Ohio needs well-trained mid-level dental providers to improve our oral health so Ohioans can lead healthy, productive lives. But in order to introduce a new type of dental provider, we also need education standards (preferably national ones). Education standards guide community colleges and state universities in developing training programs for the new providers. Without education standards, colleges and universities have been unable to take the steps necessary to set up a program to educate and train Dental Therapists to practice in Ohio. But now the void has been filled.

Recently, the Commission on Dental Accreditation (CODA), the nationally recognized accrediting body for dental and dental-related professions, took a historic step to adopt Accreditation Standards for Dental Therapy Education Programs. That means Ohio educational institutions will now have the guidance they need to craft training programs to ensure the delivery of safe, effective routine dental care through Dental Therapists. Weighing in on this decision, Dr. Edward Sterling, DDS of Dublin, OH said, “The Commission on Dental Accreditation establishment of training standards for Dental Therapists is a critical step… Now, training goals and standards are established and can be measured to assure they are met – the same way it is done throughout all of dental education.”

We’re not in the clear yet, though. CODA is delaying implementation of the Standards while gathering more data on 2 remaining questions:

• Has the allied dental education area been in operation for a sufficient period of time to establish benchmarks and adequately measure performance? and
• Is there evidence of need and support from the public and professional communities to sustain educational programs in the discipline?

Community Catalyst, our national partner in this project, sent a letter in early June which included signers from over 100 organizations and individuals, including 38 from Ohio, providing CODA with documentation which addressed these questions and calling on CODA to implement the Standards. This information will be considered at the August 7, 2015 meeting of the Commission.

We’re hoping that CODA will vote to implement the education standards so Dental Access Now! can continue to work with Ohio community colleges to develop their programs to train end educate Dental Therapists here in Ohio.

Have you or anybody you know received medical treatment that you thought was covered by insurance, only to receive a surprise bill that isn’t covered? If so, you’re not alone.

In the past two years, a whopping one out of three privately insured Americans received a “surprise” medical bill, according to a Consumers Union survey published May 5^th. CU described a “surprise” medical bill as one you weren’t expecting or where the health plan paid less than expected.

CU surveyed 2,200 adult U.S. residents as well as additional persons in Ohio (622), Florida, California, and Texas. The survey also found that nearly nine out of ten consumers don’t know the state agency or department tasked with handling health insurance complaints.

To understand why surprise medical bills are a growing concern to consumers, you need to know a few insurance terms.

Providers who are “in network” vs. “out of network:” Most health insurance plans contract with providers of medical services, such as doctors, physical therapists, or hospitals. The providers with a contract are “in network” and have agreed to a discounted fee. The insured person knows that the in-network provider agrees to accept the insurance company’s payment as full payment — subject to any co-payment or co-insurance, once the deductible has been met. Providers who have not entered into a contract with the patient’s insurance company may charge the consumer their full fee.  How much of the fee the insurance company pays depends on the insurance policy, and the patient is stuck with the balance.

Why surprise medical bills happen: The problem of “surprise” bills often arises when consumers go to a doctor or hospital that is in their network, but that hospital or doctor uses another provider who is not in the network. Frequently this happens when an out-of-network anesthesiologist assists an in-network surgeon at an in-network hospital, an out-of-network radiologist reads the X-ray, or an emergency department at the in-network hospital is staffed by a physicians’ group that is not in the network. In all of these cases, patients are ending up with bills they didn’t expect and over which they had no control. And they aren’t happy about it!

What UHCAN Ohio is doing about “surprise medical bills”: Consumers Union heard many stories from the people surveyed, and some of them are from Ohio. UHCAN Ohio and Ohio Consumers for Health Coverage (OCHC) are reaching out to those who gave their permission to be contacted to further develop the case for legislation in Ohio to address this problem. According to the Ohio Department of Insurance, the problem cannot be addressed by regulation alone without legislation. Recently, the state of New York passed a law that protects consumers in this situation while it sets up a process to resolve the payment issue between the provider and the consumer’s insurance company. 

The OCHC ACA Implementation team is developing a letter to send to Ohio lawmakers.  We have also put together a survey to get more information from Ohioans about the problems with surprise medical bills they have seen. If you would like to take the survey, you can do so by clicking here.  

When we hear words like capacity building and infrastructure building, what do they mean? For UHCAN Ohio, it means supporting organizations in communities with high concentrations of people of color, people in poverty and other at-risk populations, to strengthen their ability to serve their communities. This includes creating or strengthening access to resources that provide the outreach, enrollment, and health literacy/consumer activation services needed in their community.

The Reality of Working in Communities of Color: Often, organizations in communities of color lack the financial and personnel resources to add new services, particularly in urban cities where there are higher numbers of people living below the poverty line. Yet often these organizations are the best way to reach those living in communities of color to spread the word about or provide a new service, because they have a track record in the community, have developed trust among community residents, and are the places community members turn to when they need help.

 We’ve Made Strides But There’s Still Work To Do: We have completed our second enrollment period for the Affordable Care Act, and 235,000 Ohioans have taken advantage of coverage on the Marketplace. As a result of the Medicaid expansion over 510,000 new Ohioans are have signed up for Medicaid. However, in spite of our efforts to cover the uninsured, African Americans and Hispanics still experience some of the highest uninsured rates. This makes it particularly important that our efforts reach the uninsured from these communities.

This is where capacity and infrastructure come in. If we want these trusted organizations in African-American and Hispanic communities to be part of our outreach and enrollment strategies, we have to build capacity for them to participate.  As more of these trusted programs understand new coverage opportunities and participate in outreach and enrollment, we build infrastructure. 

What Does This Look Like? 

If we are successful, there will be faith and community-based organizations in many of our urban and rural communities that are able to:

·         provide regular information on how to get covered;

·         provide enrollment assistance; and

·         follow up with those they enrolled to make sure they get covered, learn to use their insurance, and get connected to primary care.  

How Do We Build Infrastructure?

1.       The first step is to identify organizations that are central to the community you want to reach and have an interest in covering the uninsured. For our work, we engaged faith and community-based social service organizations in communities of color. 

2.       Next, think about how they want to be engaged and what support they will need. For our project, we encouraged organizations to become enrollment sites using Certified Application Counselors who provided outreach, enrollment assistance, follow-up, and now health literacy education.  

3.       Host information sessions, build relationships, and educate. We invited churches and community organizations working in African-American, Hispanic, Asian, and African communities to community meetings where we educated them on the Marketplace and Medicaid expansion, the role of a Certified Application Counselor (CAC), and how to become an enrollment site. We also provided information on other ways they could participate in outreach and enrollment.

4.       Finally, provide supports that build their capacity to participate. We provided financial support, which allowed organizations to give small stipends to CACs and conduct outreach.   We also provided training and ongoing technical assistance to the CACs.

The organizations we are working with, their CACs, and those they assist are becoming the infrastructure in their communities who understand coverage under the ACA and can get the word out and help people enroll. This infrastructure can be used in the future to disseminate information on how to use plans, recertify Medicaid coverage, connect to care, and provide other information that will help people retain their coverage and access health care.