2015 Na(onal Medicaid and CHIP Oral Health Symposium

Transcription

1 MSDA Medicaid CHIP State Dental Association 2015 Na(onal Medicaid and CHIP Oral Health Symposium Session # 9 Primary Care Physician Integra(on into Dental Program An(cipatory Guidance, Screening & Care Coordina(on Lee Serota Washington Marrio0 Wardman Park Monday, June 1 st,

2 Learning Objec2ve(s) Par2cipants will gain knowledge in: Oral health integra2on opportuni2es within Primary Care Physician s Prac2ces. Primary Care Physicians roles in oral health an2cipatory guidance and referral. Outreach and Care Coordina2on opportuni2es with PCPs, OB/GYNs, and other medical providers. 2

3 Oral Health An2cipatory Guidance & Referral Frameworks NCQA Pa2ent/Person Centered Medical Home Standards: Iden2fy & Manage Pa2ent Popula2ons; Comprehensive Health Assessment Use Data for Popula2on Management; At least three different preven2ve care services Plan & Mange Care; Collaborate with pa2ent/family to develop individual care plan Provide Self Care Support and Community Resources; Provides educa2onal resources or refers at least 50% of pa2ents/families to resources Track and Coordinate Care; Track the status of referrals 3

4 Physician Engagement Strategies Infrastructure Resources Informa2on & Training Material Supports Oral Health Care Coordina2on & Case Management Services A Trusted Person Model of effectuating health behavior change. 4

5 Infrastructure Resources Dental Provider Network Access, Capacity & Availability Overcoming historic mispercep2ons. Programma2c Resources Physician accessible dental program toll free services and supports Physician accessible dental program website Oral Health status data, at the member level, shared with Medical plan & used in compliance and disease management programs 5

6 Informa2on & Training AAP: Champion for OH awareness among physicians Because the youngest children visit the pediatrician more oden than they visit the den2st, it is important that pediatricians be knowledgeable about the disease process of dental caries, preven2on of the disease, and interven2ons available to the pediatrician and the family to maintain and restore health. ABC: Clinical Training for Physicians Online or In Person for MDs, RNs, APRNs, MAs Allows PCPs to provide and be reimbursed for oral evalua2on (D0145) and fluoride varnish (D1203) Dental Program Administra2ve Services and Supports Member/Provider Services Phone support for referrals Care Coordinators visi2ng PCP & OB/GYN Offices regularly 6

7 Material Supports 7

8 Oral Health Care Coordina2on & Case Management Services Care Coordina2on Staff Interac2ons with Physician s Office Personnel Trusted Resource for Referrals, Care Coordina2on, Case Management Assistance for Persons with Special HealthCare Needs and Complex Care Help naviga2ng the system to streamline delivery of care 8

9 Measuring Ac2vi2es Outreaches include educa2onal visits and replenishment Type of PracAce Outreaches Materials Pediatricians ,107 OB/GYN ,409 Family Medicine ,297 Totals ,813 9

10 Measuring Outcomes PCP Pa2ent Panel Dental U2liza2on Rates PracAce Avg. PaAents August 2012 UAlizaAon August 2014 UAlizaAon Trend A 13, % 63.1% 6.4% B 3, % 55.7% 20.3% C 2, % 60.0% - 2.9% Notes Engaged, Mul2ple Educa2onal Mee2ngs, Mul2ple Replenishments Engaged, Single Educa2onal Mee2ng, Mul2ple Replenishments Not Engaged, Single Educa2onal Mee2ng, No Replenishments 10

11 Barriers Selling Oral Health to each physician/ prac2ce Resource Intensive Rela2onship Dependent Variable Outcomes Pa2ent s Economic, Literacy, Anxiety, and other barriers ul2mately drive service uptake and u2liza2on. 11

12 Future Ac2vi2es Dental Screenings (D0601, D0602, D0603) for CRAS delivered by PCP team. Integrate pa2ent oral health status and compliance into Physician s EHRs - > driven by medical plan data exchange 12

13 Disclosure and Conflict of Interest Declara2on q I declare that neither I nor any member of my family have a financial arrangement or affilia2on with any corporate organiza2on offering financial support or grant monies for this con2nuing dental educa2on program, nor do I have a financial interest in any commercial product(s) or service(s) I will discuss in the presenta2on. q I declare that I have a financial interest/arrangement or affilia2on with the corporate organiza2on offering financial support or grant monies for this con2nuing dental educa2on program, or I do have a financial interest in any commercial product(s) or service(s) I will discuss in the presenta2on. 13

14 MSDA Medicaid CHIP State Dental Association 2015 Na(onal Medicaid and CHIP Oral Health Symposium Session #9 VP Dental Services, Kaiser Founda(on Health Plan of the Northwest Kenneth R. Wright, DMD, MPH Washington Marrio0 Wardman Park Monday, June 2 nd,

15 Learning Objec2ve(s) Par2cipants will gain knowledge in: Integrated Healthcare Defini2on Case for Ac2on Challenges/Opportuni2es Kaiser Permanente Design Healthcare Implica2ons 15

16 Disclosure and Conflict of Interest Declara2on q I declare that neither I nor any member of my family have a financial arrangement or affilia2on with any corporate organiza2on offering financial support or grant monies for this con2nuing dental educa2on program, nor do I have a financial interest in any commercial product(s) or service(s) I will discuss in the presenta2on. 16

17 Integrated Healthcare Defini2on An holis(c approach to health care, recognizing that what happens in the mouth affects the rest of the body, and vice versa. It's an organiza2onal structure and culture that removes silos between medical and dental care to create a system which: Improves pa2ent health outcomes Results in service efficiencies and convenience. This can be achieved by: Coordina2ng care across the medical- dental con2nuum Providing the right care at the right 2me and in the right sesng Crea2ng insurance products that recognize the value of integra2on U2lizing technology that leverages integra2on 17

18 Integrated Healthcare Case for Ac2on Dental diseases account for between 5 and 10 percent of total health care expenditures. This exceeds the cost of trea2ng cardiovascular disease, cancer, and osteoporosis. i ii Public awareness of the importance of oral health is at an all- 2me high Screening for chronic diseases in dental offices could reduce U.S. health care costs by up to $102.6 million annually or up to $32.72 per person screened. iii Research and policy are rapidly evolving to recognize the connec2on between oral health and total health Mul2ple na2onal stakeholder groups outside den2stry are focusing on dental: Founda2ons Children s advocacy groups Major purchasers Employed adults lose more than 164 millions hours (20.5 million days) of work each year due to dental disease or dental visits

19 Integrated Healthcare Innova2on and Dis2nc2on Mauer Now More Than Ever Disease Management Health/Wellness PrevenAon We must alter our DNA and fight the urge to operate from a Disease Management" mind set where the focus is on mi2ga2ng disease burden. We MUST instead change our perspec2ve to a Dental Wellness" mind set. A perspec2ve that requires us to think in terms of preven2on and health outcomes.

20 Integrated Healthcare Kaiser Permanente Dental s Mission Provide uncompromising excellence in service to our members Build trust and respect with our members and each other Promote op2mal dental health in the pa2ents we serve Develop and apply treatment standards that are based on reliable research Foster innova2on, teamwork and professional growth Maintain the highest standards of a safe, health environment

21 Integrated Healthcare Who We Are Kaiser Permanente Quality and Health Improvement Committee Kaiser Foundation Health Plan of the Northwest Board of Directors Kaiser Permanente National Quality Committee Dental Oversight Committee Kaiser Foundation Health Plan of the Northwest Regional Operations Quality Group KFHP of the Northwest Dental Administration Ken Wright, DMD, MPH Vice President, Dental Care Services Permanente Dental Associates John Snyder, DMD Dental Director, CEO

22 Integrated Healthcare The Roles of KFHP and PDA KFHP Acts as a prac2ce management company and as a dental insurance company Is responsible for human resources, claims, billing, purchasing, and the scheduling of most appointments Provides the necessary facili2es, equipment and dental materials Recruits, hires, and trains all non- den2st staff Works in collabora2on with PDA PDA Recruits, hires and trains all den2sts Develops the clinical focus for an evidence- based dental prac2ce Manages a specialty care network of non- PDA den2sts Provides dental care to all KFHP dental members Helps manage KPD by collabora2ng with KFHP

23 Integrated Healthcare Quality is Our Mandate Quality Assurance/Improvement Commiuee Peer Review Process Peer Review Commiuee Clinical Effec2veness Commiuee Radiographic Review Process Reviews of Prosthe2c Cases Internal Lab Monitors Quality

24 Integrated Healthcare Philosophy of Care Evidence-based dentistry is the focus of all of our activities. Uncompromising quality Excep2onal personalized care and service InternaAonally recognized Leadership in oral health research Integra2ng medical with dental services Evidence- based approach to care These founda2onal principles enable the improved health and well being of those pa2ents entrusted to our care.

25 Integrated Healthcare Medical- Dental Integra2on at Kaiser Permanente Oral Health for Medically Complex Pa2ents Right Care at the Right Time 25

26 Integrated Healthcare The Total Health Equa2on: Healthy Smiles = Healthy Members PDA denasts and Northwest Permanente physicians jointly explore the potenaal for integraang medicine and denastry. Our commitment to integrated medical and dental care gives our members the power to thrive with a focus on total health and wellness. Dental care combined with medical care improves member health outcomes and the bouom line: KPNW members with medical and dental coverage weigh less, smoke less, and visit the hospital and emergency department less than members with just medical coverage. They also have higher adherence with seven of 11 HEDIS quality metrics. iv Dental ranks second among all pa2ent- facing departments in the region for care gap closure opportuni2es (e.g., breast cancer screenings, blood sugar tests, high blood pressure control). v KP Northwest s actuarial team es2mates savings of $11.1 million ader the first year for diabe2c and cardiac pa2ents who u2lize dental services. vi 26

27 Integrated Healthcare Health Outcomes How KP Dental Measures Success: Diabe2c popula2on receiving dental care have lower costs per member per month (PMPM) than those NOT receiving dental care; ader adjus2ng for pa2ent characteris2cs. Overall costs: Diabe2c popula2on receiving dental care had $129 PMPM lower costs overall than those NOT receiving dental care InpaAent costs: Diabe2c popula2on receiving dental care had $101 PMPM lower inpa2ent costs than those NOT receiving dental care ED- Urgent care costs Diabe2c popula2on receiving dental care had $13 PMPM lower ED/ urgent costs than those NOT receiving dental care 27

28 Integrated Healthcare Promo2ng Wellness Developing Transparent Oral Health Data Oral health is integral to overall health and should be viewed together to truly understand the total health of an individual. Kaiser Permanente has created an oral health status (OHS) indicator that is assigned to each patient. Stratifies members by their OHS level and general health by identifying dental members with specific chronic medical conditions that have an important link to oral health. OHS system identifies high risk patients who have not been in for a dental examination, and provides the necessary outreach. Tracks the OHS status of a group of employees over time to demonstrate change in oral health. 28

29 Integrated Healthcare Transparent Oral Health Data *Members with asthma, diabetes, kidney disease, heart disease, tobacco use, and prenatal 29

30 Integrated Healthcare Closing Medical Care Gaps Nearly 100 percent of our dental providers (136/139 KP dentists and 185/185 HP hygienists) are using the Patient Support Tool (PST) routinely The Dental Program is #2 out of 44 KP medical departments in care gap opportunities #3 in care gap closure assists (assist in closing 18,000+ care gaps each year) 30

31 Integrated Healthcare Opportuni2es Expanded role for den2sts/ extenders of primary care Superior and synergis2c teamwork Beuer collabora2on with medical specialists for treatment of complex medical condi2ons Beuer way to manage costs Beuer way to promote wellness Bundled Payment systems Professional educa2on Challenges Valida2ng the value proposi2on Demonstra2ng total health equity Expanding eligibility Access to care Payment systems IT systems 31

32 Integrated Healthcare BETTER TOGETHER QUESTIONS? 32

33 References I. A. Sheiham, Dietary effects on dental diseases, Public Health Nutri4on 4 (2001): II. World Health Organiza2on, Diet, nutri2on and the preven2on of chronic diseases: report of a joint WHO/FAO expert consulta2on, World Health Technical Report Series 916, III. Nasseh K, Greenberg B, Vujicic M, Glick M, The effect of chairside chronic disease screenings by oral health professionals on health care costs, American Journal of Public Health (2014): IV. Kaiser Permanente Center for Health Research, Comparison of HEDIS Outcomes Among Dental/Medical vs. Medical Only Popula2on (2013 ). V. Prac2ce Support, Northwest Permanente, Successful Opportuni4es Report, Visits between July 2014 and December 2014 HEDIS Measures, accessed March 16, VI. Kaiser Permanente Northwest actuarial data (claims analyzed over a two- year period from Savings based on 6,872 commercial and 2,767 Medicare members). 33

34 Contact Informa2on Kenneth R. Wright, DMD, MPH Completed dental educa2on at Harvard School of Dental Medicine Received MPH at Harvard T.H. Chan School of Public Health Periodontal Residency at UNC School of Den2stry (Diplomate) USN Service (30 years; Clinical, Execu2ve Medicine roles) Joined Kaiser Permanente Dental in 2011 (VP Dental Services) Absolutely commiued to a holis2c approach to health care that enables coordina2on of care across the medical- dental con2nuum, leverages an expanded role for den2sts as extenders of primary care, improves pa2ent health outcomes, and results in enhanced service and pa2ent care experiences. kenneth.r.wright@kp.org 34