Thursday, May 28, 2015

So, is fixed- what’s next?

By: Dan Sheehan, SVP and CIO, DentaQuest

Earlier this month, Optum, the contractor with the task of fixing the well-publicized IT glitches on, announced that its job was complete, the website is improved and consumers are able to more easily access the benefits they need. This is a big moment, not only for the Obama Administration and IT gurus everywhere, but also for the healthcare community as a whole.

By ensuring that is a more accessible and reliable outlet for millions of Americans to review and select their healthcare benefits, all involved have brought coverage to those who need it most. While this is an exciting and important moment, we cannot let this success overshadow the continued work that must be done.

Now that the major functions of are working well, government officials and their consultants must turn their attention to making the most effective tool that it can be for consumers.

Specifically, when it comes to dental benefits and, we still need to eliminate technological barriers for consumers seeking coverage. should:

·         Allow consumers to shop for and purchase a stand-alone dental plan regardless of whether they also purchase a medical plan.

Right now, a consumer can only access stand-alone dental plans when purchasing medical coverage. This limits crucial access to dental coverage and care for people who may already have medical benefits through an employer or other government-sponsored program like Medicare.

·         Develop support tools that will help consumers make the best decisions about the level of coverage they need for their families.

This could be as simple as including more educational information about dental coverage and the importance of dental care on, to help consumers make the most informed choices about their coverage options. But it could also include the development of interactive tools that allow consumers to input information about their dental needs and get recommendations on coverage options based on what they need.

While many of these fixes will certainly require time, resources and brainpower, they are crucial steps to achieve access and improve By addressing these issues, the administrators of will help remove some of the barriers that 83 million Americans face today when it comes to receiving the dental care they need.

At DentaQuest, enabling access by eliminating barriers to care is a part of our work every day, as we continue to prioritize oral health for all Americans. Tools like the new-and-improved will help us reach that goal, improve access and provide care.

Tuesday, April 28, 2015

CHIP Passes – But There’s Still More To Be Done

By Steve Pollock, President and Chief Executive Officer
On April 14, Congress passed a bill which will ensure that eight million children across the country have continued access to health insurance by extending funding for the Children’s Health Insurance Program, or CHIP, for two more years. Just a few days later, President Obama signed the bill into law. The CHIP program has been a critical source of health coverage for children and pregnant women who earn too much to qualify for Medicaid but too little to purchase private health insurance. Without passage of this bill, CHIP funding would have expired in September, leaving millions of children and hundreds of thousands of pregnant women without access to comprehensive dental care.
Since its inception in 1997, CHIP has helped children receive routine dental care that they may not otherwise have had access to. To help illustrate its success, a report issued by the U.S. Department of Health and Human Services found that 80 percent of CHIP enrollees saw a dentist in the past year, a significantly higher rate of access and use of services than for children who do not have coverage.
Congress has done a commendable job of recognizing the need for continued funding to support children’s health insurance by passing bipartisan legislation to secure its future. This is no small feat. Health equity advocates around the country are breathing a sigh of relief knowing that the health and well-being of our children took precedence over party politics. However, for dental care, we know the battle is not yet over.
Did you know that 83 million Americans still face obstacles in receiving dental care each year? Nearly half of all individuals in a 2013 survey said that over the previous 12 months they or a family member delayed seeing a dentist because they could not afford the expected out-of-pocket costs. Unlike medical insurance, states are not mandated to include adult dental care coverage within Medicaid programs; it is left up to the state to decide.
As a result, many still do not have access to dental benefits. And that hurts families. It is difficult for dentists who treat children with Medicaid or CHIP insurance to turn away parents who have immediate oral health problems but are uninsured. Dental care contributes to a person’s health and well-being over their lifespan – childhood through retirement. Preventive care saves families and taxpayers money by avoiding more costly interventions later on.
Without adult dental benefits for publicly-funded insurance programs, these 83 million Americans will continue to flood emergency rooms for dental issues and contribute to the 164 million work hours missed each year due to oral health problems. And, as recent studies demonstrate, poor oral health may be increasing the cost of treating chronic diseases like diabetes, pre-term pregnancy and heart disease. By ensuring that all have equal access to dental care, we work to improve the lives of millions while reducing healthcare costs.
Congress took a significant bipartisan step to ensure access to dental care for children. Now, state and federal leaders must act to help eliminate barriers for adults so these 83 million Americans can get the care they need to be healthy and stay that way.

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).