← Becker’s Healthcare Podcast
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- [00:01]
A
Hello everyone, this is Jacob Emerson with the Becker's Payer Issues podcast. Feel good to be joined by Dr. Richard Selko who's the Chief Dental Officer at UPMC Health Plan. Dr. Selko, thank you so much for taking the time to be with me on the podcast today.
- [00:16]
B
Jacob, thank you for the opportunity to discuss some things relevant to oral health.
- [00:21]
A
Yeah, absolutely. And before we dive into everything, we want to talk with you about, Richard, can you tell us a little bit more about yourself, your background in healthcare and what it is that you do today at upmc?
- [00:32]
B
Sure. My background in in dentistry or healthc care started back in 1985 when I graduated from St. Vincent College in La Trobe. I went to, I was luckily and fortunate enough to be accepted at the University of Pittsburgh School of Dental Medicine and I did my four years of training at at University of Pittsburgh Dental School and followed that up with one year of a hospital based residency at Monure Hospital Pittsburgh as well. I spent nearly 10 years in private practice with my, I, I took over my father's practice after he retired in 1990 and practiced there till nearly 1998. And at that point in time I went into the insurance aspect as a dental consultant working for Aetna, a life insurance company and I spent 11 years there as their ending my career there as their National Dental Director of Utilization Management. Following that I did some time in a company up in New York, New York City, PNR Dental Strategies and I was the national Dental Director for a national dental insurance company called AVESIS for a few years and after that I, I was brought on to the University of Pittsburgh Medical Center UPMC Health Plan back 11 years ago. So back in 2014 I started my career here in UPMC and I've been here since then in a few different roles, but my current role is Chief Dental Officer for the health plan and I'm involved with the Medicaid and Commercial Dental Benefits Administration.
- [02:21]
A
Fantastic. So long career in the dental industry, in the insurance industry industry. Richard, you've obviously been seen a lot about how the industries have evolved over the decades. And so where I wanted to start with you today in terms of our conversation is asking a little bit about where your role intersects with UPMC's large footprint. Obviously the health system operates in urban areas and in rural areas as well in terms of the patients and the members that you serve. So I wonder if you could delve into our, for our listeners a little bit about how you think rural dental care is different from dental care provided in an urban environment. And I ask that because we hear so much today about rural health care access. So can you give us your take on what some of the differences there are?
- [03:10]
B
Yes, certainly. Well, in the urban areas, you know, access isn't really an issue. But when we get out to the more rural areas and the surrounding areas outside of say, a metropolis or a metropolitan city, finding dentists that, you know, they're very difficult to come by and specialists in particular are even harder to find when you need their type of work, like oral surgeons or periodontists or prosthodontists. So say let's take for center city of Pittsburgh, Pennsylvania, we have a dental school within miles of the downtown area. We have many general dentists and many specialists. We have hospitals within a stone's throw of each other. But when you get into a rural area, you may have to rely on a federally qualified health center that may only have a part time dentist as an employee. They may have a full time medical staff or even a part time medical staff. But finding full time dentists in rural areas is challenging because they're not, you know, they're not highly populated. There aren't many employees that really are, are able to get to those places. And so it's very challenging to find qualified people to want to live and work in rural communities. So that's one of the biggest challenges that we face. And you know, you may think that, oh, we're in the center city of Pittsburgh and but if you go a half hour north, south, east or west, you're in an area that's not really a dental desert, but it's, you're going to drive or you're going to have difficulty finding a provider. So maybe, you know, those are the challenges right now in the centers of the urban or urban areas, finding dental access isn't really a problem. But the further you go out with your diameter in the radius of your circle there, it's definitely a challenge to find quality dental care or dental care in general. But finding access is, has been a challenge for many of our membership.
- [05:24]
A
Sure. No, it makes a lot of sense. And that really, of course, parallels with other health care services as well in terms of access in rural areas.
- [05:32]
B
Yeah, dentistry not alone in that.
- [05:34]
A
So yeah, certainly. So from UPMC's perspective then, how is the health system, how is the health plan supporting connecting individuals for patients and members in these rural areas to better dental services, to more education support? What's your thoughts there?
- [05:55]
B
Certainly we have, well, one of the things that separates us from some of the other plans and if they do have them, they. They borrowed our ideas. We have a clinical team of public health dental hygiene practitioners that are strategically located throughout our commonwealth of Pennsylvania. Let's just say we have 14 public health dental hygiene practitioners, and they're scattered in various counties or they have responsibility for counties that are in close proximity to where they live, so they'll be contacted and connect members to dentists in those communities. So we, you know, say in the northwestern part of Pennsylvania, we have a specific public health dental hygiene practitioner who knows not only the dentists in the areas, but knows other resources where they can be seen. There's a dental school up there. Lee Calm Dental School. Lake Erie College of Medicine has a dental school up in the our Erie area, which is located in northwestern va. And out in our western or eastern areas, we have Temple University, the Kornberg School of Dentistry, and the University of Pennsylvania. So we do have access to places like that. So UPMC has our hygienists, or public health hygienists that can arrange and navigate with the members to make sure that they get in to see the providers for the care that they either need specifically or want, you know, if they need a tooth taken out or if they need a filling. So our hygienists are very familiar with the providers and the resources within their own community. And that seems to be a great benefit for us because sometimes we have to have a bilingual public health dental hygiene practitioner, and they'll help their membership or our members find the provider who can best suit their needs. A lot of times they'll even go above and beyond by working with those patients or our members to find transportation to get them to the places that they need. Because one of the other issues in rural Pennsylvania is lack of consistent access by transportation. You know, depends on weather, depends on a multiple of things. But so those are things. Those are some of the benefits that we have by employing our public health dental hygiene practitioners. They really know their communities and they're able to connect our members with the providers who best serve their needs.
- [08:41]
A
Understood. So really a whole host of challenges that can make getting access to this type of health care difficult. It sounds like certainly any other resources you would share in terms of what is available to individuals living in these areas or any new trends you're seeing in the dental benefits industry, Richard, that you think is really helping expand access to more dental care.
- [09:04]
B
Yes. What I do see are trends in, certainly in the education aspect of it. They're doing more counseling on nutrition. Smoking cessation is a Big item for, for us to cover when we deal with our patients and have members that have, you know, they're trying to, to quit. So we can provide them with resources or even case managers to get them the resources that they need for those types of things. So education is certainly key. What we're trying to do is prevent the need for dental services by, you know, applying sealants to children. Other, there are other materials that can be applied to teeth. Hydroxyapatite is one that another decay preventing measure, silver diamine fluoride, which helps stop decay. So that's one of the keys to our success is by having our hygienists and other oral healthcare professionals be able to provide those types of resources and those, you know, either through demonstrating proper brushing and flossing techniques, applications of silver diamine or topical fluoride and different things like that to help make people more aware and make them a better partner in taking care of their teeth. Because you just can't visit a dentist twice a year and think that everything's going to be great. It takes some work on the patient's part to maintain that. So you come to see the professionals once or twice a year and then, and sometimes our population can't get to the dentist once or twice a year. So we have to end up going into the communities and trying to address their needs. And we do that with certain events and certain providers go out into our communities and have what we call pop up events and where people can be brought into either a local facility like a church or a library or a VFW or something like that, and they can receive some dental services that way. So we are very fortunate to have a few doctors who do the portable equipment to different locations throughout our commonwealth and that really helps increase our access. But ideally we'd like to have everybody assigned to a dental home so they can get consistent treatment and receive the services that they need when they need them.
- [11:38]
A
Understood. So a pretty multi pronged strategy here from upmc, Richard, it sounds like from education resources to allocation of physical tools to clinicians.
- [11:50]
B
Yes, it definitely is a multi pronged strategy and approach. We need not just our dental hygiene practitioners, but we need every health care provider in our community. We have our providers, our pediatric dentists that are very important in this, in this equation or this approach because many of them are the ones that are public health dental hygiene practitioners refer to. And even we have public health dental hygiene practitioners in the pediatrician's offices and that helped or not in all of them, but in many of them and that really helps us to, to get patients when they're in there for their wellness checks. We can get some dental services in there and check the teeth. So it's involving a, you know, multifaceted oral healthcare approach. And you have to understand how dentistry and medicine are integrated. I mean, there is a dental medical integration. And so, you know, the saliva that we have in our mouths, how that starts the digestion process and things like that. And so the mouth is the gateway to health. And that's really where we want to, we focus on. So as a dentist, that's our first place to look and to see if there's any. Can we identify anything that may be going on systemically? You know, you can tell, you know, bleeding gums and that may be a sign of another condition. And many times the dentist is the first person to see that patient to say, hey, you know, you know you have bleeding gums here. Do you know why? And then if they don't know why and if it's not, you know, related to an oral health condition, then that's where you engage them with their primary care physician or a specialist. So, you know, there's various things that happen and that's why it's so important to be seen by a dental provider and oral health care providers. Routinely we try to avoid having unnecessary stays in hospitals or unnecessary visits to urgent centers for tooth related issues. So if, you know, my advice to everybody would be to see a dentist, you know, and certainly as often as you can, and mitigate the circumstances. You know, take, take heed of the education, learn from the counseling that's provided, you know, maybe stop some of the habits, smoking, other things like that, vaping, chewing, and it's best to do that with the younger. At least we found better success with younger population students. You know, maybe some peer pressures kicked in where they want to try smoking or vaping and things. So it's important for us as healthcare professionals to show them the negative sides of, you know, what the bad, what's bad that can happen by prolonged chewing or smoking, things like that. So trying to educate and prevent is really the two of the major points here at UPMC Health Plan that we like to make sure that we communicate to our membership.
- [15:02]
A
Certainly, certainly. Well, I really appreciate all the detail here, Richard. And I also want to ask if there's any other initiatives, programs of note from UPMC regarding expanding access to dental care that you think are worth highlighting.
- [15:18]
B
Yes, thank you. Coming up is a really great event. It's the mission of Mercy of Pittsburgh and that would be October 24th and 25th. And it's held at the David Lawrence Convention center here in downtown Pittsburgh. It's basically a two day free dental clinic. But there's also other healthcare services that are offered which include eye care and hearing. So many local sponsors get together, including UPMC Health Plan, which is a premier sponsor of the event, where patients can not only receive dental care if, you know, whatever they need. We do everything from cleanings to fillings to extractions to small partial dentures, what we call flippers, replacing one or two teeth. We don't do complete or full dentures or major root canals like third molar root canals or, you know, molar root canals in general. But we do a lot of extractions because. And there's also the hearing in the eye, so we give away eyeglasses to those that are eligible and hearing aids. So this is all free. There's no insurance information gathered other than a name and some of the basic needs such as name and weight and things like that, to make sure that we administer, if we need to, proper amounts of anesthetic. So that's the one thing that's coming up. And there are other events in the area which are like the regional area medical events, such as the Remote Area Medical. Those are usually held in the summers and we just had one a few months ago. But we do support those types of things. We have employees that volunteer. And here at upmc, we're probably going to have, oh, I don't know, we'll probably have a thousand volunteers in total for this, our Mission of mercy here in two weeks in October 24th and 25th. But it's a wonderful event. And if you know of anybody who's interested in volunteering, please just have them go to our mompgh.org website to find out further information and details as to how to become part and active with our, our Mission of Mercy. But it's a wonderful event.
- [17:37]
A
Fantastic. Well, it's so great to hear how UPMC is sponsoring and supporting efforts like this, Richard. So I appreciate you starting over there before we go. You've got the ears of a lot of other health plan and dental leaders from all over the country right now. So I'm wondering if you'd take a minute, share any, any final thoughts with them, any tidbits of advice you want to offer as they do continue to navigate this business. Anything you would share?
- [18:06]
B
Yeah, thank you. And I'd just like to ask my colleagues and everybody out there just to understand how, how the situations of the world impacted dentistry. You know, we had. We went through an epidemic or a pandemic there, and that really impacted the needs of dental practitioners as well as the patients. So I appreciate my colleagues and everyone in our space that's doing what they can to get the patients who had to not be able to seek treatment during that pandemic and getting them in and taking care of the diseases that were unable to be addressed during that time. So I want to offer my sincere thanks to everybody in our, my profession and all the healthcare professions for doing what they can to finally get caught up and get patients in. In timely fashions and address the needs that probably got worse since there was a lack of access during that pandemic period. But as the pandemic wore down and, you know, now that offices are open again and things like that, I just appreciate everybody's input and how they've come together to make sure that the patient's needs get addressed timely and appropriately. So I couldn't be more proud to be a dentist at this point in time. And I'm proud to work with a lot of the colleagues, not only here at UPMC Health Plan, but throughout the state, Pennsylvania, and across the nation. I have friends and colleagues across the country, and they do great work, and I just. I'm proud to be associated with each and every one of them. So that's where it is.
- [19:51]
A
Wonderful. I think that's a great place to leave things. So, Dr. Selko, I want to thank you for taking the time to chat with us and for sharing your insights with our audience. We really appreciate it.
- [20:02]
B
Jacob, thank you for the opportunity.
- [20:04]
A
Absolutely.
- [20:05]
B
And to our listeners.
- [20:05]
A
If you'd like to listen to more podcasts from Becker's Healthcare, you can visit Beckershospitalreview.com.