Q&A Part 1: Improving Oral Health Through Education and Outreach With UPMC Health Plan Dental Care Managers

In this first part of a 2-part Q&A, Doree L. Rossey, BS, PHDHP, RDH, a public health dental hygiene practitioner and dental care manager supervisor with UPMC Health Plan, and Crystal Siebka, RDH, PHDHP, COA, also a dental care manager at UPMC Health Plan, share the goals and strategies of UPMC Health Plan’s Dental Care Management Program. The program works to increase access to preventive oral health services, improve oral health literacy, and help to reduce the need for restorative care through education and outreach.

Rossey highlights the approach guiding their efforts, including member-focused outreach, building dental homes, and collaborating with providers across Pennsylvania—particularly in rural areas with limited access to care. Siebka describes innovative initiatives such as interactive oral health education during the COVID-19 pandemic, collaborations with Child and Youth Services, and expanding dental programs in schools through Act 55. In this interview with The American Journal of Managed Care^® (AJMC^®), they emphasize the power of education, community engagement, and cross-sector collaboration in transforming oral health outcomes, especially for children and underserved populations.

AJMC: Can you share the overarching goals of UPMC Health Plans’ Dental Care Management Program?

Rossey: I'm so passionate and proud about this, but I'm just going to try to put it in a nutshell. There are 15 of us public health dental hygiene practitioners (PHDHDs) or dental care managers (DCMS). We're all hygienists. I serve as program supervisor; we also have 1 project analyst, 11 regionally based hygienists, and then we have 1 person designated for adults and 1 person designated for our Children's Health Insurance Program (CHIP) line of business. These women are, like, Die Hard passionate. Our big goals revolve around increasing access to preventative oral health; decreasing pain; decreasing restorative care needs; increasing the oral health literacy of all our members, our caregivers, and all our communities; and embracing that collaborative model of care.

AJMC: Your team works with a wide range of communities, from urban centers to rural areas. What strategies have you found most effective in raising oral health literacy, or oral health IQ, among such diverse populations?

Rossey: I'm going to have to go with—and I'm pretty sure everybody on our team would agree—that education is key. We go into Head Starts. We go into daycares. We are educating the maternity members. We go to health fairs. Any opportunity to get into our communities, we're going. It could be a trunk-or-treat, a baby shower of some sort that we're invited to, or back-to-school events. So, getting out there and just making people aware that oral health is so important, not just for your oral health, but your overall health. These women and I have so many fun activities to engage the children, to make it fun for them. So, when we go to the Head Starts or daycares, the kids are so engaged and having so much fun that they want to go home and brush their teeth, and then we give them the tools that they need. Some of the kids in these rural areas, or even the urban ones too, don't even have a toothbrush, so just giving them the things that they need to go home and take care of their mouths. And then, education on diet is another huge piece. There are so many kids drinking so much juice or chocolate milk; even just white milk has sugar. So, really pushing kids to drink more water. We’re also trying to get to pregnant moms to even teach them how to take care of their baby’s oral health before they're even born.

AJMC: How long have you been doing these initiatives and activities where you've seen these great outcomes?

Rossey: Well, I started out my career in a private pediatric office for about 10 years, and then I moved to UPMC. I was actually the first dental hygienist that became part of this program, and I had my own little practice in Kittanning, Pennsylvania for about a year in the Children’s Community Pediatrics office there, which was fantastic. That was in 2016. I would say in that we've seen such a huge difference in those 10 years since. The work that we're doing, especially in the group that Crystal works with, is just unbelievable.

AJMC: There is a 6-domain approach to dental care management. Can you walk us through what those domains are and how they guide your team's effort?

Rossey: Absolutely. Our main goal, obviously, is member focus. We do a lot of outreaches to our members. So, we get a list of kids who haven't been to the dentist, and we'll just call them up. We educate the parents, and we try to get them to a dentist. Our goal is to find a dental home for these children, as well as adults, because we also want them to go to the dentist every 6 months. For adults, we also work with a call agency that will call and then transfer the calls to us. We do the education piece, and again, try to schedule them. We work with the dental providers, so all our regionally based hygienists are awesome because they know their territory; they know the providers and their communities. They know the local dentists who are likely to see children with particular conditions, or which ones are open to dental sedation and which aren't. So, they're wonderful, and we've been able to collaborate with them sometimes and provide "Dental Days." For example, we'll support a Dental Day in aUPMC provider office, where we'll schedule a whole bunch of kids that are UPMC members and provide them dental care, and then that office is able to provide the follow-up care, which is one of the challenges. We work with a lot of mobile providers, which is great. We'll especially go out into rural areas in Pennsylvania where there is a dental crisis. For instance, there are some Pennsylvania counties that don't have a dental provider. So, for us to be able to go there and do a pop-up event, get people from those areas back on track, see what's going on, help educate kids, we can help connect whole communities with dentists in the area. We visit our dental providers quite often. We keep up to date on what they're doing, such as if they're accepting new patients. And then, we keep up with the medical providers. So, we keep in close contact with pediatricians, making sure that we're collaborating with them. And then, of course, we're in the community all the time; that's our biggest thing. It's fantastic that we can all have, like, a great referral system in-house too, so that if any department within UPMC feels that somebody needs to talk to a dental care manager, they just send us a little Microsoft form, and it gets connected to that hygienist in their area. They can call the provider up, and we can help figure it out so that everyone can work together and make sure that all patients are getting their care.

AJMC: Crystal, you've led dental public health initiatives that have been recognized as models across the state. Can you share what makes this work both unique and effective?

Siebka: So, continuing on what Doree said about educating our members being the key to our success and about getting out into the community and spreading the word about oral health, it’s all very important. When we had the COVID-19 pandemic hit, our community boots were on the ground. Efforts were stalled, so we had to develop a way to still connect with our members and keep them engaged while still getting our message across about oral health.

Along with my teammate Melissa, we created a hands-on soap tooth activity where we would porch drop a little kit that included a small soap “tooth” with candy sprinkles to act as sugar bugs or cavities, and brushing supplies. We do a virtual education with them, where the children would work with their parents and learn about proper brushing and flossing and how sugar bugs work. That activity often sparks a lot of “a-ha” moments for both children and parents, helping them understand how challenging it is to remove plaque and bacteria in the biofilm, how long it actually takes to brush effectively, and how “sugar bugs” return every time we take a sip of a sugary drink or eat a sweet treat. It’s one of the projects we developed during COVID, and we’re still using it today. This is a very popular activity with our Head Start groups and our daycare providers. Everybody seems to really enjoy it, and they learn a lot from that hands-on activity. I also work with Child and Youth Services (CYS) and foster family groups as well as independent living groups. I do training and education with all of them. It's important for our communities and our HHS agencies to understand the importance of dental care.

Unfortunately for our CYS kiddos, they have so many things going on that dental care sometimes gets sidelined, and oftentimes, the case workers didn't understand the dental needs of these children. So, I was able to do some deep dives into dental histories and provide education and guidance for what their dental care needs would be moving forward. I'm a support system for the foster families. They reach out to me to help find care for the kids. They have a time frame in which those children need to be seen. In counties that don't have dental providers, it's a huge hurdle for them. So, we work closely with them, and as we help them find care for all those kids in need, we train the community health workers.

The community health workers are incredible—they’re truly boots on the ground, helping their communities with referrals for medical, dental, and other services. Educating these workers is so important, especially because the dental world has its own language and operates a little differently from the medical world at times. Giving them a solid understanding of the importance of oral health—and everything that entails—means they can be a stronger support system. They know they can reach out to me if they need help finding referrals or other resources.

I also work closely with school systems. For years, I’ve worked as a public dental health hygienist in my local school district through the Tims program, providing dental screenings and education. Since the passage of Act 55 in Pennsylvania, which allows public dental health hygienists to work in schools without a certified school dental hygienist on staff, I’ve been able to expand into other school districts, including Clarion-Limestone (CL) area schools, to provide a dental scholarship for kids to go and pursue dental careers after high school. Being on the ground in the schools, meeting the kids where they are—that’s where it’s at.

And, like Doree said, some of these kids don’t even have a toothbrush. Giving them that toothbrush, educating them on the importance of oral health and its impact on their systemic health, and empowering them to take care of themselves is very rewarding. We have seen a significant drop in restorative needs, especially in the CL School District. We were able to bring Mabul Dental Services into the schools, and the kids in that district are doing so much better with their oral health. The numbers were incredible, and over a period of years, the needs for restorative care dropped significantly.

I was also able to present the Pennsylvania Coalition for Oral Health’s sugary beverage campaign to the Lion-Limestone School District. This past year, they reached out to me and asked if I could include some of my counties in the statewide campaign they were doing. I was able to incorporate their activity into the education I already provide, and it was very well received by the high school chemistry class. They have plans to expand it and would like to make it an annual program in the school district. By placing these oral health education initiatives in the schools, it empowers our students and our young people to be healthier as they grow up and mature. So that’s some of the things that I’ve been doing.