Integration of Care Committee Meeting Minutes June 17, 2020

Members Present: Paul Carr, Mitchell Caponi, Dorothy Farley, Ronnie Fortunato, Janet Goldberg, Deborah Greene, Bill Gross, Christopher Joseph, David Klotz, John Schoepp, , Joel Zive, Rose Chestnut, Stephanie Serafino, Rob Walker

DOHMH/PHS Staff: Johanna Acosta, Guadalupe Dominguez Plummer, Ashley Azor, Eleonora Jimenez-Levi, Bettina Carroll

Welcome/Introductions w Pronouns/Moment of Silence/

Review of the Meeting Packet/Review of the Minutes:

Ms. Lawrence opened the meeting with introductions with pronouns and an icebreaker. Ms. Chestnut led the moment of silence. The minutes were accepted. 

Public Comment/New Business            

None.

Line by Line Editing of the Oral Health Service Directive

Mr. Carr noted the importance of including oral HPV screenings.

The committee conducted a line-by-line reading/edit of the draft directive. Key highlights include:

• Use of PWH and not PLWH
• Program will use referrals to ensure access to other needs
• Inclusion of anti-racist service delivery
  • Will require interpretation by the Department of Health
  • Will require trainings
  • Strongest language available for inclusion
  • May need to name frameworks, ie Undoing Racism, to provide guidance
• Oral Health assessment will likely look different than the assessment for other service categories
  • Some core elements, per HRSA, remain the same
  • Is there an expectation of dentists to conduct intakes
    • Someone will have to collect this data for enrollment
    • Dentists already ask a whole health history to ensure safe treatment of a client
• Question of how to best screen for oral health issues and discomfort
  • A validated tool
    • Specific questions cannot be pulled from a validated tool, as tool is validated as a whole
    • Questions should be appropriate and non-stigmatizing
• Have never done a line item in a service directive – allocating a portion of funding to specialized services should be included in the service directive
  • Not unheard of
  • Must frame language to ensure that portion can be spent down in the case that specialty cases do not spend down the amount
• Even people with the best dental insurance have to pay out of pocket for implants
  • If we provide implants, will we reduce capacity to provide basic dental care
  • ADAP and Medicaid provide basic dental coverage – question of need for this funding through RWPA 
  • TriCounty uses their entire allocation each year
  • Sometimes bone grafts and implants are needed to seat dentures – Medicaid is supposed to cover this, but haven’t seen much success in access
• Debate over amount of capped allocation for specialized care
• Co-located care management program is more effective than case management not located on site
  • Idea is to build capacity across the portfolio
  • Should the case management portion be included in the oral health care directive or be a part of another guiding document
  • While a distinct service – this case management is specific to oral health care
  • Pilot will be small. Question of how many programs will be launched
  • Case management piece would work in partnership with current client case managers
  • When a case manager conducts an assessment, it is a direct service. If a case manager does an assessment – should be a question of “last time saw a dentist” and provide referrals. Oral health case management may be limiting
  • Case managers should be generalists by practice
  • Word case management may be the issue – they aren’t true case managers – its capacity building
  • Goal is to support integration of oral health care into system of care and build capacity among case managers to support clients’ oral health
  • Necessary to emphasize technical assistance
  • Case management envisioned as a DOHMH staff person or consultant
  • Service does not necessarily need to exist indefinitely – needed until integration is complete.

Public Comment

None.