Friday, December 12, 2014

Friday Dental Download: December 12, 2014

This week we discuss why some believe the Affordable Care Act isn’t doing enough for dental plans, learn what South Carolina is doing to improve the oral health of all its citizens, and discover that good healthcare for kids depends on where you live. Don’t forget to check out our new blog series, Why it Matters to Me. Join the conversation on Twitter using #FridayDentalDL.

1. Shortchanged in ACA, dentists hope exchanges can boost coverage: The Affordable Care Act impacts health care providers of all types, but dentists were largely disappointed by its shortcomings in expanding dental coverage. While the ACA deemed dental benefits "essential," requiring insurers to offer dental plans to children up to age 18, the law did not mandate that those plans be purchased, and insurers don't have to offer the same plans for adults. But on the positive side, Dr. Anthony Giamberardino, president of the Massachusetts Dental Society, believes state and federal health care exchanges, the marketplaces where consumers can shop for health and dental insurance, have made people more aware of available dental plans, which could prompt more people to buy coverage.

2. Dental gap: Coverage slips through reform's cracks: Dental care is a peculiar niche of the U.S. healthcare system. Even though teeth and gums are just as much part of the human body as kidneys or elbows, they are insured differently—a lot differently. The question becomes how much the law has done to advance dental care. Not enough, some advocates argue. The Affordable Care Act mandated pediatric dental services as one of the 10 essential health benefits for health plans, but adult dental services were excluded.

3. SC's Healthy Connections program supports oral health: South Carolina's new Medicaid adult dental program emphasizes prevention. That's important because dental problems -- cavities and gum disease – are largely preventable if caught early. We salute the state of South Carolina for the bold steps it has taken to ensure eligible adults have the opportunity for good oral health.

4. How Good Is Healthcare for Kids? Depends on Your ZIP Code: The Department of Health and Human Services has allowed states to choose from a menu of benchmark plans, instead of establishing a federal gold standard for children's health (a decision that runs contrary to the recommendations from the Institute of Medicine). For example, a child with autism or a stuttering problem might fare better or worse depending on where he or she lives. The only way to remedy these problems is for HHS to revise the current essential benefits plan and bar treatment limits and exclusions for children, especially those related to disability or other developmental health conditions.

5. What your teeth are trying to tell you: Statistics show periodontal disease affects over 85 percent of the population. But there's more to your mouth than tooth decay and gum disease. There are some secrets your teeth could be trying to tell you.

Wednesday, December 10, 2014

TennCare Anniversary Highlights Program’s First Year Successes

DentaQuest is marking the one year anniversary of our management of Tennessee’s Medicaid Dental Program, TennCare. We are very pleased to announce that during this first year, we reached or exceeded all benchmarks required by the state of Tennessee.

Our goal with the TennCare dental program was to make it easy for members to visit the dentist and keep their smiles healthy. The importance of establishing good oral health early in life often goes overlooked despite the fact that it is a foundation for lifelong overall health and wellness.

Upon winning the TennCare contract, our first task was to create and manage a dental program that satisfied the needs of members, the state and dentists. We are honored to have the opportunity to work with TennCare Dental Director Dr. James Gillcrist and the dedicated staff of Tennessee’s Medicaid Dental Program in delivering a program that has increased member participation, while significantly reducing program costs. Most importantly, we’re making sure members receive the right care at the right time and in the right amount.

Since October 1, 2014, DentaQuest worked to develop a high-value network from the ground up with a focus on access, quality and efficiency.
  • The current network of 869 dentists ensures that 750,000 Tennessee children eligible for dental benefits receive the highest possible quality of care. 
  • Today, there is 1 dentist for every 857 members. This ratio exceeds Centers for Medicare and Medicaid Services recommended ratio of 1 provider for every 1,500 patients.
  • Members are located 3.4 miles from the closest DentaQuest dentist.
  • The trending dental screening percentage is 90% – surpassing the requirement of 80%.

11 days, 21 hours and 10 hours – That’s the amount of time, on average between the scheduling of an appointment and a member being seen by a provider for routine, urgent care and emergency appointments, respectively.
  • Routine appointments are being scheduled within 11 days. [The benchmark is 21-days]
  • Urgent care appointments are scheduled within 21-hours. [The benchmark is 48 hours]
  • Emergency care appointments are scheduled within 10-hours. [The benchmark is 24 hours]

We are very proud to note that in every instance, we surpassed the required benchmark.

DentaQuest is dedicated to remaining transparent and accountable in our oversight of the program and has released a Report for the Community including findings from TennCare’s November 2014 analysis of the network. Please visit to download a digital version of the full report. 

Monday, December 8, 2014

Why This Matters to Me: Challenges Facing Health Plans

The Affordable Care Act is making great strides in improving America’s access to health insurance; however, this is also creating new challenges for health plans. Below, I’ve outlined some of the pressing challenges health plans are facing and will identify potential solutions in an upcoming post.

Management of the health care of formerly uninsured patients who may have more complicated care needs

The influx of new consumers with difficult to manage conditions is requiring plans to implement population management and look at unique ways to manage the health – and cost – of these patients. It is also important for these patients to have plans that cover preventive oral health care on an ongoing basis, as chronic disease correlates strongly with dental hygiene. The role of dentists in managing chronic disease is explained in my recent blog post here.

On-going costs associated with sustaining and continuously improving new systems

Whether considering introducing a new ancillary line, expanding capacities in a new market, or finding administrative efficiencies, it is important for health plans to evaluate the time, scope and money required. This analysis leads to three potential solutions: build, buy or partner. We’ll dive into the benefits of partnering in my next blog post.

Regulatory pressure is increasing and medical loss ratio (MLR) requirements are placing additional burdens on margins

The Medical Loss Ratio requires insurance companies to spend at least 80% or 85% of premium dollars on medical care and new provisions are imposing tighter limits on health insurance rate increases. Failure to meet these standards triggers a requirement that insurance companies provide a rebate to their customers. As a result, health plans need to find a way to grow their market share without significantly increasing their administrative costs.

The costs associated with the need for investments in advertising and marketing, customer service, and IT and enrollment systems to prepare for the surge in consumer demand.

To capture and manage the influx of new consumers entering the market as a result of the Affordable Care Act, insurance companies are investing in marketing, advertising and IT, and will have to continue to develop more comprehensive outreach programs.

In addition, the growth is requiring the industry to explore new ways to communicate, interpret and store information, requiring the dedication of resources to test, acquire, and implement the latest technological innovations which likely includes mobile technologies to reach patients wherever they are. 

As members’ financial situations change, the channels by which they access insurance will change as well.

Churn is a term often used to describe people moving back and forth between health insurance plans. For example, people often move between eligibility for Medicaid and eligibility for federal subsidies for private insurance bought on the ACA’s exchanges. Churn in the market increases costs, making it imperative to create products that can be easily managed regardless of how the member accesses benefits. The process puts pressure on already strained health plan administrative resources.

Healthcare has made significant advancements under the ACA; however, we need our systems, regulations and business models to evolve to ensure we can remain as productive and effective as possible.

Interested in learning more about ancillary benefits? Read more here.

Friday, December 5, 2014

Friday Dental Download: December 5, 2014

This week we learned that  kids  from lower income families are getting preventive dental care but less treatment, we discussed the importance of South Carolina’s decision to expand its Medicaid adult dental plan, and found out that 100 percent fruit juice does not promote cavities in infant teeth. Don’t forget to check out our new blog series, Why it Matters to Me. Join the conversation on Twitter using #FridayDentalDL.

1. HHS report: Poor kids getting more preventive dental care, less treatment: According to a new report by the Department of Health and Human Services (HHS), poor children received more preventive dental care but less overall treatment in 2013. All children enrolled in Medicaid and CHIP (about 45 million children in 2013) have coverage for dental and oral health services. Despite considerable progress in pediatric oral healthcare in recent years, tooth decay remains one of the most common chronic diseases among children. The rate for preventive dental services increased from 45 percent to 48 percent, compared with 2011, but the rate for dental treatment services decreased slightly from 24 percent to 23 percent in the same period.

2. New study: Pure fruit juice does not promote caries in infant teeth: It is widely believed that unrestricted consumption of acidic beverages, such as juices and soft drinks, can cause dental caries (tooth decay). However, a new study conducted by dental researchers at the University of Maryland, Baltimore, has suggested that consumption of 100 percent fruit juice is not associated with early childhood caries in preschool-age children.

3. APHA 2014: Educating parents about dental care improved kids’ toothbrushing rates: Preventing tooth decay requires more than just regular dental care – it requires active management at home. Researchers from the Louisiana State University Health Sciences Center and Louisiana State University Shreveport studied the effectiveness of in-depth parental dental education and its influence on their knowledge and dental health practices of their children. The study found that educating parents about oral hygiene does have a positive effect on their children's oral hygiene practices.

4. Matthews: Medicaid’s new dental plan will improve overall health: DentaQuest South Carolina’s dental director, Rebekah Mathews wrote an editorial that was featured in The State. This week South Carolina began its expanded Medicaid adult dental plan. Mathews explains, “South Carolina’s Medicaid adult dental program now emphasizes prevention. That’s important because dental problems — cavities and gum disease — are largely preventable if caught early. Eligible adults can receive up to $750 per fiscal year in dental services to get the restorative care they need and the prevention services they previously lacked. Having dental benefits is a key factor in an individual’s ability to live a healthy, successful life.”

Monday, December 1, 2014

Dental Enrollment Contributes to ACA 1st Year Success

By Steve Pollock, Chief Operating Officer, DentaQuest

The recent reaction to an enrollment reporting mistake made by the U.S. Department of Health and Human Services (HHS) undermines one of the often-overlooked successes of the ACA; people now have access to dental coverage and for many, it is for the first time in their lives.

Late last month, the Obama administration acknowledged that it inaccurately reported the total enrollment figure for those in coverage through the Affordable Care Act’s (ACA) health insurance marketplaces. Bloomberg News reported that the inaccuracy was due to the U.S. Department of Health and Human Services (HHS) including dental plan enrollments in its final tally. Following the Bloomberg report, critics of the ACA railed against the Administration and HHS Secretary Sylvia Burwell sent out the following via her twitter account:

There is no doubt that data transparency and accuracy is absolutely critical to measuring the impact of the ACA. Critics and supporters of the ACA alike must have accurate information. However, it would be wrong to suggest that dental enrollment through the health insurance marketplaces should not be counted towards painting an accurate picture of what coverage under the ACA looks.
More than one million people selected a dental plan through their federal or state-based marketplace last year. That number is especially significant considering that:
  • Dental coverage is optional for people shopping on the marketplaces (though it was not the intent of the law that it be optional for children) and
  • Most people do not have subsidy dollars to help them pay for dental coverage.

For much too long, access to affordable dental care has been a significant unmet health need in the US. In 2000, the US Surgeon General referred to the state of oral health in America as a silent epidemic. Although many in the oral health community have worked tirelessly to address this oral health crisis, the situation remains dire:
  • Dental disease is the number one chronic illness among children.
  • As a country, we spend more on the treatment of dental disease – which is nearly 100 percent preventable – than we do on the treatment of all cancers combined.
  • Nationwide, we lose 52 million school hours and 164 million work hours each year due to preventable dental disease.

One of the most significant barriers to accessing dental care is cost. Dental coverage significantly reduces the financial barrier to care. The ACA has made significant progress in addressing this barrier by making affordable dental coverage options available to consumers in a new and more accessible way. Just imagine the impact that the marketplaces could have in connecting people to dental coverage if the Administration opened up the option for dental shopping to anyone who needed it – not just those looking for medical coverage.

It is a problem that the reporting of the enrollment reporting snafu cast dental coverage in a negative light. However, we applaud Secretary Burwell’s call for a culture of increased transparency within the agency that she oversees. We need to have clear data on dental coverage as well as medical coverage. It is for this reason that we, along with the dental insurance industry, have asked HHS to provide a more detailed analysis of dental enrollment under the ACA.

Oral health is critical to overall health. We cannot continue to allow oral health to take the back seat in healthcare. This situation has created an opportunity to discuss both the need for greater data accuracy AND the success of the ACA in connecting Americans to dental coverage. It is time to change the discussion.

Monday, November 24, 2014

Responding to Urgent Community Needs

As we prepare to celebrate Thanksgiving with family and friends, we want to recognize some community organizations. Over the year, the DentaQuest Foundation reserves grant funds to respond to urgent equipment and capacity needs at care and prevention organizations. Without this assistance, many of these vital community health organizations might have had to limit what are often invaluable services for targeted communities. Here are some examples:
  • Little City Foundation (Chicago), operating under the umbrella of the Center for Health and Wellness, provides specialized medical and oral health care for children and adults living with autism, intellectual, or developmental disabilities. It is the only on-site facility of its kind in Illinois. Little City Foundation has developed expertise in a desensitization process has been helpful in preparing clients before they receive oral health services. The agency’s dental hygienist has been demonstrating this model to peer agencies, school districts, individuals and families in the greater Chicago metropolitan area, helping more than 350 children a year. A Community Response Fund grant has enabled a part-time hygienist to extend this training to more caregivers, school districts and peer agencies.
  • Bering Omega Community Service’s Oral Health Clinic (Texas) tends to the wellbeing of people affected by HIV/AIDS in Southeastern Texas. In 2013, the clinic cared for 2,500+ indigent and uninsured individuals. A grant from the Community Response Fund assisted with general operating costs so the clinic could continue to nurture and support patients with HIV/AIDS.
  • As a teaching hospital, St. Vincent Charity Medical Center (Cleveland) is providing a new generation of healthcare providers with an excellent medical education and a passion for meeting the healthcare needs of their communities. A Community Response Fund grant supported a residency program for six young dentists, providing exposure to all phases of general dentistry, including anesthesia, internal medicine, general surgery, and emergency service. The Residence program provides comprehensive dental services to a diverse and low-income population. 
  • Elko Family Dental Center (Nevada Health Centers) is the largest resource for primary care for uninsured, underinsured, and geographically isolated people in Nevada —its rural and frontier clinics are often the only places where people can get healthcare without having to travel hundreds of miles. The Centers accept Medicaid and offer a sliding fee scale based on federal poverty levels. The Elko dental office has two dentists and previously only one functioning dental chair. A Community Response Fund grant added a second chair and helped the clinic reduce wait times and serve many more patients.
  • Saban Community Clinic’s Comprehensive Dental Program (Los Angeles) provides oral health services to children and adults at two sites in Los Angeles. Many of Saban’s patients recently became eligible for the Denti-Cal program which added dental coverage for adults effective May, 2014. Anticipating a growing demand for dental services, Saban requested funding from the Community Response Fund to replace aging equipment.
  • The Caring Hands Dental Clinic is recognized as a Minnesota Critical Access Dental Provider and a National Health Service Corp site. Its Mobile Outreach Hygiene Clinics provide x-rays, cleanings, exams, and fluoride treatments to residents of area nursing homes. Providing dental services where the patients live eliminates the stress and possible complications of transportation and has enabled the clinic to reach patients at additional nursing homes. A Community Response Fund grant offset the cost of supplies and travel.
  • When the Roxbury Comprehensive Community Health Center (Boston) closed in 2013, thousands of patients might have been left without dental care options. Nearby Whittier Street Health Center (Boston) stepped in and has been transitioning RoxComp patients into their departments. The volume of newcomers to Whittier’s dental program resulted in backlogs with patients waiting for months to get a dental appointment. A Community Response Fund grant helped Whittier Street Health Center add dental chairs, expanding capacity, improving operational efficiencies, and increasing access to timely and cost-effective care in a high-need community. 

The oral health community is made richer and stronger because of these community organizations and their efforts. While on the path toward larger-scale systems change with Oral Health 2020, the DentaQuest Foundation will continue to provide essential resources to address urgent community needs of underserved populations.

Friday, November 21, 2014

Friday Dental Download: November 21, 2014

This week we discuss that while Americans are gaining dental coverage, they still aren’t getting treated, we learn that tooth decay is linked to risk of kidney disease, and we discover a toothbrush that makes brushing your teeth fun! Don’t forget to check out our Movember blog post to learn more about the relationship between men’s health and dental health, and our new blog series, Why it Matters to Me. Join the conversation on Twitter using #FridayDentalDL.

1. Financial hurdles remain for dental care: Americans are gaining dental coverage through the Affordable Care Act, but according to the dental community, the health care law isn't doing enough to Medicaid to improve reimbursement rates for the care. According to the American Dental Association, approximately 8.7 million children – and about 800,000 adults – could gain extensive dental coverage through the ACA by 2018. A barrier to access dental care is the lack of private dental offices that accept Medicaid or limit the number of Medicaid patients.

2. Cardiologists have knowledge gaps about perio disease: A new study in the Journal of Dental Hygiene looked at cardiologists' knowledge of the relationship between periodontal disease (tooth decay) and heart disease and found that many were unclear about the cause of periodontal disease. Over the past several years, new evidence has shown links between tooth decay and diabetes, adverse pregnancy outcomes, and heart disease. The majority of physicians who participated in the study agreed it is important for cardiologists and periodontists to work together to educate their patients about oral systemic disease risks.

3. An entrepreneur’s vision for dental hygiene: Tooth brushing as an immersive experience: Alex Frommeyer, CEO of Beam Technologies, plans to shake up the world of tooth brushing with the Beam Brush, a platform connecting consumers with their toothbrush, dental goods and services. The electric toothbrush tracks brushing activity through its partnered iOS and Android app. The app collects behavioral data, such as brushing time and movements. It also keeps score for families to compare and share. The updated brush, scheduled to come out December 1, 2014, becomes a remote control for several games, including a horizontal scrolling game with obstacles similar to Mario. This feature allows users to play a game on their app with their tooth brush – engaging them in a mission to brush their teeth for 2 minutes without getting bored.

4. Periodontal disease linked to increased risk of kidney disease: In a study of African-Americans with normal kidney function, those with severe periodontal disease developed chronic kidney disease at four times the rate of those without severe periodontal disease, according to a presentation at the recent American Society of Nephrology meeting in Philadelphia. Researcher Dr. Vanessa Grubbs noted that because periodontal disease is common and can be prevented and treated, targeting it may be an important path towards reducing existing racial and ethnic disparities in chronic and end-stage kidney disease.