June 2010

The Newsletter of Access Community Health Centers Assessing the Need:

Quality Matters
The quality of the health care our patients receive has long been a key indicator of our successful work in the community. In fact, there are many quality measures that we use when applying for grants and when we report to government health organizations. These measures are so important to our future that we have developed a plan to put into place a quality program which will allow us to understand exactly where and how to improve our performance. This is particularly relevant to our philosophy of providing a health care home for our patients --a network of services that they can rely on which includes primary care, dental, behavioral health and pharmacy services.

Dental Care in Our Community
It’s no secret. In Wisconsin and nationwide, dental care is hard to come by if you have Medicaid or are uninsured. Recent reports in the local media, including the Wisconsin State Journal and Madisonbased WKOW TV, have focused on dental health care disparities for people with limited means. In fact, according to WKOW, there are “virtually no dentists … accepting new patients on the BadgerCare health plan” in the counties where Access offers dental services. Since the 1990s, there has been extensive research and reporting on the fact that oral health has a direct impact on overall health. Diseases and conditions of the teeth and gums can be a contributing factor in problems with hearth health, such as strokes, arrhythmia and other cardiovascular concerns. As a result, researchers and health advocates have promoted dental visits particularly for more vulnerable populations like children, pregnant mothers, homeless people and the elderly. Although Wisconsin’s Medicaid program (known as Badgercare) does offer some limited benefits to cover children and pregnant women, in many cases these individuals cannot find a dental practice that will take them on as patients. Our two practices, at William T. Evjue in East Madison and at the Dodgeville Dental Clinic, were established in order to begin addressing the lack of dental care for such underserved patients. In addition to regular adult care, we provide pediatric dental appointments in order to make sure that we can see children as young as 3 years old. Additionally, when providing prenatal primary health care, Access encourages pregnant patients to schedule a dental visit as well. Because of the huge demand for dental services, Access is not always able to immediately offer an appointment to every patient who
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According to DC-based National Committee for Quality Assurance, there are a number of areas where health care organizations should focus, including access to care, management of patient data, tracking of referrals, and other key performance measures. We will be looking at all of these areas and developing methods for tracking our progress. Our goal with this new focus on quality improvement is simply this: ensuring that patients of Access Community Health Centers receive the care, the information and the resources they need to attain their best possible health. As the NCQA puts it, attention to quality will “assure that patients get the indicated care when and where they need and want it in a culturally and linguistically appropriate manner.” The first step in launching this new tool will be to hire a new “Director of Quality.” The Director’s focus will be to oversee quality improvement activities and provide related consulting and support services including policy development, data analysis, competency testing and tracking. This individual will work closely with our Chief Medical Officer, Dr. Ken Loving, as well as the rest of the management team at Access, in order to ensure we continue our journey from good to great. Sincerely, George Barton CEO, Access Community Health Centers

I’d say that 98 percent of our patients have never had routine care before, if you define that as even an annual visit to the dentist. At Access, we don’t just provide emergency or preventive care, we help patients with restoring their mouth to a healthy state so they can do things like get a job, smile at their grandchildren, and eat a steak again. –Errin Pfeifer

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By the Numbers
FQHC: What’s In a Name?
Access Community Health Centers is designated as a Federally Qualified Health Center, or FQHC, which enables us to receive grants from the U.S. Department of Health and Human Services. This funding helps pay in part for the cost of caring for patients who are either uninsured or underinsured. FQHCs are located in areas where care is needed but scarce, and improve access to care for millions of Americans regardless of their insurance status or ability to pay. Their costs of care rank among the lowest, and they reduce the need for more expensive hospital-based and specialty care, saving billions of dollars for taxpayers. Federal guidelines lay out four specific areas of expectations for FQHC’s: 1. Mission and Strategy An FQHC must serve people who are in need either in medically underserved areas (MUA) or in medically underserved populations (MUPs). A health center must also ensure that the care it provides is in line with best practices, fits with patients’ needs, and is continually focused on quality. 2. Clinical Program Health centers under the Federal guidelines are expected to provide a full range of primary care services. Primary care includes routine office visits for health problems as well as preventative check-ups, vaccinations, well-child visits and many more types of services. Patients must also be provided with a bill of rights and responsibilities. 3. Governance The rules for FQHC’s require that at least 51% of the board be made up of clients of the health center, who represent the population being served. This ensures that the center will always be responsive to the community’s health care needs. 4. Management and Finance Health centers must have sound financial systems and strategies in place if they are to fulfill their mission of providing health care to the underserved. Centers must also adhere to professional management practices, so that the organization can operate effectively and meet the needs of clients.

Access Names New Dental Officer
We are pleased to announce the promotion of Errin Pfeifer to Chief Dental Officer at Access on June 1, 2010. Errin came to Access as a dental provider in August 2007 from Oregon, where she was a dentist first at La Clinica del Valle and later served as Dental Director at Umpqua Community Health Center. She became the Dental Director at Access in September of 2008. Errin holds a bachelors degree from Luther College in Iowa, and is a graduate of the Tufts University School of Dental Medicine. This new position will allow Access to have a single point-person for dental services on the leadership team. We believe this will help drive the implementation of our strategic dental objectives and create clarity in the dental program.

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“My children were in the room with me when I had my dental appointment. They weren’t aware of any type of pain because there was none! Now they will be more willing to go to the dentist.” – 2009 patient survey

requests one. We schedule patients in blocks of appointments four week s at a time, which allows us to balance the needs of different types of patients for particular types of dental services. In addition, since many of our patients have developed significant dental problems over an extended number of years, a typical new patient may require 5 or 6 visits just to restore their teeth to a healthy condition.

Number of dental patients receiving care at Access in 2009: 8,442 Percentage of dental patients at Access who are children: 29 percent Number of Dane County Residents eligible for dental care through Medicaid: 56,453 Percentage of those residents who received dental care in 2009: 26 percent Number of dental health care call requests received by Dane County Department of Health each month: 400 Percentage of children in Wisconsin with private dental insurance: 58 percent

Access Dental Clinics
William T. Evjue Dental Clinic
Location: Madison Number of operatories: 16 Dentists: 9 Hygienists: 4 Year established: 2004 Avg. Patients seen per month: 2,000

Addressing the Need:

Dental Care Expansion Underway
Based on the high level of unmet demand for dental services in southcentral Wisconsin, our goal is to expand access to more patients so that more people are able to receive the care that they need. This means establishing a new dental clinic in the town of Sun Prairie with 11 operatories by the end of 2010, as well as expanding and reorganizing our facility in Dodgeville in early 2011. The Sun Prairie facility was purchased in June 2010 and will undergo renovations and refurbishment throughout the summer before it opens in the fall. The city was chosen as a service location based on research that clearly demonstrates the need for dental care in that community. Residents from Sun Prairie already make up about 15% of Access dental patients. Our initial foray into Iowa county took place in 2009 in collaboration with the Southwestern Wisconsin Community Action Program with the establishment of our Dodgeville Dental Clinic. Our plan is to strengthen that clinic by reorganizing care and adding space so that we can serve more people in that region. Once this additional capacity is in place, we will be able to see an additional 9,000 patients per year. This will also alleviate some of the excess demand we currently experience at our William T Evjue clinic. According to CEO George Barton “We know there’s a lot of need out there -- the best way to address it is to create a sustainable action plan that provides patients with consistent, accessible, high-quality dental care.”

Dodgeville Dental Clinic
Location: Dodgeville Number of operatories: 4 Dentists: 4 Hygienists: 1 Year established: 2009 Avg. Patients seen per month: 280

Sun Prairie Dental Clinic

Location: Sun Prairie Number of operatories: 11 Dentists: 6 (planned) Hygienists: 2 (planned) Year established: Fall 2010 Avg. Patients seen per month: 1,000 (planned)

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