Why is oral health important?
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- Katrina Skinner
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1 An Ounce of Preventive Oral Health, a Pound of Savings Colin Reusch Senior Policy Analyst Children s Dental Health Project Why is oral health important? Oral Health impacts: Nutrition Speaking Learning Social development Employment 2 1
2 The problem: a silent epidemic Tooth decay #1 childhood chronic condition Caused by preventable, transmissible, bacterial disease (dental caries) Nearly half of all kindergartners experience cavities Children with cavities in baby teeth twice-3x as likely to have decay in adult teeth Less than half of Medicaid children see a dentist Sources: Centers for Disease Control and Prevention, Agency for Healthcare Research and Quality, Centers for Medicare and Medicaid Services 3 The cost of poor oral health Thousands of children end up in OR Average cost more than $12,000 per child 53% to 79% experience new cavities within 2 years of OR treatment Hundreds of thousands end up in ER $88 million in Florida alone (2010) More than 60% of new military recruits unfit for deployment due to oral health issues Poor oral health linked to numerous adverse health outcomes 4 Sources: Pew Center on the States, A costly dental destination. January 2012.; Foster T, etal. Recurrence of early childhood caries after comprehensive treatment with general anesthesia and follow-up. J Dent Child (Chic) 2006;73:25-30; Almeida AG, et al. Future caries susceptibility in children with early childhood caries following treatment under general anesthesia. Pediatr Dent 2000;22:302-6; Eidelman E, et al. A comparison of restorations for children with early childhood caries treated under general anesthesia or conscious sedation. Pediatr Dent Jan-Feb;22(1):33-7.; Bipartisan Policy Center DoD case study,
3 WHERE WE RE MAKING PROGRESS 5 Expanding coverage for kids Source of Dental Benefits, Children Ages 2 to 18 6 Source: Nasseh K and Vujicic M. Dental benefits continue to expand for children, remain stable for working-age adults. American Dental Association, Health Policy Resources Center, October
4 Increasing utilization of care States Meeting or Exceeding First Year CMS Oral Health Initiative Goal Percentage of Medicaid-enrolled children, age 1-20, who received a preventive dental service 7 Source: Centers for Medicare and Medicaid Services analysis of CMS 416 data, Recent Federal changes CHIPRA (2009): Mandatory dental benefits in state CHIP programs State option to provide supplemental dental coverage Established core quality measures Development of public education materials, focus on new mothers 8 4
5 Recent Federal changes ACA (2010): Pediatric dental coverage part of essential health benefits (EHB) Coverage of certain oral health services at no cost to patient Numerous oral health provisions (many unfunded by Congress) Increases in Medicaid & CHIP enrollment as a result of Medicaid expansion* *CMS Medicaid & CHIP: May 2014 Monthly Applications, Eligibility Determinations and Enrollment Report 9 Ongoing Federal efforts CMS Oral Health Initiative 2 goals for 2015: Increase by 10 percentage points the proportion of Medicaid and CHIP children ages 1 to 20 who receive a preventive dental service Increase by 10 percentage points the proportion of Medicaid and CHIP children ages 6 to 9 who receive a sealant on a permanent molar tooth CDC State Oral Health Infrastructure Cooperative Agreements (21 states): Surveillance, evaluation, leadership, state oral health plan development, sealants, water fluoridation, preventive services Healthy People 2020: Oral health a leading health indicator 10 5
6 Other national efforts Dental Quality Alliance (DQA): development of pediatric quality measures Aimed at achieving better health outcomes ADA: issued new caries risk assessment codes 16 states reimburse for these codes in Medicaid & CHIP 11 OPPORTUNITIES FOR IMPROVEMENT 12 6
7 Where there s room for improvement Prioritizing prevention Care coordination One-size-fits-all approach to oral health Access to care & provider participation Separate financing systems Data collection/reporting 13 Focusing on prevention ACA preventive services: Fluoride varnish by pediatrician Fluoride supplements for kids without access to fluoridated water Oral health risk assessment & referral to dentist 1% increase in federal match for ACA preventive services if state provides them for free to Medicaid beneficiaries Bundled payments to dental providers Reimburse for caries risk assessment 14 7
8 Improving care coordination Engaging medical professionals in oral health care Case management Establishment of accountable care organizations (ACOs) 15 Delivering care differently Maximizing risk-based oral health care in Medicaid for kids Institutionalizing clinical guidelines (e.g. American Academy of Pediatric Dentistry) Periodicity schedules setting a higher floor Medical/dental integration financing, teambased care, ACOs 16 8
9 Driving innovation Ask: What are we paying for and is it improving oral health outcomes? Adopting quality measures (not just utilization measures) Changing financial incentives for plans and providers Testing new approaches through State Innovation Model (SIM) grants 17 Achieving cost savings New York State simulation model: Targeting fluoride varnish for high-risk children: reduce cavities by 65% Xylitol gum for mothers/caregivers of high-risk children: returns $1.76 for every dollar spent by Medicaid Eliminating water fluoridation in NYC: $55.9 Million over 10 years (cost to Medicaid) Potentially high savings interventions for Medicaid: motivational interviewing and tooth-brushing programs Neither require clinical care in dental office to implement 18 Source: Hirsch GB, et al. A model for examining strategies to reduce early childhood caries in New York State s Medicaid population
10 A FINAL WORD ABOUT CHIP 19 CHIP 8+ Million children covered Funding runs out in September 2015 Millions of children would transition to marketplace coverage At least 2 million low-income would kids without subsidized coverage 20 10
11 Questions? Colin Reusch, MPA
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