CT Dental Health Partnership: Progress on Oral Health

Progress on Oral Health
Covering
g Connecticut’s Kids and Families Coalition
October 9, 2014
Donna Balaski DMD
Martyy Milkovic MSW
Genesis of the Partnership
g
• 2008 Lawsuit Settlement Agreement
– Carve-out of dental services from Medicaid Managed Care
– Unified delivery of dental benefits, uniform rates, uniform
coverage
– Single program: Connecticut Dental Health Partnership,
Single ASO vendor: BeneCare Dental Plans
• Pre-Carve Out:
– F
Four Managed
M
d Care
C
O
Organizations
i ti
with
ith three
th
dental
d t l benefit
b
fit
management subcontractors
– 349 participating dentists (October 2008)
2
Pre-Dental Carve Out
HUSKY
Clients
Four Managed Care
Organizations plus Fee For
Service/Title 19
Managed
Care
Company
2
HUSKY
Clients
Dental
Vendor
2
•
•
•
•
PCPs
Managed
C
Care
Company
1
Dental
Vendor1
HUSKY
Clients
PCPs
Different
Different
Different
Different
Provider and Client confusion!
Managed
Care
Company
4
HUSKY
Clients
Dental
Vendor
2
FFS
Clients
PCPs
Managed
Care
Company
3
Dental
Vendor 3
provider networks
fee schedules
benefits
administrative rules
DSS
PCPs
FFS
Dentists
PCPs
3
Post-Dental Carve Out
CTDHP
Community
Partners
The Connecticut Dental
Health Partnership
PCPs
HUSKY
Health
Clients
Public Health
Infrastructure
CHNCT
•
•
•
•
•
One provider network
One fee schedule
One set of benefits
One set of administrative rules
One number to call/one
website
Community
Resources
4
Carve-out Strategy
Goals
- Expand access
- Improve
understanding of the
importance
p
of oral
health
- Ensure appropriate
dental service
delivery
- Measure and
improve
performance over
time
Outcomes
- Higher utilization
- Shift to preventive
care
- Lower costs
- Improved overall
health
5
Building Dental Access
p
• Dental p
provider focus on p
provider education,, p
proper
care, compliance and support for Dental Home
• Dental providers supported by:
– Dedicated call center personnel
– Dedicated network development manager
– Dental Health Care Specialist team
• Partnering with providers
– Assist with administrative responsibilities
– Client referrals and appointment assistance
– Provide constant feedback through call center interactions
and claim review communications
6
Building Dental Access, Results
CTDHP Enrolled Dental Providers
((As of 12/31))
2,000
1,800
1,600
1 400
1,400
1,200
1,000
800
600
400
200
-
1,855
1 619
1,619
1,377
1,216
1,016
589
2009
704
772
2010
2011
Individual Dentists
859
922
2012
2013
Service Locations
Pre-Carve Out: 349 Dentists
7
Building Dental Access, Results
Results: all Clients have
access to one Primary
Care Dentist in < 15 miles
at minimum
Contract Standard: one PCD
in < 20 miles
Green = Two Providers in 10 Miles
Blue = Two Providers in 15 Miles
Yellow = One Provider in 10 Miles
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Building Dental Access, Results
CTDHP Dentist Availability Measures
CTDHP Dentist Availability Measures
2009
2010
Avg. Appointment
Availability (days)
14.4
11.2
Percentage
Closed Panels
(12/31)
18.7%
14.7%
y
y Shopper
pp
Mystery
Compliance
93 3%
93.3%
84 0%
84.0%
2011
2012
2013
6.8
13.3%
9.7%
12.7%
86 0%
86.0%
Source: Rows 1 and 3: Mystery Shoppers conducted in 2009
2009, 2010 and 2012; Row 2: CTDHP
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Building Dental Access, Results
Result:
There is no physical access
problem for HUSKY Health
Dental
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Moving Beyond Access and Availability
y issues resolved
• Dental access and availability
– Many dentists near clients
– Dental offices seeking new clients
• There are other barriers now
– Oral health not seen as important in our society
– Only 50-60% utilization by the general population
– Other issues impacting our clients: life stress, dental anxiety, etc.
Much anecdotal evidence in cases: lack of follow-up, refusal etc.
• The next focus: Increase Client Demand and Drive
Utilization
– More than just education
• Social marketing to increase the importance of oral health
people’
p to p
provide info and sway
y clients
• Use ‘trusted p
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How Do We Increase Client Demand?
• Non-traditional
Non traditional approaches to:
– Informing, Awareness
– Outreach
• Reminders
– Targeted outreach for specific client groups
– Automated
calls
A
d phone
h
ll and
d mailil
Referral Pad
• Stratification of outreach methodologies
– Use appropriate tool
– Escalate to direct personal interaction if appropriate
• Comprehensive Appointment Assistance
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How Do We Increase Client Demand?
Oral Health Kit
First Tooth Bib
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Increased Demand, Utilization Results
CTDHP Client Population
Growth
CTDHP Client Unduplicated
Utilization Rates
Utilization Rates
700,000
70.00%
600,000
60.00%
500,000
50.00%
400,000
40.00%
300,000
30.00%
200,000
20.00%
100,000
10.00%
0.00%
0
2009
2010
2011
2012
2013
2009
2010
2011
2012
Total Average Client Population
Children (< 21)
Average Ever Eligible Adults
Adults (21+)
Average Ever Eligible Children
National Avg. CMS 416 12a
2013
14
Program Cost Outcomes
$200,000,000
Total
Incurred
Incurred Cost of Care
$150,000,000
$100,000,000
$50,000,000
$0
2009
2010
2011
2012
2013
Children's Services
Adult's Services
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Service Delivery Trends
CTDHP Dental Service Distribution
(Cost)
100%
90%
80%
Preventive
70%
Restorative
60%
Endodontics
50%
Oral Surgery
Orthodontics
40%
Adjunctive Services
30%
Other Dental Encounters
20%
10%
0%
2009
2010
2011
2012
2013
Increase in Preventive Care and Reduction in Treatment
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Ongoing Outreach Initiatives
• Targeted automated reminder calls
• Targeted informational mailings
• Expanded outreach through community involvement
– Ei
Eight
ht Dental
D t l Health
H lth Care
C
S
Specialists
i li t
– Impact Trusted Persons: community agencies, WIC, Head
Start, PCP’s, OB/GYN’s, etc.
– New early childhood screening initiative
– Expanded perinatal initiative
– ED/ER Initiative
– Oral health status data sharing with WIC, DCF, others
– Tight integration with CHNCT
– Other
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HRSA PIOHQI Grant
• One of three states to be awarded Perinatal & Infant
Oral Health Quality Improvement (PIOHQI) grant
(others: NY, WV)
• Expand successful pilot statewide over four years
• Provide ‘Intensive Community Outreach’ in 14
communities
– Build more partners and ‘Trusted Persons’ for perinatal women
and their children
– Community agencies, WIC, PCP’s, OB/GYN’s, etc.
• Evaluation by CT Voices
• Share what we learn in a CMS funded State-National
Learning Network
Network, mentor other states
18
ED/ER Initiative
• B
Began in
i 2012
• Identify dental users of ED/ER
(modest number)
• Automated phone calls, letters to all
• Targeted
g
outreach by
y DHCS to most
serious
• Visits to all ED directors, provide
training materials (pads
training,
(pads, posters
posters,
etc.)
ED/ER Poster
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Early Childhood Screening Initiative
• New initiative which will help measure disease
prevalence and severity in children
• Uses three new dental p
procedure codes
(D0601,D0602,D0603)
• Codes indicate ‘Low’, ‘Moderate’ and ‘High’ risk
• Will be used by public health hygienists and
complements dental home examinations
• Uses
U
recognized
i d assessmentt protocols
t
l
• Launching late 2014
20
Early Childhood Screening Initiative
• Find children slipping
between the cracks
• Dental hygienists
yg
triage
g
children by oral health
status and needs
• Individual follow-up
to the highest need children
f
• Target Early Childhood Education programs, schools,
public health settings
• Piloted by BeneCare in the MCO years
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Early Childhood Screening Initiative
Parental Permission Form
Parent Report
22
Contact Us! Please!
If you or your staff are contacted by a HUSKY Health client
regarding dental services, please have them contact us.
855-CT-DENTAL
(M – F
8:00 AM – 5:00 PM)
www.CTDHP.com
Like us on Face Book
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