Chronic Condition Dental Management (CCDM) Program

PEBB Board PresentationSeptember 19th, 2017

Kristen Simmons, RDH, MHA, PhDEL(c) – Chief Operating OfficerSally Kallianis – Key Account Executive

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Agenda

• Willamette Dental Group Overview

• Oral Disease Prevalence/Model of Care

• Chronic Condition Dental Management (CCDM) Program Overview

• Goals, Eligibility, Benefit Design, Opportunities & Cost

• Future Data Integration

• Early Results

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Willamette Dental Group Overview

• Vertically integrated delivery model

• 50+ dental office locations in OR, WA & ID

• Over 400,000 members served

• Value over Volume

• Clinical innovation

• Outstanding care3

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Dental Disease Prevalence

Tooth Decay• Bacterial infection

• Nondiscriminator

• Most common chronic disease of children & adolescents

• Bacterial infection

• Linked to many other health conditions

• Age increases risk

Source: CDC Chronic Disease Resources 4

Periodontal Disease

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Bacterial Links to Systemic Diseases

• Bacteria is always present in the mouth

• Interconnection with oral bacteria & other diseases

• Immuno-compromised patients have greater risk

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5Bodenheimer T, Sinsky C. From Triple to Quadruple Aim: Care of the Patient Requires Care of the Provider. Ann Fam Med. 2014;12(6)

• Multi-faceted Approach to Care

• Partnership in Patient Care

• Standardized Treatment by Risk Factor

• Provider Satisfaction

Quadruple AimBdatt.4

7Aubert et al Ann IntMed 1998; 129:605

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Diabetic

Non-Diabetic

Unknown

Other4,634 25%

Non-Diabetic13.529 72%

Diabetic642 3%

PEBB Patients by Diabetic Status Self Report by Patient

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Patient Engagement

• Patient Partnership

• Proactive Dental Care Plan

• Patient compliance increased & improved

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Chronic Condition Dental Management Program

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CCDM Program Goals

• Provide targeted care for those PEBB members with specific disease sets and risk factors

• Improve the oral and overall health of PEBB members with prevalent chronic conditions

• Opportunity for collaboration between dental plan and health plan carriers

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CCDM Program Overview

• Target specific high cost/high impact chronic conditions

• Diabetes & Cigarette smoking

• Quality measures & benchmarks for participation, oral health improvement

• Using plan data, ascertain program participant subset

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CCDM Program Overview

• Targeted outreach to PEBB members who fit data criteria

• Engagement efforts to encourage participation

• Removal of cost barriers for specified codes based on risk

• Copay waiver; related to disease management

• Operational redesigns, IT enhancements, care coordinators & case management

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CCDM Benefit Design

• For PEBB CCDM participants:

• No cost share for certain services

• Identified by specific CDT codes

• $5 office visit copay still applies to basic & major restorative services

• Orthodontia & implant copays still apply

• For all other PEBB WDG members:

• Continuation of existing benefits

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CCDM Eligibility

• Detailed Medical & Dental History

• Self-attested conditions of diabetic and/or smoking status

• Immediate identification & outreach to eligible patients

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CCDM Program Opportunities

• Conservative estimates of 5 – 10% of the WDG PEBB members in the high & extreme risk categories

• Reduction in the prevalence of caries & gum disease

• Greater adherence due to outreach, care coordination and removal of financial barrier

• Cost savings by reducing costly restorative treatments (long term)

• Potential – but unknown – savings on medical care

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Early Results

• 47% acceptance rate for CCDM program

• 90% utilization rate for CCDM program participants

• Services counts higher in most categories

• Higher PMPM for program participants16

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Future Data Integration

• WDG axiUm links to HIS using customized Health Level 7 (HL7) interfaces

• axiUm includes module for patient access (future functionality)

• SNOMED integration

• Two way data exchange between WDG & Health Plans

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Cost Impacts

• Increased utilization for Program participants

• Decrease in revenue from removal of $5 office visit copay

• Outreach/administrative costs

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Questions?

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