Smiles Across America Webinar Series

Date: 12/15/20105

Strategies to Increase Oral Health Care Access

for Children in Medicaid: The Power of

Collaboration

/Oral Health America @Smile4Health

Connect with OHA!

/Oral Health America @Smile4Health

HOUSEKEEPING INFORMATION

• Please remember to MUTE your phone.

• Questions are welcome! We’ll allow 10-15 minutes after the presentation for questions.• Questions will be accepted in writing through the control

panel on the upper right hand of your screen.

• Submit questions at any time; we will address them at the end of the presentation.

• Webinar is being recorded; for rebroadcast on OHA’s website – OralHealthAmerica.org

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OUR MISSION

Oral Health America’s mission is to change lives by

connecting communities

with resources to drive access to care, increase

health literacy, and advocate for policies that

improve overall health through better oral health for

all Americans, especially those most vulnerable.

OHA PRIORITIES

ADVOCACYHEALTH

LITERACYACCESS

OHA’s Programs and Campaigns are designed to improve

access to care, oral health literacy and policies that

prioritize the impact of oral health on the overall health of all

Americans – particularly those most vulnerable.

Campaigns for Oral Health Equity

Educate the public, including policy makers, about the importance of oral health for overall health

Emphasize the need to prioritize oral disease alongside other serious health conditions

Advocate for policies that positively impact programs and stakeholders

Current campaigns include:

toothwisdom.org Demonstration

Projects

Professional

Symposia

Advocacy Health Education &

Communications

Technical Assistance

Product Donation

Grant Funding

www.chcs.org

Advancing access, quality, and cost-effectiveness in publicly financed health care

December 15, 2015

Working to Improve Oral Health for Children in

Medicaid: The Power of Collaboration

Supported by the DentaQuest Foundation

I. Overview of Children’s Oral Health in Medicaid

II. Working Collaboratively with Managed Care

III. Women, Infants, and Children (WIC) Pay-for-Prevention Project

IV. Pursuing Legislative Change

V. Leveraging Existing Resources

VI. Statewide Collaborative Efforts

VII. Questions

Agenda

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Presenters

Stacey Chazin, MPH, CHESDirector of Prevention ProgramsCenter for Health Care Strategies

Jessica Lipper, MSJProgram OfficerCenter for Health Care Strategies

Katherine LibbyProgram DirectorVirginia Oral Health Coalition

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About the Center for Health Care Strategies

A non-profit health

policy center

dedicated to

improving the

health of low-

income Americans

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Medicaid’s Purchasing Power

Medicaid serves 70 million Americans

With Medicaid expansion, may serve more than 80 million

45% newborns

33% children

Many people with chronic illnesses and

disabilities

Many frail elderly

Poor health care quality is an issue for

all Americans; however, the gap is substantially greater

for Medicaid beneficiaries

As the largest purchaser of health insurance, Medicaid

can leverage its purchasing power to:

Access performance data

Identify and address gaps in quality

Focus of CHCS Oral Health Initiatives

• Support state Medicaid agencies and stakeholders to advance oral health care access, utilization and quality for low-income children and adults.

• Facilitate collaborative learning and provide direct technical assistance.

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Use of Dental Services by Medicaid-Enrolled Children

• Dental care is fully covered by EPSDT, but fewer than half of Medicaid-enrolled children nationally receive any dental service each year, and even fewer receive a preventive dental service.

• Rates of preventive dental service utilization have been increasing slowly, but vary widely by state – ranging from 21% in Ohio to 60% in Connecticut.

• States that have achieved increases in utilization often grapple with how to improve beyond a certain point.

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Barriers to Oral Health Care Among Medicaid-Enrolled Children

• Inadequate:

► Number of Medicaid-participating dental providers

► Willingness of dental providers to treat young children

► Transportation to appointments

► Awareness of Medicaid dental benefits and oral health care guidelines

• Cultural barriers

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CMS National Oral Health Initiative

• A 2010 to 2015 initiative with two goals:

► Goal #1 – Increase by 10 percentage points the proportion of Medicaid and CHIP children ages 1 to 20 (enrolled for at least 90 days) who receive a preventive dental service.

► Goal #2 – Increase by 10 percentage points the proportion of Medicaid and CHIP children ages 6 to 9 (enrolled for at least 90 days) who receive a sealant on a permanent molar tooth.

• CMS continues to support states to improve access

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CHCS Medicaid Oral Health Learning Collaborative

• Supported seven states working toward the two CMS national oral health goals

• Provided quality improvement concepts and tools, peer learning opportunities, and tailored technical assistance

• Conducted all-state and individual state technical assistance calls and convenings

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Focus of State Aims to Advance Preventive Dental Service Utilization

• Increasing the percentage of:

► Oral health providers delivering a preventive dental service

► Non-dental providers delivering fluoride varnish with a dental referral

► All children (or specific ages) who receive a preventive dental service

► Pregnant women ages 19-21 served by WIC who receive a preventive dental service

► Children who have a dental home

• Reducing age of first dental visit

• Increasing use of alternative providers

• Improving rates and accuracy of billing and reporting

• Tracking referrals to dental care

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Range of Interventions: Goal #1

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Providers

• Dental gap reports and peer comparisons

• CE for online oral health training

• Messages about oral health care in provider forums, mailings, calls

• Reimbursement to PCPs for fluoride application

• Incentives for provider performance and reporting; expanded office hours

Families/Members

• Calls and letters to families with last dentist visited; help to schedule appointment

• OBGYNs educate pregnant women about importance of oral health

• Oral health messages in educational materials for pregnant women

• Plan newsletters with oral health messages

• Public service announcements in customer service hold times and social services waiting rooms

Focus of Aims to Support Goal #2

• Percentage of children ages 6-9 who receive dental services from a dental home

• Percentage of providers applying sealants to children ages 6-9

• Plan encouragement of sealant application

• Number of schools with sealant programs

• Percentage of children ages 6-9 receiving a sealant in a particular setting

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Range of Interventions: Goal #2

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Providers

• Required to serve as dental home

• Incorporate messages about sealants in provider education

• Train non-dental providers in sealant application

• Educate school nurses on importance and availability of sealants

• Allow hygienists providing services in public health programs to bill Medicaid

Families/Members

• Assign members to dental home

• Educate members about importance of sealants

• Call members with no dental history to help schedule a dental visit

Working Collaboratively with Managed Care: Arizona

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• State is contracted with 15 managed care organizations (MCOs) serving 90%+ of all Medicaid beneficiaries

• MCOs provide:

► Gap reports to providers of members who have not received a fluoride application

► Outreach to general and pediatric dentists through mailings, phone calls, and forums

► Provider education through online training

• AHCCS-conducted outreach to managed care dental directors, MCOs, and quality improvement staff

• AHCCCS-driven dental work group, ongoing monitoring and oversight

Efforts to Increase Fluoride Varnish by Non-Dental Providers: Arizona

• Policy change allowing reimbursement to primary care providers for fluoride varnish application

• Outreach to non-dental providers through mailings, phone calls, and forums

• Monthly gap reports

• Provider education through online training

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Takeaways from Arizona’s Efforts

• Proactively let providers – both dental and non-dental – know how they are doing.

• Use all methods of outreach available; what works for one entity may not work for another.

• Policy changes to reimbursement are helpful as a means of incentivizing non-dental providers to apply fluoride varnish.

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WIC Pay-for-Prevention Project: New Hampshire

• Services provided by a registered dental hygienist under public health supervision

• Dental clinics held at regular intervals, up to once per week

• Referrals made to local dental offices

• Three original pilot locations, currently operating in two

• Evaluation of return on investment for on-site treatment and referrals

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Partnering with New Hampshire WIC

• Oral health education messages from the dental hygienists and dental assistants align with WIC’s nutrition messaging:

► Eliminate sugar-sweetened beverages

► Reduce consumption of fruit juice

► Eat more fruits and vegetables

► Smoking cessation for pregnant women

• Quarterly visits by WIC-enrollees to local offices provide an opportunity to:

► Reinforce dental hygiene

► Provide preventive dental services on a regular basis

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Takeaways from New Hampshire’s Efforts

• Think out of the box – look for ways to bring dental care to high-risk populations

• Consistency is key

• Identify partners within the community

• Use messaging that is in-sync among the partners

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Pursuing Legislative Change: Minnesota

• Focus on revision to Medicaid dental reimbursement and delivery system

• Efforts began with stakeholder meetings resulting in a report to the legislature recommending:

1. Increase base payment rates for dental services and refine the payment structure;

2. Support an evidence-based, integrated service delivery system; and

3. Improve administrative structures.

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Pursuing Legislative Change: Outcomes

• The legislature requested the Department of Human Services to draft a legislative proposal

► Stakeholders engaged to aid in crafting legislation

• Although unsuccessful in passing the full legislative package:

► Rates for rural providers were increased

► Teledentistry was added to the benefit set

► The Department continues to work with stakeholders for further legislative change

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Takeaways from Minnesota’s Efforts

• Sometimes it makes the most sense to focus on the bigger picture.

• Stakeholder involvement is critical, especially when working with lawmakers.

• Stronger stakeholder relationships exist because of the process.

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Leveraging Existing Resources: Washington

• Access to Baby and Child Dentistry (ABCD)

► Recruit and train dentists

► Work with community organizations to identify eligible children and remove barriers to access

► Train primary care providers to deliver preventive services

• Inter- and intra-agency collaboration

► Children’s Administration

► Health Care Authority

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Leveraging Existing Resources: Washington

• County coordinators work closely with dental champions, the dental society, and participating dentists to ensure eligible children are receiving necessary care

• County coordinators:

► Conduct outreach to organizations

► Identify and enroll young children in ABCD

► Match each child to a dentist

► Outreach to clients under age 20 with no recent dental visit

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Takeaways from Washington’s Efforts

• Utilize resources already available

• Delegate work to those on the ground

• Actively pursue providers

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Collaborating to Improve Oral and Overall Health in Virginia

Katherine Libby

Program Director

Virginia Oral Health Coalition

December 15, 2015

Overview

• Background

• Setting the stage for collaboration in Virginia

• Examples of collaborative efforts and some results

• Key takeaways

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Virginia Oral Health Coalition

Individuals and organizations from wide range of issue

and stakeholder groups work

together to lift up issues, identify

solutions and enact change

Backbone organization

convenes, coordinates,

communicates and drives

Shared problem solving,

implementation and strategies promotes

change

Striving to integrate oral health into all aspects of health and wellness through advocacy,

education and public awareness

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Setting the Stage - Key Partners and Activities• VaOHC, Medical and Dental Collaboration Initiative

• DentaQuest, LLC, Early Dental Home (EDH) pilot project

• Virginia Department of Health, Bright Smiles for Babies

• Department of Medical Assistance Services (DMAS), Oral Health Learning Collaborative

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What do you notice about each of these organizations?

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Overarching Goal: Improve access to and utilization of oral health care services for Smiles for Children enrollees

Targeted: Increase the number of children receiving oral health prevention services in medical primary care and that have a

dental home by age one

Targeted: Increase the number of pregnant women enrolled in Medicaid and FAMIS MOMs receiving dental services

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Expanding The Network

• “Traditional” stakeholders– Public health dental professionals– Dental safety net

• “Non-traditional” stakeholders– Medical providers– Academic institutions– Provider associations– Department of Social Services– Women, Infants, and Children program– Headstart– Home visitors– Childcare workers– Managed care organizations– Grassroots organizations

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Aligning Activities and Stakeholder Groups

• Medical Dental Collaboration Task Force

• Early Dental Home Group

• Pediatric Champions

• “Data and Strategies” Team – OHLC core group

– DMAS

– DentaQuest

– Virginia Department of Health

– VaOHC

Part of it all!

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Collaboration At Work - Example

• Increasing oral health prevention activities and dental referrals in pediatric primary care– Survey about oral health practices in pediatric practices– Meetings with pediatric providers (‘focus groups’)– Creation of local ‘champions’ position– In office trainings, group education at conferences, grand

rounds– Dissemination of dental referral tools, strategies and program

information– Toolkits for providers– Utilizing data to target strategies, learn and guide future efforts

(e.g., examining disparities)– Developing best practices

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Collaboration At Work - Example

• Increasing the number of pregnant women enrolled in Medicaid and FAMIS MOMs receiving dental services– Early Dental Home Work Group

• Disseminate information about oral health and dental benefits

• Identify opportunities for education for non-traditional stakeholders

• Think creatively about other opportunities for outreach

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Collaboration At Work - Results

• Increased number of non-dental providers billing for fluoride varnish

• Established 2 pediatrician and pediatric dental provider champion teams (Richmond, Roanoke)– Facilitating education and training in local

community

• Delivering information, education and training to non-dental providers in a variety of settings– (e.g. School Nurses Association, American

Academy of Pediatrics Virginia Chapter Board, Independent Practice Association meetings)

• Electronic oral health in primary care toolkits –all information in one spot!

• Using data to target outreach to providers

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Collaboration At Work - Results

• Providers contacting us for more information about oral health and fluoride varnish trainings

• Department of Social Services request for online learning modules for childcare workers

• Core group members often perceived as being from the same organization

• Relationships leading to new or expanded opportunities

…less tangible, but equally important!

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Why It’s Working

• Diversity of partners – expanded reach

• Activities are mutually reinforcing work toward common goal

• Helps overcome organizational/capacity limitations

• Maximizes limited resources

• Relationships are sustainable (and often free!)

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What It Looks Like

• Continual communication and information sharing – One-on-one, through project teams,

workgroups (Early Dental Home, Champions planning, etc.)

• Cross promotion, education and outreach – tag team!

• Scheduled, regular meetings• Periodic assessment of current

activities, gaps, opportunities• Stakeholder engagement and outreach

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What It Takes

• Dedicated time to relationship development and building trust

• Understanding limitations

• Communication

• Support, individually and as organizations

• Openness

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Takeaways

• Involved leadership• Collaborative structure – driving force behind

sustainability• Understand individual and organizational focus

areas and limitations – create partnerships that fill gaps

• Communication is key• Time spent engaging new stakeholders, building

relationships, and learning about what they are doing is time well spent!

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If you want to go fast, go alone.

If you want to go far,

go together.

African Proverb

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To Summarize…

• What works for one state, may or may not work for another and depends on factors such as:

► Geography

► Demographics

► Payment system

► Resources – financial, human, and otherwise

• There are many ways to improve utilization by addressing barriers on a small or large scale

• Actively pursue and engage stakeholders, fostering new and existing relationships

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To Summarize…

• Engage leadership in state departments, as well as community organizations

• Communicate with a wide range of stakeholders

• For more information about approaches to advancing oral health for children served by Medicaid, visit www.chcs.org.

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Question and Answer Session

• Questions are welcome! This session may last for 10-15 minutes.

• Write your questions in your control panel on the upper right hand of your screen.

• Submit questions at any time.

Contact Information

• Stacey Chazin, MPH, CHES• schazin@chcs.org

• Jessica Lipper, MSJ• jlipper@chcs.org

• Katherine Libby• klibby@vaoralhealth.org

• Tyler Brown• tyler.brown@oralhealthamerica.org