Wednesday, April 22, 2015

When We Pay for Performance, Prevention is Key

By Steve Pollock, Chief Executive Officer

In the midst of a constantly-evolving climate in health care, one thing is constant: our pursuit of the triple aim. In my last blog post, I discussed how ancillary benefits can achieve the goals of the triple aim: to improve population health, advance quality of care and reduce long-term costs. Here, I’ll discuss another way payers and providers can solve this puzzle -- through pay-for-prevention programs.

Pay-for-performance programs encourage providers to keep their patients healthier through financial incentives. A national survey found that 52 percent of health maintenance organizations (HMOs) have implemented some form of pay-for-performance already. Additionally, the Affordable Care Act includes a number of provisions that encourage this goal of controlling costs while increasing health outcomes. We’re finding that this means we need to do more than reactive care.

Preventive care is the solution across the board, be it medical or dental services. Oral disease is preventable, not inevitable. Treating cavities is much more costly – to the patient, the provider and the payer – than providing the initial services that could have prevented the cavity in the first place.

Working with our health plan partners, DentaQuest has found a way to weave in a pay-for-performance program that has been successful through our PreventistrySM initiative. In one program, we saw an increase in the number of higher-risk children who received fluoride treatments by 30 percent after just 12 months.

As our health care needs change, we are adapting to ensure our members stay healthy and receive the treatment they need – when they need it.  We are looking for opportunities to shift our focus to treating preventable health issues before they emerge, rather than waiting until patients come to providers after issues arise.

Tuesday, April 14, 2015

Tips for Tots: Set Your Kids Up for Healthy Teeth

By Dr. John Luther, Chief Dental Officer, DentaQuest

Whether it’s changing diapers or taking the kids to soccer practice, parents of children of all ages have ample responsibility to keep their children happy and healthy. Even from an early age, this duty includes promoting good oral health to ensure their kids have healthy smiles for a lifetime.

Current research shows that just over half of children between the ages of six and 11, and 28 percent of preschoolers have tooth decay. Some might say, “It’s okay to have cavities as a child – they’ll lose those teeth anyway.” But, in reality, these statistics are a serious issue. Contrary to what many believe, getting cavities is NOT an inevitable part of growing up.  Dental disease (cavities and gum disease) are nearly 100% preventable. Kids who have cavities grow up to be adults with tooth decay, and that can lead to other serious and costly health problems later on.
Luckily for busy parents, here are a few easy, preventive habits that can help your children maintain good oral health:

Head to the dentist when first tooth emerges
Connecting your child to a dental home, or an ongoing relationship with a dental care provider, from the moment the first tooth comes in is essential to long-term oral health. From the first visit onward, make sure to schedule dental check-ups every six months. You’ll learn the dos and don’ts about taking care of your child’s teeth at home. Also, during these initial preventive visits, a dentist can help make sure your child’s teeth and gums are in optimal condition for permanent teeth to come in.

Before teeth, use a washcloth
While you’re waiting for your baby’s teeth to grow in, get prepared by gently cleaning the gums twice a day with a wet washcloth. When the baby teeth do come in, keep up the routine so the teeth stay strong and healthy, and the mouth will be free of cavity-causing bacteria from the start. The lower teeth typically appear after eight months, followed by the upper front teeth at 10 months and molars at 26 months.

Choose healthy snacks
In moderation, fruits are healthy alternatives to other snacks with added sugars – however, not all fruits are the same. While firm fruits like apples and pears can help keep plaque off the teeth, bananas and raisins are chewy, sticky and full of sugar that can stick to your teeth. Granola bars, another deceivingly unhealthy snack, are packed with sugar. So, when you give your child a mid-day snack, think about nuts or seeds instead which help rebuild tooth enamel. If your child is very young, it’s a good idea to check with your pediatrician about peanuts.

Avoid surprisingly sugary drinks
Apple juice and milk are classic childhood drinks, but when provided in excess or at the wrong time, these drinks could promote tooth decay. Watering down juices to a mixture of ¼ juice and ¾ water can drastically cut your child’s sugar intake. If it’s a drink before bed, be sure to stick to water – not milk – as the sugars linger in your child’s mouth overnight, feeding bacteria that cause cavities. After any sugary drinks or snacks, rinse your child’s mouth with water and be sure to brush before bed.

Wednesday, March 25, 2015

Winning Strategies for Health Plans: Medical Dental Integration: One Plan’s Perspective Leading to Success

By Steven Pollock, Chief Operating Officer, DentaQuest

We are continuing to see new data that links preventative attention to oral health with improvements in overall health and well-being -- beyond the dental office.

Most notably, health plans have taken note of this connection through dental-medical integration programs. These plans target members with medical conditions linked to oral health issues, such as diabetes or heart disease, and have become an increasingly common component in commercial group benefit programs. Within Medicaid, Medicare and CHIP programs, dental-medical integration brings the best of both worlds to health plans and customers - an opportunity to improve care outcomes and decrease costs.

Recently, I led a webinar discussion during which Dr. Justin Cramer, chief medical officer of Missouri Care, shared his experiences with a dental-medical integration program targeted at Medicaid members. Missouri Care is part of the WellCare family of health plans which provides managed care services to health care programs supported by the government, with a focus on Medicaid and Medicare.

In 2011, Missouri Care approached DentaQuest to help gain control over the rising cost and ineffective care of ER utilization for dental visits. In response, we created DentaQuest’s ER Diversion program to educate and redirect members to a dental office setting during dental emergencies, rather than the ER.

By way of background, reports from the American Dental Association (ADA), Florida Public Health Institute, Rutgers University and the Pew Center revealed a growing number of young adults (18-34) from low-income communities who were using the hospital emergency department for non-traumatic dental care. Not only are ERs among the most expensive sources of care, but they also are poorly equipped to provide dental care and are often only able to provide temporary relief for the problem.

To tackle this issue, DentaQuest and Missouri Care executed a three-prong approach to:
  • Educate members on the importance of preventative care;
  • Decrease emergency dental care; and
  • Increase dental care in a dental office setting.

To accomplish these goals, DentaQuest reached out to Missouri Care members who had recently visited the ER for dental-related issues by phone and mail. Our team provided assistance in finding a dentist, helped them schedule an appointment and offered suggestions on what to do next time they had a dental emergency.

We tracked the effectiveness of the outreach in several ways -- claims data, individuals who went to dentist in office setting, and education. The chart below speaks to the success of the program from 2011 to 2014.

Missouri Care is just one example of how dental-medical integration is achieving the triple aim of improving quality of care, reducing costs and improving member health outcomes. Furthermore, studies have shown that medical costs related to chronic diseases go down significantly when we treat dental disease to improve overall health. Long gone are the days of solely treating the outcomes of dental disease - we now know that by increasing our focus on prevention and early intervention, we can lower the cost of medical and dental treatment in the long-run.

Thursday, March 19, 2015

Think Teeth: Kids’ dental health improving, but there is still work to be done

By Ralph Fuccillo, President, DentaQuest Foundation

A recent CDC report revealed promising news - early childhood caries in preschool-aged children is at its lowest rate in 25 years. Preventing oral disease at an early age leads to a lifetime of healthy smiles, and this achievement is one that should be celebrated.

However, tooth decay is the still most common chronic disease of early childhood — 5 times more common than asthma. Half of all kids experience tooth decay before age 12.  

At the DentaQuest Foundation, as a part of our Oral Health 2020 goals, we’re working with a growing network of partners to ensure that 75 percent of children reach age five without experiencing tooth decay. Although we have made great strides in reaching this goal, there is still much to be done.

We all want the best for our children, but oral health doesn’t always get the attention some other health issues do. That’s why it’s especially striking to look at the research that points out how tooth decay can have long term impact on children’s lives.  For example, children with poor oral health were nearly three times more likely to miss school, according to a study from the North Carolina Health Assessment and Monitoring Program. Children who reported recent toothaches were four times more likely to earn a lower grade-point average than peers reporting no dental pain. 

Luckily, the most common chronic childhood disease is also almost completely preventable. We have identified many cost-effective, simple ways to reduce tooth decay. The cost of applying a decay-preventing dental sealant to a child’s permanent tooth is much less than the cost of filling a cavity, and ongoing maintenance of that restoration. To provide another example, would you believe that every $1 spent on water fluoridation saves $38 in dental costs? By providing early, preventive care, we can improve overall health and save costs for the long-term.

In addition to making dental care more cost-effective overall, programs such as Children’s Health Insurance Program (CHIP) have made care more affordable for individuals. CHIP has been a critical source when it comes to providing dental coverage for children whose families earn too much to qualify for Medicaid but too little to purchase private insurance. CHIP and Medicaid are already an oral health safety net for millions of children, covering services such as teeth cleanings, check-ups, x-rays and fluoride treatments.

Although CHIP currently ensures care for eight million children across the county, affordability will become a concern in the near future unless Congress chooses to extend CHIP funding before it expires in September. However, creating affordable care is only half the battle. An estimated 3.7 million children are eligible but not enrolled in Medicaid or CHIP, resulting in even more children who could miss out on preventive care merely because they are unaware of the benefits available to them.

Our duty to the next generation and their families is two-fold: to provide education on preventive oral health care and the benefits available to them, and to ensure that their preventive care stays affordable and accessible. If we can do this, our goals of improving the oral health of all are well within reach. However, if we do not follow through on both of these promises, it’s likely that much of our progress will be lost.

We can work together to make changes. These free materials have been developed so you can help families make good oral health habits, and provide tips for pregnant women, parents and caregivers.  There are also resources, in both English and Spanish, to spread the word on social media.

Join us and others in this movement by visiting to learn more.  Share your stories and show your support for this movement by connecting with Oral Health 2020 on Twitter and Facebook. 

Thursday, February 19, 2015

Get a Head Start: Prioritizing Our Kids’ Dental Care

By Ralph Fuccillo, MA, President, DentaQuest Foundation

As Dr. Luther mentioned in his post last week, February is National Children's Dental Health Month. I’d like to highlight an oral health program for children that is seeing some exciting results, which could serve as a leading best practice when it comes to prioritizing our kids’ oral health. In this collaboration between Massachusetts and Pennsylvania, called Building Successful Collaborative State Oral Health Consortiums, we are addressing oral health disparities and promoting access to care for children.

Most infants and one year-olds in the U.S. have seen a physician, but a mere 2 percent have ever visited a dentist. Surprising to many, children who wait until age two or three to see a dentist actually experience more dental issues than those who visit a dentist on their first birthday, or when the first tooth comes in, as recommended by the American Dental Association. In an effort to change this trend, the DentaQuest Foundation and Head Start Association worked together to encourage early childhood oral health care.

Head Start offers a comprehensive preschool program to low-income children, and also provides families with relevant health information and ensures that children in the program receive regular physical and oral health check-ups.

Through a grant from the DentaQuest Foundation, the Massachusetts and Pennsylvania Head Start Associations created a three-pronged approach to encourage early childhood care for oral health, which includes:
  • Developing relationships with key stakeholders including state oral health and public health organizations;
  • Promoting oral health education; and
  • Increasing access to oral care. 

Now in the third and final year of our initiative, our Head Start partners have experienced promising successes to share in both states.

The Pennsylvania Head Start Association has done a great job of getting the word out about early childhood care. They developed effective oral health coalitions through multiple forums, which had more than 175 participants. Additionally, they've trained more than 250 individuals in the “Cavity Free Kids” curriculum, which helps children practice good oral health habits. Of these trained individuals, many are teachers, infant/toddler specialists, family advocates and more. Furthermore, to date, more than 335 Pennsylvania dentists have been educated on the importance of treating one year-old children.

The Massachusetts Head Start efforts successfully connected children to dentists, giving them a “dental home”. At the start of the initiative, only 19 percent of dentists said they treated children age one or younger. Massachusetts Head Start implemented a program called “Connect the Dots”, to help dentists and primary care doctors understand the importance of starting a dental home at an early age. At the end of the first two years of the initiative, the number of dentists in Massachusetts reporting the treatment of children at age one grew from 19 percent to almost 40 percent.

We're proud of our work with the Massachusetts and Pennsylvania Head Start Associations, but we still have more work to do if we want to meet our national goal of 75 percent of children to reach age five cavity-free. From a national perspective, Head Start programs offer a great opportunity to reach our youngest children at a critical time in their development. We are looking at the lessons learned from the work done in Massachusetts and Pennsylvania, and sharing these tactics with our community partners across the U.S. By training the next generation on best practices, we are mobilizing communities to be sure all children receive the dental care they need, when they need it.

For more information on Head Start, visit (National Head Start Association) and (the Office of Head Start’s Early Childhood Learning and Knowledge Center). 

Friday, February 13, 2015

It’s National Children’s Dental Health Month and Here are Six Steps to a Lifetime of Healthy Smiles

By: Dr. John Luther, Chief Dental Officer and Senior Vice President, Dental Management, DentaQuest

February is not just for Valentine’s Day and cold winter weather - it’s also National Children’s Dental Health Month!

While we often focus on the importance of kids’ oral health in our work (and on this blog) we wanted to take a moment to recognize the importance of this month, and of promoting steps that can help protect the next generation of teeth.

The need for better education and care is clear:
  • In the United States, 28% of preschoolers and 51% of 6-11 year olds have cavities.
  • American children lose 52 million school hours due to oral health problems each year.
  • Dental disease is the most common chronic disease in children in the U.S.- even more common than asthma. 

From the Peach State Health Plan, our partner in Georgia, here are some simple steps that will help you set your kids up to have a lifetime of healthy teeth:

  1. Go see the dentist! There is a misconception that you don’t need to worry about healthy habits until permanent teeth are in. In reality, it begins well before that – cavity-causing bacteria can impact a lifetime of dental health, beginning with the first baby tooth. It’s important to see a dentist at least twice a year, even when those teeth just begin to grow in.

  1. Got fluoride? Believe it or not, fluoride is a crucial part of having healthy teeth - every $1 invested in fluoride saves $38 in treating tooth decay. It’s vital to not only have fluoride in your water, but to also use toothpase with fluoride. Many families are always on the go, so if you give your kids a lot of bottled water, make sure it has fluoride included.

  1. Ask your kids’ dentist about sealants. Dentists can apply sealants to permanent molars when a child is 5-6 years old – before tooth decay even begins - providing a thin layer of protective plastic coating to teeth.

  1. Snack smart. Many snacks kids love – from cookies to potato chips – are high in sugar and starch, which weaken tooth enamel. While its best to limit snacking between meals, be sure to reach for a healthy snack like yogurt, fruit or veggies.

  1. Take two! Everyone should brush their teeth twice a day for two minutes each time. Since two minutes can be an eternity for kids, play their favorite tune while you help them brush their teeth.

  1. Break the thumb-sucking habit. While most kids outgrow thumb sucking, dental problems can occur when kids start to get their permanent teeth and still suck their thumbs. Ask your pediatrician or dentist about ways to help break the habit.

We hope that these steps will help you promote oral health with your kids during this special month and beyond!

And we’d like to say thank you to our partners in Georgia for these excellent pointers. To learn more about the Peach State Health Plan, and some of the innovative work the team there is doing with Emory University, visit:

Tuesday, January 20, 2015

Using Ancillary Benefits to Battle Margin Compression

In a recent post, we examined some of the key drivers of margin compression in this new era of health care reform:

  • Increased taxes
  • Minimum loss ratio
  • Increased competition
  • Greater price transparency
  • Standard benefit requirements

These factors, combined with the substantial costs associated with member churn, are driving a business truism within the health care industry: to effectively battle margin compression, health plans must strive to be present in multiple markets, and they should consider how ancillary benefits can be used to maintain and grow their business.

Of course, our industry is not the first to face game-changing legislation similar to the ACA. Following the attacks of September 11, 2001, airlines grappled both with stricter regulations that were costly to implement and shrinking demand as travelers responded to the tragedy.

Around the same time, websites like Expedia and Orbitz emerged as one of the primary sources to purchase airline tickets. These sites facilitated greater price comparison and increased price transparency, much like we are seeing today within the health care marketplace.  Clearly, this kind of comparative shopping can significantly impact consumer behavior and choice.

The airlines that most successfully navigated these challenges attracted consumers with competitive base pricing and used optional amenity costs - such as added leg room, luggage fees, and food upcharges- to bring in additional revenue. Following a similar model, health plans can use ancillary benefits that appeal to consumers who are interested in purchasing supplemental care, thus preserving a significant portion of their customer base and the associated revenue stream.

Expanding into multiple markets to offset the effects of member churn can be similarly powerful in the fight against margin compression. Offloading members is costly and the movement of members between Medicaid and health exchanges can threaten the overall stability of a health plan by compromising its ability to predict its financial risk. Health plans that have a presence in multiple markets can preempt the negative impact of member churn and better preserve and protect their bottom line.

As is often the case with landmark legislation that impacts such a fundamental part of our daily lives, the Affordable Care Act has brought vast improvements and interesting challenges to the healthcare industry. Health plans have a unique opportunity during this watershed time to explore how ancillary benefits and market expansion can grow and protect their business and membership base.  

Learn more. DentaQuest is hosting a webinar discussing how health plans can use ancillary benefits like dental to grow their market share and control medical costs. Please join me, along with Dr. John Luther, DentaQuest's Chief Dental Officer, and Dr. Justin Cramer, Chief Medical Officer of Missouri Care, who will speak about Missouri's first-hand experience with medical integration.

On the Frontlines of Medical-Dental Integration
Wednesday, January 28
1:30 p.m. CT

Register at