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)

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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

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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

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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

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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

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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

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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

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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

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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

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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

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How Do We Increase Client Demand?

First Tooth Bib

Oral Health Kit

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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

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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

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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

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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

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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• 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

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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.)

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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

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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

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Early Childhood Screening Initiative

Parental Permission Form Parent Report

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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-DENTAL(M – F 8:00 AM – 5:00 PM)

www.CTDHP.com

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