Milestones Pedodontic Residency established by Pediatric Dental Associates at Episcopal Hospital in Philadelphia Mandatory Managed Car
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1 Special Smiles in Pennsylvania Developing Comprehensive Oral Health Policy: Challenges and Opportunities for State Health Policy Makers The Hilltop Institute June 17, 2008 Mark S. Goldstein, DDS Pediatric Dental Associates Special Smiles, Ltd. Paul R. Westerberg, DDS, MBA Chief Dental Officer Pennsylvania Dept. of Public Welfare
2 Milestones Pedodontic Residency established by Pediatric Dental Associates at Episcopal Hospital in Philadelphia Mandatory Managed Care implemented in the Southeast Zone of HealthChoices First DPW-sponsored Dental Summit in Pennsylvania Proposal to create a dedicated dental facility to treat special needs patients proposed by Pediatric Dental Associates 2
3 Negotiation/Contracting Phase Required negotiations with the four Managed Care Organizations (MCOs) operating in SE HealthChoices Global budgeting was proposed with capacity to be divided between MCOs according to market share Venture capital was provided by Pediatric Dental Associates Universal participation by MCOs required for operational status 3
4 MA Managed Care in Pennsylvania State Administered and MCO Voluntary Managed Care Mandatory Managed Care Mandatory Managed Care
5 Location of Special Smiles, Ltd. September 2001 HealthChoices Southeast Zone
6 Location of Special Smiles, Ltd. September 2001 Philadelphia County Special Smiles, Ltd. Temple University Hospital Episcopal Campus
7 Analyzing the Process Opportunity Relationships Perseverance 7
8 Opportunity Managed Care Implementation Focus Flexibility Provider Initiative Expertise Availability 8
9 Relationships State t Government (DPW) MCOs Provider Community Membership (Patients) Advocacy Community 9
10 Perseverance Concept Development Negotiations/Contracting Implementation Continuation 10
11 Who We Are Comprehensive, Cost Effective Outpatient Dental Care Improved Access to Care Intellectual and Physical Disabilities Education and Outreach for Parents and Direct Care Staff
12 Our Patients Individuals Who Require Anesthesia to Complete Routine Dental Care: Age 12 and Older Intellectual Disabilities Physical Disabilities Maladaptive Behaviors MR/MH Dual Diagnosis
13 Patient Demographics Referral Sources 68% Community- Supported 18% Intermediate Care Facilities (ICF) 18% 14% 68% CLA ICF/MR Lives at Home 15% Parent-Supported > 50% Severe to Profound Disabilities 20% Non-MR Patients MR Classification 20% 7% 18% MR Mild MR Moderate MR Severe MR Profound 27% None Specified 28%
14 What We Do Full Mouth Rehabilitation Comprehensive Oral Exam, Prophylaxis, Fluoride, Sealants Full Mouth X-Ray Amalgam and Composite Fillings Endodontics Periodontal Scaling and Root Planing Minor Oral/Periodontal Surgery Excision and Biopsy of Lesions Gingivectomy/Alveoloplasty Extractions 100% of care delivered d under IV sedation or general anesthesia
15 Treatment Break Out Procedures by Treatment Category 25,000 20,000 22,111 20,079 15,000 13,069 10,000 6,706 5,000 3,200 - Preventive Restorative Perio Endo/Oral Surgery Extractions
16 How It Works Two Appointments Screening Lifetime Medical and Dental History Physical Exam from Primary Care Physician Diagnostic Lab Tests as Directed by Anesthesia Protocol Consent for Dental Treatment and Anesthesia Full Mouth Rehabilitation
17 Milestones Over 60,000 Procedures Completed! 5,000 Full Mouth Rehabilitations Education and Outreach to 400 Parents and Agency Personnel Reduced Cancellation Rate from 47% to 10% over 6 years
18 Relationships Ongoing contracts with HealthChoices HMOs Americhoice of Pennsylvania Health Partners Keystone Mercy Health Plan ACCESS Established Collaborative Partnerships Philadelphia Coordinated Health Care Public Citizens for Children and Youth Over 100 Advocacy Agencies
19 Perseverance Administrative Competencies Advocacy Continuous Quality Improvement Cancellation by Reason Code 13% 13% Missing Paperwork 11% Illness/Medical Patient Not NPO 29% No Transportation 34% No show/other
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