West Hawai‘i Teledentistry Pilot Expands to Maui
A Hawai‘i Department of Health survey, titled the Hawai‘i Smiles report, which was released in 2016 confirmed Hawai‘i’s children have the highest prevalence of tooth decay in the nation. That same survey also showed a disproportionately higher prevalence of tooth decay among low-income children, especially those who live in Hawai‘i, Maui and Kaua‘i counties.
Despite ranking at the bottom of the nation for children’s oral health, Hawai‘i is taking concrete steps to change the oral health status of Hawai‘i’s children and has become a pioneer in teledentistry. Through a public-private partnership, the Department of Health, Pacific Center for Special Care at the University of the Pacific’s School of Dentistry, the HDS Foundation and numerous other community partners are changing the future trajectory of Hawai‘i’s children by using a proven virtual dental home program to improve their oral health and overall health.
The public-private partnership has successfully demonstrated the value of the teledentistry pilot project in West Hawai‘i over the past two years. As a result, the HDS Foundation is providing funding for a third year. The HDS Foundation contributed about $315,000 in the first two years of the pilot and this year will allocate an additional $319,000 to continue the pilot. In addition, the HDS Foundation committed $125,000 for the first year of a three-year project on Maui to and increase the ability of the program to operate there five days a week. The Hawai‘i Medical Service Association (HMSA) Foundation is also contributing $125,000 to expand the successful program to Maui.
The DOH and the University of the Pacific are collaborating with West Hawai‘i Community Health Center to provide dental care through the virtual dental home model of care, which provides oral health education as well as diagnostic and preventive dental services to participants at the Women, Infants, and Children’s (WIC) site in Kona and three Head Start sites in Kona and Waimea
“Our pilot focused primarily on those children in West Hawai‘i who typically would not receive or have access to dental care until their tooth decay or oral health disease reached an advanced stage, when there is pain and infection and require more costly intervention,” said Dr. Andrew Tseu, a dentist and chief of the Hospital & Community Dental Services Branch of the Hawai‘i State Department of Health, who is overseeing the project.
According to Matthew Shim, chief of the Family Health Services Division of the Hawai‘i Department of Health, there are significant disparities in access to oral health services and, consequently, oral health that are well documented in Hawai‘i. While these disparities are common in many states, they are magnified in Hawai‘i because of the geography of the island state, concentration of dental services on O‘ahu, and lack of fluoride in the water, a safe and proven decay prevention measure. As a consequence of these and other factors, Hawai‘i has a history of having some of the worst dental health in the country.
“Instead of reinventing the wheel and starting the program from scratch, the Department of Health chose a proven model for its pilot project in West Hawai‘i,” Dr. Tseu said. The teledentistry program, or virtual dental home, is an innovative system that makes it easy for patients to receive diagnostic and preventive services in community settings. It was developed by Dr. Paul Glassman, professor of dental practice and director of the Pacific Center for Special Care at the University of the Pacific School of Dentistry to improve care for underserved populations. Dr. Glassman and his team have been working with the Hawai‘i Department of Health to design, start and support the West Hawai‘i pilot.
In July 2016, Gov. David Ige signed a law Senate Bill 2395, which required the state’s Medicaid managed care and fee-for-service programs to cover services provided through telehealth, beginning Jan. 1, 2017. This allowed for health services provided through a telehealth consultation to be covered — and be reimbursed to dentists — at the same rate as a face-to-face visit between a patient and a healthcare provider. The pilot project in West Hawai‘i plans to submit claims for services this year as a way to make the program financially self-sustaining.
While the West Hawai‘i pilot project is serving children, the expansion of the virtual dental home system to Maui will serve both children and adults.
“We are excited that this expansion to Maui will allow us to use the virtual dental home to now serve kūpuna,” said Dr. Tseu, noting that the Hawai‘i State Department of Health has determined that there are more than 2,000 children and adults who could potentially be served by this project as it grows.
Partners for the Maui expansion include:
- Hale Makua Health Services, which provides a wide range of senior care services at two nursing homes;
- Hui No Ke Ola Pono, private, not for profit community-based health program of the Native Hawaiian Health Care System;
- Maui Family Support Services which operates the Early Head Start program;
- Maui Economic Opportunity which manages 13 Head Start centers on Maui;
- Special Supplemental Nutrition Program for Women, Infants and Children (WIC), a federally funded program within the Family Health Services Division that provides supplemental food packages for either pregnant, breastfeeding, or postpartum women, and infants and children under age five who meet income guidelines and have a medical or nutritional risk.
Hawai‘i is borrowing proven, best practices from other states to make dental care more accessible for those who may not be able to easily go a dentist office to receive care. Using technology, Hawaii‘ families can participate in a virtual dental visit from sites that are closer to their home or workplace and at convenient times.
The virtual dental home project, now entering its third and final year, is based on the success of a six-year demonstration project in California, which involved 11 communities and nearly 50 sites and treated more than 3,400 patients.
This teledentistry project is part of the Hawai‘i Department of Health’s strategic plan to increase the use of telehealth in the state to improve access to care. The California project has demonstrated the use of telehealth-connected oral health teams can reach people who traditionally do not receive dental care to deliver proven and effective prevention strategies. This program is now being replicated in Colorado and Oregon. Hawai‘i is one of the pioneering states to adopt the program, which is ideal for the neighbor islands since the majority of dental resources are concentrated on O‘ahu.
The virtual dental home uses technology to connect dental hygienists with patients at convenient community locations such as Women, Infants and Children (WIC) centers, preschools, and schools with dentists who are in dental offices and clinics.
A dental hygienist uses portable imaging equipment and an internet-based dental record system to capture and upload patient information to a dentist who examines the patient virtually by securely reviewing the records and x-rays for a diagnosis and treatment plan. In addition to x-rays, a hygienist also collects photographs, charts of dental findings, and dental and medical histories for electronic records.
At the direction of the dentist, the dental hygienist completes preventive procedures at the community site and refers patients to dental offices for procedures that require treatment by a dentist. Since most of the care is provided in a community setting, this frees up a dentist to take care of more advanced oral health conditions in the dentist office. An important component of the virtual dental home system is education for patients, parents, and caregivers by a dental hygienist who is at the community site on a regular basis.