. POPULATION NM HEALTHCARE WORKFORCE REPORT 2015, 2016, 2017 WHILE NEW MEXICO’S DENTIST GREW AT A RATE OF 8%, THE STATES POPULATION REMAINED STATISICALLY UNCHANGED. (-4557 RESIDENTS BETWEEN 2015-17) State of the Workforce FAST FACTS