ct dental health partnership: progress on oral oct 9... · health partnership husky health clients...
Post on 06-Feb-2018
214 Views
Preview:
TRANSCRIPT
Progress on Oral Health
Covering Connecticut’s Kids and Families CoalitiongOctober 9, 2014
Donna Balaski DMD Marty Milkovic MSWy
Genesis of the Partnership
• 2008 Lawsuit Settlement Agreementg– 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 M d C O i ti ith th d t l b fit– Four Managed Care Organizations with three dental benefit management subcontractors
– 349 participating dentists (October 2008)
2
Pre-Dental Carve OutHUSKYClients
HUSKYManaged
Care
Clients
Four Managed Care Organizations plus Fee For
Service/Title 19
Managed C
Clients Company 2
PCPsDental Vendor
2
Service/Title 19
• Different provider networks• Different fee schedules
Different benefitsCare Company
1
PCPsDental Vendor1
HUSKYClients
• Different benefits• Different administrative rules
Provider and Client confusion!
HUSKYClients
Managed Care
Company 4
Dental
FFSClients
Managed Care
Company 3
PCPsDental Vendor
2
DSS
3
PCPsDental Vendor 3
PCPsFFS Dentists
Post-Dental Carve Out
CTDHP
The Connecticut Dental Health Partnership
HUSKY Health Clients
PCPsCommunity Partners
• One provider network• One fee schedule• One set of benefitsClients
CHNCTPublic Health Infrastructure
One set of benefits• One set of administrative rules• One number to call/one
website
Community Resources
4
Carve-out Strategy
Goals Outcomes
- Expand access
- Improve understanding of the importance of oral
- Higher utilization
- Shift to preventive phealth
- Ensure appropriate dental service delivery
Measure and
Shift to preventive care
- Lower costs
- Measure and improve performance over time
- Improved overall health
5
Building Dental Access
• Dental provider focus on provider education, proper p p , p pcare, compliance and support for Dental Home
• Dental providers supported by:– Dedicated call center personnel– Dedicated network development manager– Dental Health Care Specialist teamDental 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 communicationsand claim review communications
6
Building Dental Access, Results
CTDHP Enrolled Dental Providers (As of 12/31)
1 6191,855
1 4001,600 1,800 2,000
( )
1,016 1,216
1,377 1,619
859 922800 1,000 1,200 1,400
589 704 772 859 922
200 400 600
-2009 2010 2011 2012 2013
Individual Dentists Service Locations
7
Pre-Carve Out: 349 Dentists
Building Dental Access, Results
Results: all Clients have access to one Primary Care Dentist in < 15 miles at minimum
Contract Standard: one PCDContract Standard: one PCD in < 20 miles
Green = Two Providers in 10 MilesBlue = Two Providers in 15 MilesBlue = Two Providers in 15 MilesYellow = One Provider in 10 Miles
8
Building Dental Access, Results
CTDHP Dentist Availability MeasuresCTDHP Dentist Availability Measures
2009 2010 2011 2012 2013
Avg. AppointmentAvailability (days) 14.4 11.2 6.8
PercentageClosed Panels
(12/31)18.7% 14.7% 13.3% 9.7% 12.7%
Mystery Shopper 93 3% 84 0% 86 0%y y ppCompliance 93.3% 84.0% 86.0%
Source: Rows 1 and 3: Mystery Shoppers conducted in 2009 2010 and 2012; Row 2: CTDHP
9
Source: Rows 1 and 3: Mystery Shoppers conducted in 2009, 2010 and 2012; Row 2: CTDHP
Building Dental Access, Results
Result:Result:
There is no physical access problem for HUSKY Health
DentalDental
10
Moving Beyond Access and Availability
• Dental access and availability issues resolved y– Many dentists near clients – Dental offices seeking new clients
• There are other barriers nowThere 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.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 UtilizationUtilization– More than just education
• Social marketing to increase the importance of oral health• Use ‘trusted people’ to provide info and sway clientsp p p y
11
How Do We Increase Client Demand?
• Non traditional approaches to:• Non-traditional approaches to:– Informing, Awareness– Outreach
• Reminders– Targeted outreach for specific client groups
A d h ll d il Referral Pad– Automated phone calls and mail
• Stratification of outreach methodologiesUse appropriate tool
Referral Pad
– Use appropriate tool– Escalate to direct personal interaction if appropriate
• Comprehensive Appointment AssistanceComprehensive Appointment Assistance
12
How Do We Increase Client Demand?
First Tooth Bib
Oral Health Kit
13
Increased Demand, Utilization Results
CTDHP Client UnduplicatedUtilization Rates
CTDHP Client PopulationGrowth
50.00%
60.00%
70.00%Utilization Rates
500,000
600,000
700,000Growth
30.00%
40.00%
300,000
400,000
0.00%
10.00%
20.00%
2009 2010 2011 2012 20130
100,000
200,000
2009 2010 2011 2012 2013 2009 2010 2011 2012 2013
Children (< 21)
Adults (21+)
2009 2010 2011 2012 2013
Total Average Client Population
Average Ever Eligible Adults
National Avg. CMS 416 12aAverage Ever Eligible Children
14
Program Cost Outcomes
$150,000,000
$200,000,000
TotalIncurred
$50,000,000
$100,000,000
Incurred Cost of Care
$0
$50,000,000
2009 2010 2011 2012 2013
Children's Services
Adult's Services
15
Service Delivery Trends
CTDHP Dental Service Distribution(Cost)
70%
80%
90%
100%
Preventive
40%
50%
60%
70%Restorative
Endodontics
Oral Surgery
Orthodontics
Adjunctive Services
0%
10%
20%
30%Adjunctive Services
Other Dental Encounters
Increase in Preventive Care and Reduction in Treatment
0%2009 2010 2011 2012 2013
16
Ongoing Outreach Initiatives
• Targeted automated reminder callsTargeted automated reminder calls• Targeted informational mailings• Expanded outreach through community involvement
Ei ht D t l H lth C S i li t– Eight Dental Health Care Specialists – 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– OtherOther
17
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• 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 mentor other statesLearning Network, mentor other states
18
ED/ER Initiative
B i 2012• Began in 2012• Identify dental users of ED/ER
(modest number)(modest number)• Automated phone calls, letters to all• Targeted outreach by DHCS to most g y
serious• Visits to all ED directors, provide
training materials (pads posterstraining, materials (pads, posters, etc.)
19
ED/ER Poster
Early Childhood Screening Initiative
• New initiative which will help measure diseaseNew initiative which will help measure disease prevalence and severity in children
• Uses three new dental procedure codes p(D0601,D0602,D0603)
• Codes indicate ‘Low’, ‘Moderate’ and ‘High’ risk• Will be used by public health hygienists and
complements dental home examinationsU i d t t l• Uses recognized assessment protocols
• Launching late 2014
20
Early Childhood Screening Initiative
• Find children slippingFind children slipping between the cracks
• Dental hygienists triage yg gchildren by oral health status and needs
f• Individual follow-up to the highest need children• Target Early Childhood Education programs, schools,
public health settingspublic health settings• Piloted by BeneCare in the MCO years
21
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 BookLike us on Face Book
23
top related