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.

‘Action for Dental Health’ in Congress

While we all paid close attention to health care in the Senate last week, the House Energy and Commerce Committee made a critical, yet mostly overlooked step to advance oral health for at-risk populations.

On July 27^th, the Committee unanimously passed HR 2422, or the Action for Dental Health Act of 2017. This bill calls for Congress to authorize additional oral health promotion and disease prevention programs to help at-risk populations struggling to obtain appropriate oral health care.

The bill points out that more than 181 million Americans will not see a dentist, but almost half of people ages 30 and older have some form of gum disease and nearly a quarter of children under age 5 already have cavities. 

As we at DentaQuest well know, caries is the most prevalent chronicdisease among children and can be prevented. What’s more, we see time and again that Americans of all ages are in desperate need of access to oral health care - Missions of Mercy like the one in Wise County, Va., is a great example. Both the Washington Post and The New York Times covered the July event, for which thousands of people come from miles away and lineup for hours and even days just to get access to dental and other services.

If this new legislation passes through Congress, the Centers for Disease Control and Prevention will award grants and collaborate with states, counties, public officials, or other stakeholders to implement a variety of initiatives.

These activities could include oral health programs that:

·         more broadly use portable/mobile dental equipment;

·         facilitate the establishment of dental homes;

·         eliminate geographic, language, cultural, or other barriers to care;

·         reduce the use of emergency departments for dental conditions; and

·         provide dental care to nursing home residents.

It is exciting to see bipartisan support for dental care initiatives that have tremendous impacts on the oral and overall health of patients. This type of work will drastically improve the health of Americans. And it has the ability to address the estimated $2.6 billion in free care that dentists currently deliver, as well as the nearly $2.1 billion spent on dental cases in hospital emergency departments – 80 percent of which could be treated in a dental office for roughly $4 million total, according to the bill.

Bipartisanship like this must continue and we urge legislators to make oral health a critical component of any health reform legislation that passes through this Congress. 

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 Foundation grassroots grantees ready to leap for oral health

I recently heard the perfect analogy for our oral health advocacy during the DentaQuest Foundation’s Grassroots Engagement Strategy annual meeting. It’s a saying gardeners have about the growth process of perennials: “The first year they sleep, the second year they creep, then the third year they leap!”  This year is the year for the grassroots organizations and their partners to leap!

DentaQuest Foundation’s Grassroots Engagement Strategy started in March 2015 as an initiative to engage those most directly impacted by oral health inequities. Focused in six key states - Arizona, California, Florida, Michigan, Pennsylvania, and Virginia - the Grassroots Engagement Strategy leverages an existing network of key oral health advocates and stakeholders operating at the state level. The DentaQuest Foundation has funded 20 community-based organizations within these states to provide oral health outreach and take action on social justice and oral health equity, all with the goal of improving public perception of the value of oral health in their communities.

These 20 grantees represent deep and diverse experience working directly with community members and contribute essential perspectives of community advocacy and action. They are providing community-grounded voices within a broad group of stakeholders at the state, regional, and national levels, a perspective that is critical if we are to reach our mission of improving oral health for all.

The Grassroots Engagement Strategy has now entered its third year of development, and the purpose of the annual meeting this spring was for grantees to learn from one another about what has been accomplished in the last year, what is planned for the year ahead, and how to deepen the commitment to health equity.

On day one, each organization presented its community-driven plan that covered stakeholders, how they have incorporated the Oral Health 2020 goals into their communities, 2017 organizational priorities, their proudest moments, and their greatest challenges.

For example, one organization discussed advancing a legislative advocacy strategy around protecting oral health equity policies, while dealing with the major challenge that oral health is not a top priority for the community members facing other economic and social challenges.

On day two, many of the Oral Health 2020 national advocacy partners presented the resources and tools in development that will support the grassroots organizations in their work. Attendees also discussed how they can learn from one another and build their capacity to make change at the community level.

Additionally, there were presentations on different approaches to advocacy and lobbying, including how to provide empowerment opportunities for community members in advocacy and public policy.  Partners also discussed how they work collaboratively with other organizations to activate coalitions and networks that share common goals.

The underlying themes throughout the discussion:

• health equity 
• the link between oral health and other social determinants of health 
• the implications that these have 
• who  needs to be at the table  

Similar to previous years, the grassroots organizations returned home with a sense of rejuvenated momentum for oral health.   Words like “motivated,” “energized,” and “connected” were used by attendees format the close of the meeting.  With the political landscape changing, the role of grassroots organizations engaging in advocacy is even more critical at the local, state and national levels.

When community members are educated on the topic of oral health and have the passion and understanding of its impact, their voices are powerful.  

The Oral Health 2020 Network is excited to see the progress that will continue in these communities and beyond. The grassroots grantees are ready to “leap” into action for year three of the Grassroots Engagement Strategy!

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Guest post from DentaQuest Foundation's grants team member Liana DiRamio. Learn more about the grants and programs here: http://dentaquestfoundation.org/about/our-mission. 

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.

DentaQuest Institute Releases New Report on Interprofessional Care in Rural Communities

New white paper delves into the role of interprofessional networks to coordinate person-centered care and improve oral health

DentaQuest Institute, in collaboration with the South Carolina Office of Rural Health, the Medical University of South Carolina, the Colorado Rural Health Center, and the Pennsylvania Office of Rural Health, just released a new white paper , MORE Care: Narrowing the Rural Interprofessional Oral Health Care Gap. The report highlights the importance of interprofessional oral health networks in achieving person-centered care and population health improvement. By producing coordinated care pathways between dental medicine and primary and behavioral health, interprofessional oral health networks have the potential to improve patient outcomes, increase patient and provider satisfaction, and reduce the cost of providing and receiving care.

The report is the result of two years of collective findings from the Medical Oral Expanded Care (MORE Care) Initiative involving twenty-one Rural Health Clinics and fifteen rural dental care partners located in Colorado, Pennsylvania, and South Carolina. MORE Care partners provide insight into the main factors affecting the initiation of interprofessional oral health practice observed during the early phases of MORE Care.

The white paper, and a soon-to-be-released implementation guide, offer insight into the needs of Rural Health Clinics and rural dental care teams as they undertook the creation of interprofessional oral health networks (IPOHNs). In addition to creating interprofessional oral health networks, the purpose of MORE Care is to serve as a vehicle for adopting system change in the rural communities.

For more information on how dental programs serving rural communities can leverage MORE Care, contact Rebekah Mathews, director of transformation at rebekah.mathews@improvingoralhealth.com.

Healthy Vision Month reminds us to make our eyes a priority

May is Healthy Vision Month. With that in mind, we at eyeQuest encourage everyone to make eye health a priority and take steps to protect vision for a lifetime.

Vision might change as we get older, but vision loss is not a normal part of aging. Common eye diseases such as glaucoma, diabetic retinopathy, and age-related macular degeneration threaten millions of Americans, potentially robbing them of vision, mobility, and independence.

New technologies are making a difference, but early diagnosis, timely treatment, and appropriate follow-up care are essential to preventing irreversible vision loss.

Early stages of common eye diseases typically have no symptoms and can only be detected through a comprehensive dilated eye exam. If you are over 40, a dilated eye exam is recommended yearly, especially if you are at higher risk for eye disease.

As an example, Glaucoma, which causes “silent” damage to the optic nerve, is more common in people with certain risk factors such as African-Americans ages 40 and older; everyone ages 60 and older, especially Latin Americans; and people with a family history of the disease.

The number one cause of permanent loss of vision in people under age 60 is diabetic retinopathy. Also for people over 60, the risk for age-related macular degeneration (ARMD) rises significantly.
 
All of these conditions progress without any symptoms at all. The good news is that with early detection through regular eye exams, they are all manageable.  Vision loss is mostly preventable if treatment is started before the damage is done.

Recent clinical trials sponsored by the National Eye Institute have shown great progress in the prevention of AMRD-related vision loss. The latest study results (known as AREDS) determined that people at high risk of developing AMRD could lower their risk by about 25 percent by taking vitamins with certain antioxidants and minerals –  another reason to eat your spinach and other green leafy vegetables.

So, do your older self a favor and think about how important your vision is during healthy vision month. If it has been more than a year since your last eye exam, schedule an appointment and then ask your eye doctor about any of your risk factors. Awareness and regular eye care can make a difference. Much like regular dental care!  

Make healthy vision last a lifetime. During Healthy Vision Month, encourage friends and family to make eye health a priority. For more information about keeping eyes healthy, visit https://www.nei.nih.gov/hvm/ and download a healthy vision month toolkit.

Guest post from eyeQuest Vision Director Vidya Baliga