Remarks to the 2010 Pew Children’s Dental Campaign Conference

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by HRSA Administrator Mary K. Wakefield

November 17, 2010
Washington, D.C.

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Thanks to each of you for the opportunity to be here today.

Your conference theme, “Partnering for Policy Change:  Moving a Children’s Dental Health Agenda,” is important from HRSA’s vantage point.  HRSA has been and continues to be an important partner in improving access to oral health care for kids.

I also want to learn from you about opportunities we may have to collaborate in new ways.

My remarks will focus principally on HRSA’s efforts, but I assure you that my colleagues in CMS, NIH, the Indian Health Service and CDC all share your vision of improving children’s oral health.

By way of a concrete example, dental caries is the most common childhood disease.  Children miss an estimated 51 million school hours each year for dental problems and visits.  In partnership, we should be able to do a lot to reduce or eliminate this disease burden.

I want to begin my remarks with a quick overview of some of our key programs, and how they contribute to improved oral health – broadly and specifically – for children.   You may be surprised by the agency’s reach, and the potential avenues for collaboration with us.

HRSA manages a $7.8 billion portfolio of 80 different grant programs:

• Our 1,100 community health center grantees provide primary and preventive care at more than 7,900 sites, where they serve nearly 19 million patients.  Last year, our health centers provided oral health care to more than 3.5 million patients, approximately a third of whom were children.  And this number will increase because of vast new investments in health centers in the Affordable Care Act.
• We administer the Ryan White HIV/AIDS Program, whose 900 grantees provide top-quality care to more than a half-million low-income and uninsured people living with HIV/AIDS. All parts of the program support the provision of oral health services.

In 2008 (the latest year for which data are available), Ryan White grantees (in Parts A-D) provided oral health services to 86,446 clients. 

The Ryan White Program also supports the Community-Based Dental Partnership which funds 12 programs for a total of over $3.7 million.  These programs establish clinical rotations for students and residents in community based settings that provide dental services to people living with HIV.  The program serves a dual purpose of increasing access to oral health care for this underserved community, while providing a hands-on learning opportunity for oral health professionals.

Also under Ryan White, the Dental Reimbursement Program supports dental education and dental hygiene education programs that train students to provide care to patients with HIV. Award recipients trained 11,000 students and residents in HIV oral health care between July 1, 2007 and June 30, 2008.

In addition, we support 15 organizations through targeted grants that are testing innovative models of care to provide oral health care to HIV-positive, underserved populations in bothurban and non-urban settings.

• Shifting to another HRSA bureau, our Maternal and Child Health Title V block grants to states provide health care services and counseling to six of every 10 women who give birth and their infants.

As many of you know, HRSA has long been a champion for improved oral health for kids.  The Title V Needs Assessment assures gaps in states are identified, and 31 States and 2 US Territories have an oral health-specific performance measure for their Title V programs.  

Additionally, our text4Baby initiative, a free mobile health service, delivers oral health care and other important health-related messages to women from early pregnancy through their babies first year of life.

• HRSA also strengthens the nation’s health care workforce – nurses, physicians, dentists and more – by supporting training, curriculum development, and scholarship and loan repayment programs.

We know that getting kids into oral health care is contingent upon having an adequate oral health care workforce.  Our Title VII workforce programs and others support dental workforce training.  In 2010 alone, HRSA’s Bureau of Health Professions awarded $31.3 million in new grants to train general, pediatric and public health dentists and hygienists.  These were among $44.8 million in oral health training awards BHPr made during the fiscal year.

• Through our National Health Service Corps, we place primary care professionals in medically underserved areas, where they're needed most. The Corps provides scholarships and student loan repayments in exchange for two or more years of service in health professional shortage areas.

Last year, the National Health Service Corps supported 770 dentists, 140 hygienists and 75 dental scholars.  And here again, this number is going to increase.  It is critical that it does.  An estimated 50 million people live in regions designated as dental health professional shortage areas.

• We house the Department’s Office of Rural Health Policy, which bolsters rural hospitals and coordinates health care among coalitions of rural providers.  Through their Outreach grants, ORHP supports efforts in rural communities to improve access to oral health care.

The Outreach program supports projects that demonstrate creative and effective models of service delivery in rural communities.  Many of the projects address access to culturally appropriate, affordable oral health care services.

• HRSA also works to increase and improve the use of telehealth to meet the needs of underserved people, especially those living in rural and remote areas.

HRSA has two grantees that provide teledentistry services to patients, including preventive dental care to children.

So there has been a lot of work on oral health going on throughout the Agency, and we expect to do more.

When I arrived at HRSA, I sat down with my senior leadership and we discussed areas where HRSA could – and should – focus its efforts.  Behavioral health and oral health were two key areas where we believed we could make a difference.   Expanding oral and behavioral health services and integrating them into primary care settings are key goals in our agency’s strategic plan.

To support that work, we also created an Office of Strategic Priorities, charged with coordinating and strengthening the Agency’s oral and behavioral health efforts.

I’ve outlined some of HRSA’s oral health care programs and how we’ve identified oral health as a priority – now let’s talk about how the Affordable Care Act will impact HRSA’s work going forward.

HRSA will oversee 66 different authorizations under the Affordable Care Act.  These responsibilities confirm the importance of HRSA’s mission and underscore the scale of the work that lies ahead.

HRSA’s been given new program authorities - and in some cases dollars to move them forward.  Perhaps the most gratifying news is that the ACA promotes primary care, oral health, preventive measures and their integration into a system that dramatically increases access to health services.

The Affordable Care Act invests $11 billion in expanding health center sites and services over the next 5 years.  I told you earlier that health centers serve almost 19 million patients annually.  The Affordable Care Act will enable us to nearly double the number of patients served by 2015.

To put this expansion in an oral health context, the health center system currently constitutes the largest oral health provider in the nation.  Besides serving the 3.5 million dental patients I mentioned earlier, health centers employ more than 2,500 dentists, over 1,000 dental hygienists, and more than 4,800 dental assistants, technicians, or aides.

The new law also supports school-linked health initiatives, including school-based health centers.

These measures give health centers the real opportunity to meet children where children always are – at school.  They will help kids to remain healthy so they can learn in class free from dental pain.

$100 million is available this year to fund an estimated 200 school-based health center capital construction awards.  Applications are due Dec. 1.  

In addition, the Office of the HHS Secretary has selected a proposal to pilot the integration of comprehensive oral health services into existing school-based health centers in September 2011.

The goal of the pilot grant program, School-Based Comprehensive Oral Health Services, is to decrease oral health disparities among children and adolescents from families with low incomes by increasing access to education, preventive care and treatment through the school-based health centers. 

The Affordable Care Act also makes tremendous investments in HRSA’s health professions programs, including $1.5 billion for the National Health Service Corps through 2015.  More than 2,800 new Loan Repayment awards and over 200 scholarships are expected in FY 2011.  Thousands more NHSC clinicians will be serving underserved communities than were serving just a few years ago.

Investing these dollars in primary care training and development will help ensure we have the providers we need and they are serving where needed most.  And these dollars, of course, build on the $2.5 million for health centers, the NHSC and workforce training programs that HRSA received last year under the Recovery Act.

In September, HHS Secretary Kathleen Sebelius announced awards totaling $130 million to expand the health professions workforce; almost $89 million of that amount came from Recovery Act.  Of the total announced by the Secretary, nearly $24 million was in support of pre- and post-doctoral training for dental residents, dental faculty, and loan repayment for faculty and training for practicing dentists.

With this support from the Congress and President Obama, we are increasingly confident that we can contribute to improved access by increasing the supply of providers, including dental providers, serving in the right places to meet the growing need for routine access to care.

But even with these resources, we face many challenges on the oral health front. 

Workforce shortages persist.  We are nearly 7,000 practitioners short of the number necessary to extend services to those underserved communities, and the dentistry workforce is among the most rapidly aging in the health professions.

HHS is working to address these challenges.  I co-chair – along with the Assistant Secretary for Health – the HHS Oral Health 2010 Initiative.  It is being led by HRSA with support from the U.S. Public Health Service Oral Health Coordinating Committee, which has been revamped.

The Initiative’s overarching goal is straightforward: Promote the concept that good oral health is integral to good physical health.

The Initiative aims to create a systems-based approach to oral health care through a solid foundation of coordination, collaboration, and integration of Department-wide efforts.  It emphasizes four goals:

• oral health promotion and disease prevention;
• expanded access to care;
• enhancement of the oral health workforce; and the
• elimination of oral health disparities.

The Initiative will also promote policies that integrate oral health into primary care.

For its part, the Oral Health Coordinating Committee has been restyled as the agency’s oral health “think tank.” The Committee will ensure that HHS employs strategies that address its oral health goals and that the Department and all its agencies integrate oral health into their programs.

The Committee will hold HHS accountable for addressing oral health challenges.  The HHS strategic plan includes a call to expand the primary oral health care team.  This means promoting models that involve new providers.  It means expanding the scope of existing providers.  It means having medical providers deliver evidence-based oral health preventive services where appropriate.

This refocus of HHS oral health activities illustrates a new, holistic approach.  It recognizes there has been an unfortunate disconnect across agencies, and that we must move to break down silos. 

As mentioned, its premise is that good oral health is integral to sound overall health.  It is critical that non-dental providers understand this.

Moreover, this effort pivots off the belief that all health professionals – not just practitioners of dental care, should be up to speed on the importance of oral health care.  If they are not, we cannot be as successful as we will otherwise be in improving oral health at the population level.

Even before HHS hit the “refresh button” on oral health policy, HRSA recognized it could provide leadership in the area.  To begin, we conducted an oral health inventory – a first-of-its-kind, comprehensive profile of all the activities in HRSA.   Having taken stock of the inventory, we can heighten our impact on oral health nationally by collaborating across programs and professions.

And as I noted, HRSA’s Office of Strategic Priorities is charged with providing leadership and coordination to improve oral and behavioral health infrastructure, delivery, and systems of care.  The office also establishes goals and objectives to improve the quality of oral and behavioral health care.

To those ends, HRSA has commissioned the Institute of Medicine to do two studies for us – the Oral Health Initiative Study and the Study on Oral Health Access to Services.

The Oral Health Initiative Study will have a broad focus across all HHS programs. It will examine the current system, including private practice, and will explore ways to improve our oral health literacy.  Most importantly, it will examine new and innovative ways to engage the public with key messages about prevention.

The second study, on Oral Health Access is much more HRSA-centric. We're looking at gaps and barriers in access for disadvantaged populations, those served principally through the safety net.   Many of you know that publicly funded oral health programs account for a small percentage of total direct care resources, yet they provide access to care for those most in need.  This is especially critical when so many people are experiencing economic distress.

These studies are taking place simultaneously.

Findings of the access study will be of interest to the Initiative group and vice versa. We've asked the IOM to be listening and mindful of opportunities to share between the two workgroups. We expect collaboration across the board with these two studies.  The studies will be completed no later than mid-2011.

So, a common HRSA strategic priority and HHS goal is to integrate oral health into primary care.  The effort is as timely as it is critical.

We have an HHS Secretary who gets it, an Assistant Secretary for Health who supports it, an effective network of health center oral health programs, and increasing numbers of physicians and other medical providers willing to integrate preventive oral health care into their practices.

Already, we are working with states and our public health dentistry partners to advance the oral health agenda systematically.

You can help us by identifying areas where there is a need to increase access to dental care.  You can offer support as health centers develop grant applications.  You can provide technical assistance as they implement new delivery sites.

To learn more about what HRSA is doing in oral health, go to: http://www.hrsa.gov/publichealth/clinical/oralhealth .

In closing, just as this is a ‘new day in American health care,’ we get the priority – we’re trying to drive more substantial efforts for health centers, public health dentists, providers, professionals in the field of oral health.

I think that we have an opportunity here that we haven't had in many years.

We all need to be engaged.  And, with your help, I know we can make the system work more effectively so that more families get the oral health care they need.

There is a tremendous amount of expertise, talent and commitment in this room, and I thank you all in advance for the work we are going to do.

I strongly urge everyone here today to seize the moment…leverage the momentum of this unique time.

Our missions are mutual and our cause is common. With the HHS prioritization on oral health, HRSA’s strategic emphasis on oral health, the Affordable Care Act and its dollars … with your expertise and leadership…everything appears in place and where it should be in order for us to move the needle on oral health. 

We are prepared to deliver as never before.  Together, we will do it.

I look forward to considering your questions and hearing your ideas about how to best advance the common enterprise of improving oral health care access and quality throughout the nation.

Thank you.