Friday Federal Roundup: CBO, CHIP, and More

As a partner to states and the largest Medicaid / CHIP dental benefits administrator in the country, we at DentaQuest must stay updated on the latest health care policy trends - in large part because anything in the health space affects the oral health space.

Recent federal health reform proposals could have significant implications for Medicaid programs, exchange populations, and oral health coverage for low-income families. We keep our employees apprised of the latest happenings in Washington D.C. with weekly federal newsletters, and thought this week was particularly relevant for more than our staff.

Here’s this week’s newsletter.

CBO Releases Report on Subsidies 

According to a report released earlier this week by the non-partisan Congressional Budget Office (CBO), insurance premiums for ACA plans would rise 20 percent next year and in some areas of the country, people would not have any insurance options if the Trump administration scraps key ACA subsidies. Trump has repeatedly threatened to pull the ACA subsidies, particularly since Congress failed to pass repeal and replacement legislation before the summer recess. CBO’s analysis also found that eliminating the payments would increase the federal deficit by $194 billion over a decade because of higher spending on premiums subsidies. Trump must decide by early next week whether or not to make next month’s payment.

Congress Turns Attention to CHIP

Funding for the Children’s Health Insurance Program (CHIP) expires September 30th. With Congress out on recess, this leaves few legislative working days to ensure that nearly 9 million children maintain their medical and dental coverage. While CHIP reauthorization has historically been a bipartisan issue through the years, the hotly-contested debates over ACA repeal and replacement have left state officials anxiously awaiting assurances from Capitol Hill that 2017 will be no different. We will continue to monitor federal discussions on the future of CHIP and advocate where possible for the vital inclusion of dental coverage in reauthorization efforts.

Trump Administration Encouraging Medicaid Redesign Efforts, State Innovation

As Congress takes a pause on repeal and replacement efforts while they are on recess, states are looking to the Trump administration in the interim for more regulatory flexibility. CMS is expected to soon approve a Medicaid waiver from Kentucky which among other things would require most Medicaid-eligible adults to work as a condition of receiving coverage. Arizona, Arkansas, Indiana, and Maine are considering similar work requirements. HHS Secretary Tom Price and CMS Director Seema Verma have both expressed that they are in favor of such Medicaid redesign proposals.

Last month Alaska became the first state to get increased flexibility from the administration to prop up its individual marketplace with a reinsurance program. Minnesota, New Hampshire, Oklahoma, and Oregon are some other states that have already filed or are considering similar waiver proposals to submit to CMS.

HHS Proposes to End Obama-era Payment Programs

HHS Secretary Price has announced plans to eliminate two Obama-era Medicare bundled payment programs and scale back on a third. This proposal would cancel initiatives that make hospitals more accountable for the cost of certain joint replacement surgeries and cardiac care, and shrink an existing program covering hip and knee surgeries. This is considered a victory for providers who oppose requirements to participate in new payment models. We will continue to monitor whether or not HHS will take further action to roll back requirements in order to slow down the transition to value-based reimbursement structures.

Congress: Protect Access to Dental Health Care

As the Senate debates health care bill proposals to transform our care delivery and financing systems, we must ensure they protect access to dental coverage for all Americans.

Over the past few years, more and more Americans have been able to access affordable dental coverage. In fact, since 2000, the percentage of children without dental coverage has been cut in half.

Medicaid has played a critical role in this progress. Dental services are considered an essential part of the Early Periodic Screening, Diagnostic and Treatment (EPSDT) program, which ensures that children receive regular dental care. Adults have also benefited in recent years, with 5.4 million adults gaining coverage through Medicaid expansion.

Other public programs have also helped. Because pediatric dental benefits are considered an essential health benefit on the exchanges, more kids have coverage. Further, many adults have selected dental coverage through the marketplaces.

As more of us gain access to coverage, we see the rate of untreated decay declining among low-income children, and research shows that costly emergency department visits for dental-related issues have declined. These improvements are in large part attributable to the fact that more people have access to dental coverage.

Over the past several months – continuing this week and for likely the near future – Congress has explored various avenues for health care reform. The value of oral health care and dental coverage cannot be overlooked in these conversations.

Let’s not overlook that tooth decay remains the most chronic condition among children, which can affect school performance and attendance.

Additionally, optimal oral health is not simply a goal in itself, but is vital to creating healthier communities. Research has shown that tooth decay can result in an elevated risk for diabetes, heart disease, and stroke. What’s more, recent studies demonstrate that treatment of gum disease can lead to better overall health management—as evidenced by lower health care costs and fewer hospitalizations—among people with common health conditions like those mentioned above or even pregnancy.

Any health care reforms must ensure dental remains a priority.

By improving access to dental coverage for low-income families in the past few years, we as a nation have made tremendous strides to

• ensure children are well-positioned for a lifetime of optimal health;  

• decrease poor quality, high-cost emergency department visits for dental-associated issues; and

• improve the oral and overall health of vulnerable populations.

We hope Congress pursues solutions that protect these improvements.

DentaQuest Remains Voice for Oral Health Equity in Disparities Leadership Program

For the second straight year, DentaQuest is participating in the Massachusetts General Hospital’s Disparities Leadership Program. Last year, DentaQuest became the first oral health organization to be accepted into the program. Over the next 12 months, we will build upon our previous efforts to promote oral health equity for Medicaid and CHIP populations.

The Robert Wood Johnson Foundation recently released a paper that defines health equity as “the ethical and human rights principle that motivates us to eliminate health disparities,” both a process and an outcome.

Now in in its 11th year, the program gathers a variety of health care leaders to develop strategies that address disparities in health care. We are particularly excited to remain part of this team, which is designed to cultivate leaders who can align equity efforts with the transition to value-based health care.

DentaQuest is one of five health plans in this year’s class and once again the only oral health organization. Our project will focus on how to leverage data and our national footprint to identify and alleviate oral health disparities, while also promoting equity as a key objective for our own organization.


Why is it important that oral health leaders are involved?

Despite progress towards a more equitable health care system, oral health disparities persist.

• Untreated dental disease is disproportionately prevalent among racial and ethnic minorities
•  42 percent of African American adults and 36 percent of Hispanic adults have untreated dental disease, compared to 22 percent of Caucasians
• Among adults with incomes below the federal poverty line, 42 percent have tooth decay—that’s three times more than adults with incomes above 400 percent of the federal poverty line.
• Rural areas experience higher rates of dental disease and tooth loss with lower preventive utilization rates.
• Barriers such as cost and fear of discrimination mean just 10 percent of the surveyed LGBT population say they have regular dental visits.

With much progress still to be made, the four branches of the DentaQuest enterprise—benefits administration, philanthropy, science, and care delivery—will work in tandem to reduce inequities in the communities we serves across the country. This work not only enables us to get closer to achieving oral health for all, but also will drive our work with others.

Ultimately, our participation in this program steps up our ability to address health equity collaboratively with our partners – from states and clients to providers and patients.

Proud to Reflect on DentaQuest Giving Back, Remain Committed for 2017

The start of a new year is an opportunity to reflect and consider how we fit into the community at large. Through our corporate giving program and the volunteered talents of our staff, we are investing in our neighborhoods, supporting our stakeholders, and creating leadership opportunities for our employees. Here are highlights from 2016 that will help us have even greater impact for 2017:

Community is the Foundation of What We Do

We awarded Corporate Giving funds to safety net dental programs and community organizations that help thousands of at-risk children, families, people with disabilities, and seniors. We were also involved with organizations working to feed the hungry, prepare the next generation workforce, end health disparities and inequity, and help neighbors who are struggling to get through each day.

In 2016, DentaQuest’s Giving Program touched 165 organizations in 26 states. And that is in addition to the millions of dollars in investments made by our DentaQuest Foundation and our DentaQuest Institute to community change makers who are working for better policies, financing, and care with a goal of improving the oral health of all. All this matters because oral health really is fundamental to living a healthy life and important to academic and economic success.

Missions of Mercy Dental Clinics

While our 24 million members have access to quality dental care, there are millions more who are uninsured or underinsured and fall through the cracks at the worst of times. Many of them depend on the arrival of the Mission of Mercy, a multi-day free clinic staffed by volunteers, for essential dental care services. Working with local dental societies and our local staff volunteers, DentaQuest supported 21 free care clinics in 18 states.

Consider that, on average, each Mission of Mercy clinic serves 1,500 to 2,000 patients; the dental clinics that we supported provided over $15,000,000 in services and helped nearly 30,000 individuals who have great needs and few other options.

Stand Together in Times of Crisis

Our employee-directed Corporate Giving Committee directed financial support to communities that suffered in 2016: areas recovering from Hurricane Matthew in Florida and South Carolina, the once-in-a-century floods in Louisiana, flooded areas of rural West Virginia, the destructive wildfires (and tornado) in Tennessee. Support was also sent to Orlando after it suffered a violent shooting and to a help those in need after a five-alarm fire in Cambridge, Mass.

Throughout the year, we provided toothbrushes to schools, after school programs, and community health fairs serving at-risk children in high need neighborhoods. And through our matched giving program, our employees made additional contributions to charities close to their hearts.

Sweat Equity 

For us, giving is a combination of equity and sweat. Our employees look forward to attending local events that support the community and are willing volunteers at health fairs, walks for a cause, and dental care clinics.

During our annual Mission Month (mid-September to mid-October), we roll up our sleeves and leave the office to conquer high-impact projects tailored to the need of the community. This year, it was to feed families at Ronald McDonald Houses, paint and update schools and community centers, remove invasive plants from local rivers, and reclaim and replant city gardens.

We participated in 35 events in 11 states. A remarkable 67 percent of our employees participated in a Mission Month project, contributing over 3,612 volunteer hours, valued at $93,912.

Some go even further. Our Living the Mission Awards honor employees who go above and beyond for their sustained volunteer contributions to a charitable organization outside of Mission Month or company-sponsored events. Congrats again to those awardees!

What's Next?

Looking back on what we’ve accomplished in 2016, it is with pride that we can say we live our mission every day.  We truly are the dental company with vision, and heart. Looking forward, we will aim higher, find ways to give more of ourselves to those around us, and ultimately stay true to our mission - improving the oral health of all.

Adult Medicaid Dental is Key to Overall Health, Requires Increased Access

Medicaid programs are well-positioned to prioritize optimal oral health in their states through adult dental benefits, but systematic changes are necessary to fully address barriers to dental care.

Although Medicaid programs are required to provide pediatric dental coverage for low-income children, extending those benefits to the adult population is optional. Currently 15 states offer extensive dental coverage for low-income adults on Medicaid, while 17 states only provide coverage for dental emergencies or provide no coverage at all.

Robust adult dental benefits can have tremendous impacts on state Medicaid populations:

·         Individuals with dental benefits are 42 percent more likely to have a dental checkup within the year than individuals who don’t have coverage. Additionally, when parents receive care, their children are more likely to go to the dentist as well.

·         Reducing or eliminating Medicaid adult dental benefits has led to significant increases in dental-related emergency department visit and associated costs in states like California.

·         Ensuring low-income adults have access to comprehensive dental coverage can improve employability, as adults lose millions of work hours each year due to dental disease.

·         Increasing access to dental coverage can help to reduce disparities as well because untreated dental disease disproportionately afflicts racial and ethnic minorities.

·         Treatment of gum disease can lead to better health management — as evidenced by lower health care costs and fewer hospitalizations — among people with common health conditions, such as type 2 diabetes, heart disease, and pregnancy. These links to improved overall health management are particularly critical for Medicaid beneficiaries.

The economic, oral health, and overall health outcomes above are tremendous arguments for states to invest in a Medicaid adult dental benefit, but access challenges will persist without systematic approaches to oral health.

In this month’s publication of Health Affairs, research conducted by the DentaQuest Institute and the American Dental Association shows that emergency department utilization for oral health conditions rose in Kentucky after Medicaid expansion, which included a dental benefit for adults.

In the emergency department, patients generally receive palliative and costly care. A combination of pain-management (usually opioids) and infection management for preventable conditions costs the U.S. health care system an estimated $1.6 billion annually.

Presumably, increasing coverage under Medicaid would have reduced emergency department utilization and associated costs. Why didn’t this happen for Kentucky?

Although Kentucky expanded dental coverage to adults in Medicaid, the state still faced many challenges:

• 23 percent of low-income individuals cited inconvenient locations or time as a reason to avoid going to a dentist.
•  Kentucky’s reimbursement for dental services was 44 percent of commercial rates.
•  Due to few dental providers in the state, Kentucky had 99 dental health provider shortage areas, and only 39 percent of Kentucky dentists participated in the Medicaid program.

Coverage is a critical first step to ensuring access to dental services for adults served by Medicaid, but it cannot be the only step. 

While information in Kentucky suggests that an increase in emergency department use following the addition of an adult Medicaid dental benefit is likely temporary, strategies to improve oral health in a state must go beyond coverage alone.

Key strategies that states must consider include:

• provider capacity and support, 
• reimbursement rates,
• dynamic oral health education, and 
• the integration of oral health screenings and/or referrals into primary care are. 

These factors are critical to ensure that patients receive the most appropriate care in a timely manner and in the most appropriate setting.

Fortunately, organizations like DentaQuest are creating multi-pronged approaches to these systemic oral health challenges.

At DentaQuest, we align philanthropy, science, coverage and care to improve the oral health of all. DentaQuest Foundation delivers millions of dollars in grant funding to hundreds of initiatives across the nation, fostering oral health innovation at the grassroots level. Ideas that prove most promising are leveraged by the DentaQuest Institute, which develops innovative clinical care and practice management solutions to help providers deliver optimal care.

Programs and initiatives that prove to be both effective and scalable by the DentaQuest Institute are then integrated in a broader fashion by DentaQuest Benefits Administration and the DentaQuest Care Group, fueling a comprehensive disease management approach toward health that is prevention-focused and outcome-driven. 

We are more than just a dental administrator. We are an incubator of innovation and a proving ground for pioneering initiatives in the oral health space that improve health.

These types of collaborative solutions that incorporate a wide array of stakeholders are imperative to successfully improve oral health in a state and to achieve the Triple Aim – reduce healthcare costs, improve the patient experience, and achieve better health outcomes. 

Let’s improve oral health with provider-focused, patient-centric Medicaid dental partnerships

States and managed care organizations face real challenges when it comes to running a successful Medicaid program and helping people get and stay healthy. Medicaid leaders find themselves faced with extremely difficult decisions about how best to prioritize critical needs of the population – often times there are no silver bullets. Yet, Medicaid dental partnerships are a great step forward.

In the past, the dental component of a Medicaid program has fallen victim to tough decisions, receiving fewer resources and lagging behind when it came to ensuring access to needed care. And people suffered.  

Recognizing this, states started to look at their Medicaid dental programs differently. They began seeking out industry experts like DentaQuest to help work directly with Medicaid agencies or to support managed care organizations to implement best practices. 

The result was that more people got access to the medically necessary oral health they needed.

   

Rapidly expanding regulatory requirements and Medicaid budget pressures, as well as the tidal wave of value-based payment and care models initiated by the Affordable Care Act, mean states once again find themselves at a crossroads when it comes to their Medicaid dental programs.  

Forward thinking states are moving past the notion that access to treatment is all it takes to improve the oral health of all. They recognize that an effective Medicaid dental program must achieve the Triple Aim: lower costs, improved population health, and better patient experiences.  

Tennessee is a perfect example of a dental partnership focused on the triple aim. 

In 2012, state Medicaid leaders recognized they were no longer meeting the oral needs of the people they served and set out to create a new Medicaid dental program model. They also recognized that they needed a new partner, not just a vendor, to help develop and implement a holistic approach to oral health.   

Today, DentaQuest partners with the state to administer the TennCare Medicaid dental program and through this partnership, more children have access to preventive care at a lower cost to taxpayers.  

Since partnering with TennCare in 2013, DentaQuest has saved the state $27.5 million by prioritizing preventive care, which helps to avoid extensive, costly future procedures. In the second year of the program, the number of children participating in the program increased by 8 percent to 810,000 enrollees. Through our dental home program, we’ve made sure that each and every one of the 810,000 children is connected to a dentist who is willing and able to provide care.  

TennCare has been able to handle the influx of patients thanks to a provider participation increase of 31 percent. DentaQuest has focused on easing the administrative burdens placed on providers and facilitating transparent communications.  

This successful model is built upon the idea that aligned incentives can improve outcomes.  

DentaQuest has a shared responsibility when it comes to improving outcomes and reducing costs. This challenge should not fall on providers and states alone. DentaQuest must meet outcome benchmarks—set by the state—related to access, network adequacy, outreach, and cost.  

DentaQuest met or exceeded benchmarks in all categories during the first two years and is poised to demonstrate success again in year three.   

The results of this model are encouraging: 

• Average distance to a provider is 3.7 miles, compared to a benchmark of 30 miles 
• Wait times for routine, urgent, and emergency care are significantly lower than the state’s thresholds 
• 100 percent of beneficiaries have patient-centered dental homes—providing accessible, comprehensive, and coordinated care to enrollees 

 

DentaQuest has been able to succeed in part by educating and engaging patients and families—even hosting over 80 community events last year.  

This type of patient-centric program should serve as a model for other state Medicaid programs and partners. Change and innovation should not mean complexity and burden. 

There is a better way forward and DentaQuest has a roadmap to get there.