Hello, everyone. This is Jacob Emerson with the
Becker's Panger Issues podcast.
We're going to be joined by doctor Richard
Selco, who's the chief dental officer at UPMC
Health Plan. Doctor Selco, thank you so much
for taking the time to be with me
on the podcast today.
Jacob, thank you for the opportunity to discuss,
some things relevant to oral health. Yeah. Absolutely.
And before we dive into everything we wanna
talk with you about, Richard, can you tell
us a little bit more about yourself, your
background in health care, and what it is
that you do today at UPMC?
Sure. My background in, in dentistry or health
care started back
in '19,
'85 when I graduated from Saint Vincent College,
in Latrobe.
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 Montefiore
Hospital here in Pittsburgh as well.
I spent nearly ten 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 eleven 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 Avisis,
for a few years. And after that, I
I was,
brought on to, the University of Pittsburgh Medical
Center, UPMC Health Plan,
back, eleven years ago. So back in 02/2014,
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.
Fantastic. So a long career in the dental
industry and the insurance
industry, Richard.
You've obviously then 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 is
asking a little bit about, where your role
intersects with UPMC's
large footprint.
Obviously, the health system operates in urban areas
and 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
on what some of the differences there are?
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 say for center city of Pittsburgh,
Pennsylvania.
We have a dental school within a, you
know, 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 know, 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 a full time dentist 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 wanna 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, southeast, or west,
you're in an area that's not really a
dental desert, but it's,
you're gonna drive or you're gonna have difficulty
finding a a provider. So maybe,
you know, those are the challenges right now.
In the centers of the urban or urban
areas,
the having 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 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.
Sure. No. It makes a lot of sense,
and that really, of course, parallels with, other
health care services as well in in terms
of access in rural areas.
Yeah. Dentistry is not alone in that. So
Yeah. Certainly.
So from UPMC's perspective then, how is the
health system how is the health plan supporting,
connecting individuals or patients and members in these
rural areas to better dental services,
to to more education and support?
What what's your thoughts there?
Certainly. We have well, one of the things
that separates us from some of the other
plans and, if if they do have them,
they 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 where 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 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 Com Dental School.
Lake Lake Erie College of Medicine has a
dental school up in the our Erie area,
which is located in Northwestern VA.
And our 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 and
to
places like that. So UPMC has our hygienists,
our our 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 public health dental hygiene practitioner,
and they'll be they,
they'll help their their membership or our members,
find the provider who can best suit their
needs.
A lot of times, they're 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. It 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 their communities, and they're
able to connect our members with the providers
who best serve their needs.
Understood. So, really, a whole host of challenges
that can make getting access in 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 trend you're seeing in
the dental benefits industry, Richard, that you think
is really helping expand access to to more
dental care.
Yes. I what I do see and
are are trends in,
certainly, in the education aspect of it. They're
doing more counseling on nutrition.
Smoking cessation's 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's another
decay preventing measure, silver diamine fluoride,
which helps stop decay.
So
that's one of the key
keys to our success is by having our
hygienists
and other
oral health care 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 so of 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 gonna 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 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
where people can be brought into either
a 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
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.
Understood. So a pretty multi pronged strategy here
from the APMC, Richard, it sounds like, from
education resources,
to allocation of of physical tools,
to to clinic.
Yes. It 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 our
public health dental hygiene practitioners refer to. And
even the we have public health dental hygiene
practitioners in the pediatricians' 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 health care 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 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 two, three 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 wanna try smoking or vaping and
things. So it's important for us as health
care professionals to show them
the, the negative
sides of or, 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.
Certainly. Certainly. Well, I I really appreciate all
the details here, Richard. And I also wanna
ask if there's any other initiatives,
programs of note from UPMC regarding expanding access
to dental care, that that you think are
worth highlighting.
Yes. Thank you.
Coming up is a, a really great event.
It's the, Mission of Mercy at Pittsburgh,
and that would be October,
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 health
care 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 planings 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 gonna have,
oh, I don't know. We'll probably have a
thousand volunteers in total for this our Mission
of Mercy here in in two weeks in
October.
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.0rg
website to, find out further information and details
as to how to,
become part and active with our, our mission
to Mercy, but it's a wonderful event.
Fantastic. Well, it's so great to hear how
UPMC is sponsoring and supporting efforts like this,
Richard. So I appreciate you sharing with us.
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 could take a minute,
is there any any final thoughts with them,
any tidbits of advice you wanna offer as
as they do continue to navigate this business.
Anything you would share.
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 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 the
that pandemic
and getting them in and
taking care of the diseases that were unable
to be addressed
during that time. So I wanna offer my
sincere thanks to everybody in our,
my profession and all the health care 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 lack of access during that
pandemic period. But as the
pandemic worn, wore down and the 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. Wonderful. I think that's
a great place to leave things. So, doctor
Salfour, I wanna thank you for taking the
time to chat with us and for sharing
your insights with our audience. We really appreciate
it.
Jacob, thank you for the opportunity.
Absolutely. And to our listeners, if you'd like
to listen to more podcasts from Becker's Health
Care, you can visit beckershospitalreview.com.