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DENTAL DENTAL ADVISORY ADVISORY

COMMITTEECOMMITTEE

November 15, 2013Richmond, Virginia

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SFCSFC PEDIATRIC DENTAL PEDIATRIC DENTAL UTILIZATIONUTILIZATION

and and ADULT SERVICESADULT SERVICES

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Increase Pediatric Dental Increase Pediatric Dental UtilizationUtilization

53%53% of children ages 0-20 utilized dental services in SFY 2012: 53% previous

year 24% when

program started

60% 60% of children ages 3-20 utilized dental services in SFY 2012: 61% previous

year 29% when

program started

Notes: * SFY 2012* and 2013 - Represents new CMS guidelines –

unduplicated individuals who have been continuously enrolled for 90 days versus previous enrollment of 1 day.

Source: Centers for Medicare and Medicaid Services EPSDT 41 Report produced on SFY reporting timeframe. Figures are based on claims received through September, 23, 2013(3 months lag time).

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Annual Dental Exam Comparing Annual Dental Exam Comparing SFC to HEDIS 2013SFC to HEDIS 2013

Measures the percentage of members 2-21 years of age who had at least one (1) dental visit during the measurement year.

Data shows that 62.26% of the members had at least one dental visit; well above the HEDIS National Medicaid average of 49.07%. Percentage of members with at least one dental visit was above

the 75th percentile of the HEDIS national data.

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SFCSFC PROVIDER NETWORK PROVIDER NETWORK

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Increase Provider ParticipationIncrease Provider Participation

As of September 30, 2013, 1801 dentists are participating in the SFC program:

This represents approximately 28% of the 6,529 Virginia licensed dentists.

The number of providers enrolled in the program has tripled since July 1, 2005.

More than 85% are accepting new patients85% are accepting new patients. For SFY 13, approximately 80%80% of network providers are submitting

claims as compared to less than half prior to SFC.

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NETWORK RECRUITMENTNETWORK RECRUITMENT

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Provider Recruitment ActivitiesProvider Recruitment Activities

Attended the National Dental Association meeting (July 26, 2013)

Attended and displayed at the VDA annual meeting (September 20-22, 2013)

Approved letter from VDA to be sent to all attendees of the VDA Annual meeting that are not participating providers (247 providers) Awaiting VDA President signature

Recruitment presentation presented to Virginia Association of Free and Chartable Clinics (20 clinic sites) with minimum of 35 providers (October 22, 2013)

Attending the Virginia Academy of General Dentistry meeting (November 8, 2013)

Attended and displayed at the Virginia Oral Health Summit (Nov 8, 2013)

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Adult Dental ServicesAdult Dental Services

10.49%10.49% of SFC adults ages 21 and over utilized dental services in SFY 2013.

Assistance with the treatment of adults is still needed.

Recent activities to expand the number of dentists treating adults include: Kool Smiles in Christiansburg and Danville is treating some

adults for non-complicated extractions Franklin Dental Clinic is now treating adults Atlantic Dental Care (New Church -Eastern Shore) is

treating Adult members 20 of the Virginia Association of Free and Charitable clinics

are considering treating adults Rescue Mission of Roanoke is considering treating adults

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NEW PROGRAM INITIATIVES:NEW PROGRAM INITIATIVES:

PreventistryPreventistrySMSM Sealant Program Sealant Program

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Overview of Early Sealant Placement Results

The results show an increase in sealant placement for ages 6, 7, and 12.

We see a slight decrease in sealant placement rates for age 13 even though these children are included in the Preventistry program. In priors periods, we saw an increase in sealant rates for

those 12 and 13 so many of the children age 13 may have already had their second molars sealed.

There is also an increase in sealant placement for children who are ages 8 since many are on the list because they were 7 at the beginning of the period.

There is a decrease in sealant placement (often significant) in other age groups that aren’t identified by the Preventistry program.

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NEW PROGRAM INITIATIVES:NEW PROGRAM INITIATIVES:

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Early Dental Home Pilot AreaEarly Dental Home Pilot Area The Pilot was launched July 1, 2013 and

will run for at least 12 months. Targeted Pilot Area – Greater Richmond

Area: Richmond City Henrico Hanover Chesterfield

Periodic assessments will be conducted to determine when and how to expand the initiative.

Program goals: To increase oral health and overall health

outcomes To increase caries risk assessments and

dental referrals by medical providers To increase access to care, EPSDT related

visits and utilization of preventive services

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Baseline Data and GoalsBaseline Data and Goals

7/1/12 - 6/30/13 Age 0-5Total Enrollees 34,558 Members with 90 Day Continuous Enrollment 31,994 Overall Utilization 44.49%Preventive Utilization 43.02%Fluoride Rate 27.11%

Goal for the Greater Richmond pilot areas is to increase utilization in each area by 3%.

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Member AssignmentsMember Assignments

City/County < Age 1 Age 2 Age 3 Age 4 Age 5 Grand TotalChesterfield 1,343 2,602 1,349 1,406 1,398 8,098Hanover 239 410 241 236 246 1,372Henrico 1,868 3,483 1,756 1,793 1,753 10,653Richmond City 1,206 2,529 1,293 1,369 1,345 7,742Grand Total 4,656 9,024 4,639 4,804 4,742 27,865

Letters were mailed to each head of household to inform the parent/guardian of their child’s assigned Dental Home.

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Early Dental Home Next Steps Next Steps Continue to assign new members as

enrolled in the SFC program Implement Healthy Smiles Wellness

Program: After their first and second

birthdays, DentaQuest mails a birthday card to the member’s home.

Implement Value add member incentive(s): Member oral health backpack after

first visit For participating providers in the

Early Dental Home pilot area, expand Preventistry report to include: Sealants Topical Fluoride Preventive 6 month check-ups

Quarterly monitoring of utilization (overall, preventative and fluoride) results

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NEW PROGRAM INITIATIVES:NEW PROGRAM INITIATIVES:

Broken Appointment Tracking & Broken Appointment Tracking & OutreachOutreach

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Broken Appointment AnalysisBroken Appointment Analysis From July 1, 2011 –

September 30, 2013: 463 of 1801 (26%) of

SFC providers reported a broken appointment.

760,133 appointments were scheduled

24,856 broken appointments were reported

Based on data for this period, 3.27 broken appointments per 100 appointments were reported. An estimated 1,262,507

broken appointments were unreported for the period.

Phone call outreach implemented 11/2011

Postcard outreach implemented April 2012

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Broken Appointment Analysis Broken Appointment Analysis (cont.)(cont.)

24% of members reported are breaking more than 1 appointment.  76% of members broke only 1 appointment.

65% of members that broke an appointment did visit a dentist following their broken appointment.

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MEMBER OUTREACHMEMBER OUTREACH

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Sussex High School Pilot Sussex High School Pilot ProgramProgram

Program Objectives: Develop and implement a pilot project with a

group of teens to increase dental services for this population

Encourage teens to consider occupations in the dental field

Who: 1st year: target 10th grade students at Sussex

High (approximately 90 students) 2nd year: target all Sussex High School grade

levels

What: Teen Outreach:

• Teen Oral Health PowerPoint Presentation• Teen Questionnaire • Evaluation• Incentive for visit once return dental visit

form• Of those that return dental appt form,

enter into drawing for electric toothbrush• Keep toothbrushes and oral health supplies

in the clinic to use as needed• Find a dentist for next year’s career day• Question and Answer cards-PE teacher will

give extra credit for those with good questions

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Sussex High School Pilot Program Sussex High School Pilot Program (cont.)(cont.)

What (cont.): Parent/Guardian Outreach:

• Letters/handouts in report cards

• Information on website and around school

• In future, attend a back to school night

When: Program was implemented on

October 14, 2013

Evaluation: Identify the number of students

that go to the dentist up to six months following the presentation by using the Dental Visit Form and checking claims history

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Collaboration with Health PlansCollaboration with Health Plans

DentaQuest is working with each of the health plans to ensure awareness of oral health services available to Smiles For Children members.

Collaborative efforts include: MCO distribution of

DentaQuest fluoride varnish pads to pediatricians and family practice practitioners

Newsletter articles Attendance at health plan

provider meetings (i.e. Anthem provider forum)

Distribution of DentaQuest pregnancy kits to pregnant women is scheduled to begin in Jan 2014

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Postcard Reminder ActivityPostcard Reminder Activity

June 2012 Mailing

DentaQuest identified all members, ages 1-20 (age 1 on or after 6/1/11), in the 30 counties with the lowest utilization rates.

These members had no date of service between June 1, 2011 and March 1, 2012.

33,78133,781 postcards were mailed to these members.

Of the members receiving postcards, 6,700 (20%) received services within 6 months following the postcard reminder.

January 2013 Mailing

DentaQuest identified all members, ages 1-20 (age 1 on or after 1/1/2013), in the 54 counties with the lowest utilization rates.

These members had no date of service between March 1, 2012 and September 1, 2012.

84,821 postcards were mailed to these members.

Of the members receiving postcards, 22,367 (26%) received services within 6 months following the postcard reminder.

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Meetings and EventsMeetings and Events DentaQuest partners with more

than 30 organizations throughout the Commonwealth. Some of these partners include: Home visitors Head Start Association and the

Health Advisory Committee Virginia Association of Early

Childhood Education Virginia Rural Health Association Virginia Oral Health Coalition Virginia Association of School

Nurses National Association of Social

Workers-Virginia Chapter

Participation in community outreach events include: RVA Streets Alive Newport News Children’s Fest New River Valley Children’s

Health and Safety Day Give Kids a Smile Day Mission of Mercy Events

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PROVIDER OPERATIONSPROVIDER OPERATIONS

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Provider Operations UpdatesProvider Operations Updates Direct DepositDirect Deposit - As of October 30, 2013 , 81.7%81.7% of all SFC

payees are enrolled in direct deposit. Provider Verification ProjectProvider Verification Project – Since June 2013, DentaQuest

has been conducting a Provider Verification Project. As of September 30, 2013, 575 (45%)575 (45%) of the verification forms have been received.

1-800 # for Credentialing Calls1-800 # for Credentialing Calls – Effective 12/2/2013, providers will have direct access to Staff knowledgeable about credentialing/recredentialing process.

App CentralApp Central – During 4th Quarter 2013, DentaQuest will begin pilot testing a “smart” application that will allow Providers to electronically complete credentialing applications. Upon completion of the pilot test, the new feature will be rolled out across all DentaQuest markets.

Provider Web PortalProvider Web Portal – The DentaQuest Provider Portal now features 2 new message types:

Appeals DDS Peer to Peer Call Request

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Provider EducationWinter 2013 Provider Training Seminars:Winter 2013 Provider Training Seminars:

As part of our ongoing provider education efforts, DentaQuest is offering training to all providers via a Webinar:

Monday, Dec. 2, 2013 at 12:00-1:30 pm Tuesday, Dec. 3, 2013 at 12:00-1:30 pm Wednesday, Dec. 11, 2013 at 12:00 –1:30 pm Thursday, Dec 12, 2013 at 12:00–1:30pm

Training topics include: IVR Self Service Functions, Authorizations for OR cases, Changes to Office Reference Manual, Enhancements to the Provider Web Portal, Broken Appointment Tracking, Sealant Program, Dental Home Program and more

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New! Free Online CEU Credits DentaQuest Institute recently

launched a free online dental learning center, allowing dental professionals to earn certified education units for completing learning modules.

Modules include self-paced curriculum on prevention and disease management of caries, from birth to maturity. Go to

http://www.dentaquestinstitute.org to open the online learning center.

Click the Register button to sign up and create your user name and password.

Upon registration you will have access to all the learning resources available.

Watch our Leader Profile videos from oral health leaders who are practicing prevention and disease management.

Browse the Resource Library to view webinars, access valuable web links, and read white papers

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THANK YOU!THANK YOU!