Medicaid Assistance Program Oversight CouncilJune 13, 2014

Improving the Oral Health of HUSKY Members

• Carr vs. Wilson-Coker Settlement Agreement– Carve-out of dental services from Medicaid Managed Care in

September 2008

– Unified delivery of dental benefits, rates and coverage

– Single ASO vendor, BeneCare Dental Plans

• Pre-Carve Out:– Four MCOs with three dental benefit management

subcontractors

– 349 FFS participating dentists (October 2008)

Genesis of the Partnership

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Pre-Dental Carve Out

Four Managed Care Companies plus FFS/T19

•Different provider networks•Different fee schedules•Different benefits•Different administrative rules

Provider and Client confusion!

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Post-Dental Carve Out

The Connecticut Dental Health Partnership

•One provider network•One fee schedule•One set of benefits•One set of administrative rules

The CTDHP leverages the State’s ASO configuration through a contract with concrete performance

incentives.

Carve-out Contracting Premise

Goals Outcomes

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Community Health Network of Connecticut, Inc.

CTDHP – DSS Oversight

ValueOptions

Logisticare Solutions, LLC

BeneCareDental Plans

• Network development focus on provider education, compliance and support for Dental Home

• Providers supported by:– Dedicated call center personnel

– Dedicated network development manager

– Dental Health Care Specialist team

• Partnering with providers– Integrate qualifications and panel limitations of professional

practice into client referral processes

– Provide continual feedback through call center interactions, claim review communications and meetings

Building Dental Access

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CTDHP DentistAvailability Measures

  2009 2010 2011 2012 2013Average AppointmentAvailability (days) 14.4 11.2   6.8  PercentageClosed Panels (12/31) 18.7% 14.7% 13.3% 9.7% 12.7%

Mystery ShopperCompliance 93.3% 84.0%   86.0%  

Building Dental Access, Results

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Building Dental Access, Results

Contract Standard: one PCD in <=20 miles

Results: all Clients have access to one PCD in <= 15 miles at minimum

Green = Two Providers in 10 MilesBlue = Two Providers in 15 MilesYellow = One Provider in 10 MilesRed = One Provider in 15 Miles

• Dental access and availability issues resolved – Many dentists located near clients – Dental offices actively seeking new clients

• Primary barriers limiting Client demand for service:– Oral health not seen as important in our society– Only 50-60% utilization by the general population– Much anecdotal evidence in cases:

• Lack of follow-up• Refusing recommended treatment• Misunderstanding of benefits

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Moving Beyond Access and Availability

•The next focus: Increase client demand to improve utilization

– More than just education• Created social marketing strategies to elevate the

importance of oral health• Use ‘trusted people’ to provide information and persuade the

clients to seek dental care

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Moving Beyond Access and Availability

• Innovative approaches used for:– Informing, increasing awareness– Outreach– Anticipatory guidance

• Compliance reminders:– Data driven– Discreet messaging for specific client cohorts– Automated phone calls and mail

• Stratification of outreach methodologies:– Use appropriate tool– Escalate to direct personal interaction if appropriate

• Comprehensive appointment assistance with education

How Do We Increase Client Demand?

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Increased Demand, Utilization Results

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• Prior-Authorization/Claim Review implemented Feb 2010– Ongoing utilization review

– Monitor provider service delivery

– Provide specific feedback regarding compliance with dental regulations and community standards of dental care

• Cost containment and cost avoidance are an effect of our focus on quality care: appropriate dental services in the right setting at the right time.

Assuring Appropriate Service

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Program Cost Outcomes

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A demonstrable improvement

in the client populations’ oral health status.

Service Delivery Trends

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• Targeted automated reminder calls• Targeted informational mailings• Expanded outreach through community involvement

– Eight Dental Health Care Specialists – Impact ‘Trusted Persons’: Community Agencies, WIC,

Head Start, PCP’s, OB/GYN’s, etc.– Expanded Perinatal initiative– ED/ER Initiative– Oral health status data sharing with WIC, DCF, other

agencies.

Ongoing Outreach Initiatives

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Collaboration with the other ASOs

• Work closely with all ASOs on individual case management• Community Health Network of Connecticut

– Oral health status data– Perinatal outreach integration– PCP/PCMH supports

• Value Options– Integration of BH data into orthodontic case approval

• Logisticare Solutions– Rapid response integration

• Hewlett Packard– Dentist provider enrollment and re-enrollment– Prior-Authorization automation– Orthodontic Claim automation

‘Trusted Person’ Strategy

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• Reach our clients through the people they trust – Pediatric PCP medical practices– OB/GYN practices– Key community agencies

• Personal visits by Dental Health Care Specialists• The message: oral health is important

– Get regular care in a dental home– Maintain good oral hygiene

• The ask:– Training meeting with all staff– Add oral health to client visit– Use our ‘prescription pad’ to refer– Distribute our oral health kits

‘Trusted Person’ Strategy

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• Identified 226 pediatric PCP offices - high number of clients, low dental utilization rates

• Identified all 207 OB/GYN offices in HUSKY Health• Identified 4-6 key agencies in each community• Materials utilized

– Staff information packet (articles, referral information, etc.)– PCP, OB/GYN and generic referral pads– Oral health kits (toothbrush, toothpaste, floss, how-to-brush-and-

floss sheet, CTDHP information)• Follow-up visits

– Deliver more materials, build relationship– Deliver CTDHP bibs

to OB/GYNs for postpartum

Results

Connecticut was one of only three states to receive the top grade from the Pew Center on the States in both 2010 & 2011, the last years they graded all states on dental health policies

A 2012 study by the Connecticut Department of Public Health showed that, between 2007 and 2010, untreated decay was reduced -50% for Head Start children, -19% for Kindergarten students and -33% for third grade students

The Commonwealth Fund’s 2011 State Scorecard on Child Health System Performance found that Connecticut was in the top ten states overall

In 2013 CMS referenced Connecticut as having the largest increase in the percent of children receiving a preventive dental service in the country

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Excerpt of letter from Cindy Mann, Director, Center for Medicaid and CHIP re: CMS Oral Health Initiative, 4/18/2013

Results

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Connecticut

#1

Results

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CHILDREN’S ACCESS TO DENTAL CARE SEES STRIKING IMPROVEMENT SINCE INCEPTION IN 2008 - Connecticut State Dental Association News Release, 3/14/2012

CHILDREN’S DENTAL SERVICES IN THE HUSKY PROGRAM: Program Improvements Led to Increased Utilization in 2009 and 2010 - CT Voices for Children Report, November 2011

Report shows improvement in children's dental care - WFSB-TV Channel 3, 3/14/2012

State report to show improvement in dental care for poor kids - The Norwich Bulletin, 3/14/2012

HRSA PIOHQI Grant

Trends

Finance

Machiner

y

• 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 of data by CT Voices • Share what we learn in a CMS funded State-National

Learning Network, mentor other states

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Emergency Department Initiative

• Identify users of dental services in an ED

• Automated phone calls, letters to all• Targeted outreach by DHCS to those

with most serious conditions• Presentations to ED Directors • Follow up visits to all ED directors,

provide training, materials (pads, posters, etc.)

• Less than 2% of ED visits for dental reasons - CTHA study, 2012-2013

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• New initiative which will help measure disease prevalence and severity in children

• Uses three new dental procedure codes (D0601,D0602,D0603)

• Codes indicate ‘Low’, ‘Moderate’ and ‘High’ risk

• Will be used by public health hygienists to complement dental home examinations

• Uses recognized assessment protocols

• Launching in the Fall of 2014

Early Childhood Screening Initiative

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Early Childhood Screening Initiative

• Find children slipping between the cracks

• Dental hygienists triage children by oral health status and needs

• Individual follow-up to the highest need children through the use of a reporting tool and claims analysis

• Target ECE programs, schools, public health settings

• Based on a pilot by BeneCare in the MCO years

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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-DENTALMon-Fri, 8AM-5PM

www.CTDHP.com

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