In an effort to address disparities in oral health, and overall health, Arcora Foundation, the Foundation of Delta Dental of Washington, is pioneering a Local Impact Network (Network) approach to influence lasting change. Currently operating in four areas of the state, Networks provide a structured approach to link and engage local partners and stakeholders in creating innovative solutions that best fit the needs and culture of the community.
The goal is to build local capacity to reduce oral health disparities. This is a new approach for Arcora Foundation, which typically partners directly with local organizations for specific projects.
As Washington State looked to address population health issues through Accountable Communities of Health (ACHs) and a Medicaid Transformation waiver, Arcora Foundation sought to develop a corresponding new model to target oral health disparities within the ACH infrastructure. The Network approach begins with identifying local leaders and bringing them to the table to design and implement community-driven strategies to make measurable improvements in oral health.
Arcora Foundation launched the Network approach in Spokane in 2017. Arcora Foundation had existing strong relationships in the community and engaged a trusted local partner, Smile Spokane, to help identify the leaders of organizations who were critical to making an impact on oral health. These Spokane leaders worked together to develop seven anchor strategies that align with the existing work of partners. These strategies include:
- Community Care Coordination – Connecting people to dental care that accepts their insurance
- Opioid Prescribing Practices – Reducing the use of opioids for dental pain management
- Medical Dental Integration – Providing oral health preventative services in medical settings
- Access to Care – Creating access pathways for vulnerable populations
- Sealants – Increasing the number of children who receive dental sealants at school
- Place-Based Approaches – Providing coordinated care in community-based settings
- Community Education – Promoting targeted education messages to influence health
In 2018, Arcora Foundation spread the Network model to Thurston County, partnering with CHOICE Regional Health Network, and most recently to Olympic Community of Health and North Sound ACH, two ACHs that chose oral health initiatives as a focus. Establishing a more networked approach for oral health within these ACHs allows the Foundation to leverage ongoing, broader efforts to transform health.
As with any new initiative, Networks have not come without challenges. In Spokane though it brought money to invest, Arcora Foundation stepped back and encouraged partners to drive solutions. Arcora Foundation employs shared decision-making models to combine its expertise with the knowledge and experience of local partners.
For example, in the past the Arcora Foundation Board traditionally made all grant decisions, but in the case of the Networks the Board has agreed that grants to community partners of less than $150,000 can be made without board approval.
Productive partnerships and shared decision-making require trust. Kristen West, Senior Director of Programs and Policy, observed that in Spokane this took several months of relationship building. Once trust was established, the nature of the Network relationships shifted and Arcora Foundation became one of several equal participants at the table. The Network has grown closer and is starting to make decisions collaboratively with a focus on population health, not separate interests. But as West explains,
“This is one of our challenges going forward. As we expand into new areas and new markets, how do we build trust early?”
So far, the Network approach is starting to have measurable results. In Spokane, three times as many children are now receiving dental sealants in the school sealant program. The Network is using Arcora Foundation’s DentistLink tool to help Medicaid patients identify dentists that accept their insurance and partnered with the Rides to Care program to help these patients get to dental appointments.
Local partners are enthusiastic about this innovative approach to address oral health disparities. Chuck Teegarden, Executive Director of Communities in Schools Spokane said,
“The funding and leadership of the Arcora Foundation and Smile Spokane have led to a revolutionary approach to providing dental sealants for children. As a result, sealants have been provided to many more children, using a sustainable methodology.”
As Networks move forward, Arcora Foundation is prioritizing further evaluation, to identify and address systemic barriers, and to measure ongoing impact of this new model to affect change. To date, a key takeaway is that trust is essential and shared decision-making goes a long way to establishing and maintaining the partnerships needed to make meaningful, sustainable progress to reduce oral health disparities.
Longer-term, Arcora Foundation plans to expand its network approach, continuing to other ACHs and areas that have not yet begun to address oral health disparities.
By Marjie High