What is Possible Now?

This evaluation surfaced progress and achievements as well as opportunities to continue improving access to high-quality oral health care across North Carolina. Of course, the Foundation cannot address all of these challenges and opportunities alone. Multiple actors across the ecosystem (e.g., funders, safety-net clinics, grassroots organizations, policymakers, community partners, conveners, and private practice practitioners) highlighted the value of engaging in collaborative action. Following are some possibilities raised by evaluation participants for the field to consider next.

Increase focus on workforce development

Expanding and strengthening the dental workforce is imperative to fully realize sustainable improvements in access to care.

  • Partners can continue to identify strategies to train the next generation of dentists, dental hygienists, and assistants to meet the oral health needs of those in North Carolina. Future training could further encompass public health dentistry, policy advocacy, and leadership practices to advance oral health across the ecosystem through actions beyond clinical practice and patient care.

“A third of North Carolina’s dental assistants are slated to retire in the next two years… And we’re already in a shortage, so, workforce is gonna be just, I think we’re gonna have to have a laser focus on that and look for some different models and different policy wins to just, to improve that in the state.”

Ecosystem partner

  • Partnerships and systems can also be leveraged to further incentivize trained dental clinicians to stay in North Carolina and practice in communities with high oral health care needs. This spans from loan forgiveness to professional development/advancement opportunities and changes to the medicaid program that support sustainability for practices serving its beneficiaries.

“I think primary care providers, particularly those that work with low income populations that may not have access to dental care… They can be real advocates, both pediatric and just general primary care because they see it.”

Ecosystem partner

Evaluation participants highlighted the value of further developing and strengthening the capacity of NC’s non-dental workforce by:

  • Leveraging community health workers and building their capacity to support oral health of communities (e.g., through care coordination and education).
  • Supporting whole-person care by integrating and educating non-dental professionals (especially medical providers). Actors outside of dental environments can also help educate families, advocate for needed services, and link individuals to oral health care.

“Expanding the workforce that can focus on prevention for kids is something that should be focused on. Our community health workers, for example, who are going into teaching and educating at-risk moms about health, are they talking about oral health? Should they be trained to be talking about oral health?”

Ecosystem partner

Bolster efforts to strengthen and expand Medicaid

More research and thought leadership can help address factors driving underutilization and poor access to oral health care, especially through the Medicaid program in North Carolina.

  • Many partners, including the Blue Cross NC Foundation, its grantees, and the Collaborative, have engaged in efforts related to Medicaid Transformation in Oral Health for North Carolina, and momentum is building. Partners can sustain this momentum by implementing recommendations and calibrating efforts to account for new learnings from the ecosystem.
  • The oral health ecosystem in NC would also benefit from additional thought leadership in understanding how to balance provider incentives to participate in Medicaid with the quality and value of care delivered to beneficiaries, to fully realize the benefits of a transformed Medicaid program.

It would be interesting to see what the ideal administrative option would be for the Medicaid program. I don’t know that parents and caregivers and even our beneficiaries, the adult beneficiaries, they necessarily favor managed care or they’re against managed care.”

Ecosystem partner

Prioritize community inclusion

Grantee partners and ecosystem actors alike highlighted the importance of including community voices in identifying priorities for actions, elevating lived experiences, and bringing about long-lasting, meaningful change to the oral health ecosystem.

  • There are opportunities to strengthen feedback loops with communities and elevate the lived experiences of those most impacted by the current system through listening sessions, strategic planning meetings within the community, highlighting patient advocate voices, and more.
  • Relatedly, partners noted that it is vital that these efforts to further engage, include, and elevate communities are made in a respectful, equitable, and supportive manner, as opposed to being transactional and burdensome. 

“They have not really tapped into the communities that have truly been marginalized and left out of a lot of conversations…..there’s definitely been some headway and some movement in those areas but I do think that there’s a lot more that needs to be done, and that’s a lot of work….I think there’s power in people and I think that really thinking about how to invest directly in communities and what that looks like and how that happens; there’s room there.”

Blue Cross NC Foundation grantee

Continue funding direct services as well as broader systems changes

Impacts driven by grantee partners can be maximized through longer-term, cohort-based, multi-year grants by funders. This can further facilitate a culture of peer learning, engaged philanthropy, and complementary efforts by diverse grantees (and ecosystem actors) to address oral health issues across various levels of the system.

  • Funders and conveners can further elevate and bridge on-the-ground provider experience to policy change through advocacy capacity building and accessible opportunities to influence policy decisions.
  • Ultimately, given what we know to be true about the current oral health ecosystem in NC (and across the U.S.), investments in policy change and broader system-wide efforts can be enhanced by developing the infrastructure for direct service delivery (albeit significantly preventative), oriented towards meeting the imminent need for care in communities.

“And I think that’s the beauty of this. It’s an alignment of policy advances and funding investments. So they worked to reduce the barriers so that [safety net clinics] could expand their services. The rules were changed to make it easier to do or actually possible to do. And then the investment followed so that those services would actually be developed…Everybody now works together on things that no one ever thought these groups would work together on, and that has made a difference in terms of policy.”

Ecosystem actor interview respondent

Expand care for older adults and individuals with special healthcare needs

In the US, older adults and individuals with special healthcare needs (both adults and children) are severely underserved. A few grantees and ecosystem actors expressed the opportunity to build the capacity of existing provider networks to serve these communities and prioritize policy efforts to improve quality care.

  • Focusing on infrastructure, policy, workforce, and increasing access to preventive services are the most pressing priorities, given the widespread and long-term impact.
  • Accordingly, this recommendation highlights an opportunity for partners who have the capacity and relevant influence, to consider what it will take to start addressing the oral health of older adults and individuals with special healthcare needs.

“I just think that if we could do, for adult Medicaid beneficiaries, particularly for special needs adults and for the elderly, what we’ve done for early childhood and school aged children, that would be fantastic. I mean, that to me, that’s the dream.”

Ecosystem actor interview respondent

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