Unexpected opportunities: Q&A with LDPP ambassador Jared Fine, DDS

For more than 38 years, Jared Fine, DDS, MPH, was the dental health administrator for the Alameda County Public Health Department, where he built one of the most progressive and effective dental health programs in the state. After retiring from the department, Fine became an advocate for sugar-sweetened beverage taxation in Oakland, accepted a position as co-chair of the state oral health advisory council and now is the community dental ambassador for the Alameda County Local Dental Pilot Project (Department of Health Care Services, DTI, Domain 4). In this Q&A, Fine talks about that project and the role of private dentists.

Q: Please tell us a little bit about Alameda’s Local Dental Pilot Project.
The Alameda County Public Health Department was awarded funding for the Healthy Teeth, Healthy Communities pilot as part of the Local Dental Pilot Project of the Dental Transformation Initiative, Domain 4. We specifically designed the HTHC program to overcome the barriers to and challenges in utilizing services experienced by Medi-Cal-enrolled families, as well as the dentists who are called upon to provide dental care.

Central to HTHC’s success is creating a dental provider community of practice or COP — a network of private practice dentists and federally qualified health centers who recognize the importance of equitable access to care, are knowledgeable of barriers to care experienced by Medi-Cal enrollees and are proficient in applying preventive dentistry and motivational interviewing. HTHC will provide participating dentists free C.E. courses in collaboration with UCSF pediatric dentistry faculty; incentive payments for providing family oral health education to the caregivers of children 0-5 years of age and for providing data for children seen in the program annually; and support to assure that families are successful dental consumers, including keeping appointments, being knowledgeable about the importance of dental prevention, completing treatment plans and sustaining continuous treatment over time.

In addition, HTHC is building a new workforce of 27 community dental care coordinators who are embedded in local social service agencies and care locations and trained to outreach to eligible families, engage them in the program and provide dental care coordination services.

Finally, in development is acare coordination data management systemthat will enable CDCCs to document outreach, coordinate care, keep appointments and assure continuity of care for families that they have appointed to dentists participating in the community of practice. The system will provide real-time information about the utilization of services and serve as the basis for coordinating the financial incentive payments to participating dentists.

Q: What is your role in the HTHC pilot?
As the HTHC community dental ambassador, I work with the Berkeley, Alameda County and Southern Alameda dental components, as well as individual dentists and federally qualified health centers to recruit providers, support CDCCs and assist dental providers to help families navigate the program. I also collect feedback on the provider experience with HTHC and provide training and technical support to facilitate contracting between FQHCs and individual dental providers.

Q: We sometimes hear community agencies or dentists express skepticism about organized dentistry’s role or the role of individual private practicing dentists in these types of public health projects. As one who has been a bridge between these two worlds for a long time, can you tell us your thoughts on this?
I am inspired by the response the program is getting as we meet individual dentists in their offices. Naturally we hear about past difficulties and concerns about the Denti-Cal program. However, when we explain how HTHC is addressing those issues, especially the help offered by the CDCCs, a transformation seems to occur. Furthermore, the coordinators’ active partnership with the office staff to establish appointments based on what the dentist and the office chooses gives dentists control over how their office will participate.

One dentist confessed that years ago when she first signed up to provide care to Denti-Cal-enrolled children, she had a nightmare that one day a big yellow school bus would roll up to her office full of kids to treat and what would she do! But having heard how the CDCCs and the office staff work together to regulate the flow of patients, she was completely comfortable with signing up. Another dentist asked many questions and raised concerns from previous experiences that were financially and administratively onerous. When we finished answering all of his and his office manager’s questions, he not only agreed to join the program but thanked us for designing a program that would enable him to serve the community. Moreover, he said he wanted his other offices to be in the program as well.

One office at a time, we seem to be changing the narrative about serving the Denti-Cal-enrolled population!

Q: What advice would you give to other DTI Local Dental Pilot Programs? To private practice dentists?
My main advice to LDPPs is to utilize the private practice network of dentists in your communities. Reach out to your local dental society to develop a partnership, try innovative approaches to treat the participants in Medi-Cal public health funded programs and recognize that dentists are essential to providing care. Dentists must be respected and honored for overcoming barriers to participating in the program and providing care to vulnerable populations.

Dentists: You are essential to addressing the dental needs of Californians. Success cannot be accomplished without you! Reach out to your dental component leadership and ask what you can individually and collectively do.

For more background on the Dental Transformation Initiative, Domain 4, read the CDA article, “Selected local pilot projects to improve children’s oral health.” 

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Tom Olinger, DDS, has served in many different roles during his dental career, including Navy dentist, dentist in private and clinic practice and Dental Board of California member. Olinger recently accepted a position as the chief dental officer for San Diego County. CDA publications staff reached out to Olinger to learn more about that position and his work in San Diego County now that Proposition 56 funds will generate more than $800,000 annually for San Diego County’s oral health program.

Dentists in selected counties have an opportunity to participate in pilot projects that seek to improve the oral health of California children enrolled in Denti-Cal. In February 2017, the Department of Health Care Services announced the 15 selected proposals for Local Dental Pilot Project funding, with awards totaling $150 million over four years.