Dentists Adapt to Healthcare Reforms

By: Dr. Rob Compton, DDS, Director of the DentaQuest Institute

I had the opportunity to represent the DentaQuest Institute at the Massachusetts Dental Society’s New England Oral Health Summit recently.

Attended by hundreds of dentists across New England, the Summit focused on upcoming changes to oral health as a result of the Affordable Care Act (ACA) and significant cultural shifts in the way health care is delivered. I spoke about the emerging and important role of data analytics in dentistry. 

Among the many questions about changes in the profession, what struck me most were the concerns about the transition from volume-based care to value-based care. In the medical world, this transition began long ago and the ACA is only speeding things up. However, the dental profession is just beginning the transition and without fully understanding what it means, it can be overwhelming.

Healthcare professionals go into the medical field to help patients and the goal is always, first and foremost, to keep patients healthy. But they also need to make a living and run a business. Value-based care is about focusing on costs, quality and, most importantly, outcomes. The goal is to reduce cost strains and reliance on the health care system by keeping patients healthier. The challenge is that under the current system (referred to as fee-for-service), medical professionals are paid each time they provide care to a patient, so if a patient is cared for in a way to prevent further illness, it reduces the need for additional treatment, and doctors and dentists make less money. 

In the new health care delivery model - data analytics is king. A number of models are emerging to help organizations remain financially viable while providing better outcomes for patients. We are seeing hospitals merge into larger coordinated care systems like accountable care organizations and patient-centered medical homes. Physicians are moving away from private practices and are trending towards employment in a larger system. Global payments are no longer a buzzword or a theory. They are actually happening.

But in dental, this trend is just starting and it needs to move fast. Dentists have every reason to feel uneasy about a transition in payment models that could affect their livelihood. The focus is now on outcomes, rather than easily countable treatments, which requires measurement. Organizations like DentaQuest are developing models to measure preventive treatments and ensure that patients are receiving the high-quality care they deserve – and that dentists are being paid for it. For example, when patients leave the hospital and then are readmitted within 30 days for the same illness, hospitals will now be penalized for not keeping the patient well. The ultimate goal is to encourage hospitals to keep the patient healthy and out of the hospital.

Dentists don’t have the time to sit idly by. Instead, they have a unique opportunity to learn about health care reform and make their voices heard by actively participating in the transition.  Change is coming and as one of the panelists said at the Summit “if you aren’t at the table, you may be on the menu.”

Highlights from the Massachusetts Dental Society’s New England Oral Health Summit

By Ralph Fuccillo, DentaQuest Chief Mission Officer and DentaQuest Foundation President

Earlier this month, we had the opportunity to participate in the Massachusetts Dental Society’s (MDS) New England Oral Health Summit to educate oral health professionals about the upcoming changes to oral health care delivery as a result of the Affordable Care Act (ACA).  I was joined by my colleague, Dr. Robert Compton, DDS, DentaQuest Institute Executive Director.  We were pleased to represent the DentaQuest Foundation and the DentaQuest Institute at the Summit and to collaborate with the MDS Foundation on this important issue.

The Summit encouraged oral health professionals and dentists to work together to ensure that everyone is involved in shaping the future of health care delivery and reform.  An estimated 1 in 5 (about 17 million) children go without dental care each year, but beginning in 2014, individual and small group health plans will offer essential pediatric dental benefits giving access to nearly 27 million children. 

More than 200 oral health professionals from across New England attended the summit to discuss what the oral health community can accomplish together. Participants spent the morning hearing from speakers about the current health care delivery environment and changes due to the ACA. In the afternoon, attendees interacted through panel and group sessions to talk more specifically about changes in how oral health care will be delivered, evaluated and reimbursed.  Participants worked together to develop messages for dental care providers across New England about the future impact of the new health care environment on dental care delivery and how we  must all  be involved.  The more of us that are at the table, the better.

View the video below or click here to learn more.

Say Hello at AHIP Institute2013 and Exchange Conference

Guest post by Michael Enright, National Director of Sales, DentaQuest

Next week, DentaQuest will attend America’s Health Insurance Plans (AHIP) Institute 2013 and Exchange Conference. The conference, which will gather health plans from across the country in Las Vegas, is an opportunity to connect, and collaborate with thousands of health care stakeholders. 

At the AHIP Exchange Conference on June 12, DentaQuest Chief Analytics Officer Shaju Puthussery and DentaQuest Institute Executive Director Dr. Rob Compton will join me in leading a breakfast session called “Aligning Business Strategy and Dental Benefits to Meet the Needs of Today’s Healthcare Consumer.”

This time of healthcare reform has been a challenge for many organizations.  There are critical decisions to be made for 2014, 2015, and beyond.  Their focus is to provide increased value to their members and ensure they are making the necessary adjustments to stay relevant in the changing market.  Our session will set the stage for the opportunities ahead regarding dental and vision benefits. Participants of our session will:

• Learn how the right dental partner can help grow membership, control costs, and improve health through dental management, data analytics, and preventive programs; 
• Gain insight into how integrated dental benefits create value for health plans and how data analytics go hand-in-hand with value-based healthcare; and 
• Leave with a better understanding of why collaborative, patient-centric dental care is vital within the context of the Affordable Care Act. 

We encourage you to stop by our breakfast session and say hello. For attendees also attending the AHIP Institute 2013, please visit us at Booth #458 on June 13.

For specific details about the AHIP Institute2013 and Exchange Conference, visit http://www.ahip.org/Conferences/Institute2013/.

Preventive Visits Matter—A Lot

By Dr. John Luther, DentaQuest Chief Dental Officer

This week, a study featured in the June issue of Pediatrics, conducted by the Department of Health Care Organization and Policy and Lister Hill Center for Health Policy of the University of Alabama at Birmingham School of Public Health, raised a few eyebrows within the dental care community.  The study reported more preventive visits for children do not reduce overall dental or medical (inclusive of dental) expenditures.

Study researcher Bisakha Sen, PhD, and colleagues analyzed data from Alabama's Children's Health Insurance Program (CHIP) between 1998 and 2010. The database included 14,972 children younger than 8 years and 21,833 children aged 8 years or older. 

The study concluded that more preventive visits were associated with fewer subsequent non-preventive dental visits and lower non-preventive dental expenditures for both groups. However, the study also concluded preventive visits did not reduce overall dental or medical (inclusive of dental) expenditures. 

The American Academy of Pediatric Dentistry (AAPD) responded to these conclusions by providing some important contextual considerations for the results, including the family’s ability to access care and preventive services, the levels of health literacy of the family, and social, cultural and economic pressures. 

As a dental administrator for many state health plans, DentaQuest understands that CHIP programs are the vehicle for many at-risk children to get dental care.  These children often start at a deficit, with multiple unaddressed dental needs, some more pressing than others, and therefore they need an ongoing treatment plan.  And, as the AAPD response points out, there are other costs not counted as dental, such as dental emergency room visits and services that must be performed under general anesthesia.

Preventive care is important for everyone, but especially for children. Dental disease is caused by a bacterial infection. It is the most common disease of childhood. Children with untreated dental disease have difficulties eating, learning to speak, and even stay focused in school. The impact of untreated dental disease stays with the child as he or she grows into an adult.

My key takeaway from this study is: “more preventive visits were associated with fewer subsequent non-preventive dental visits and lower non-preventive dental expenditures.” And that’s a good thing.

Prevention is a long term investment in improving lives.

Oral Health Literacy and Health Equity

By Ralph Fuccillo, DentaQuest Chief Mission Officer

Nearly nine out of ten U.S. adults find it hard to use the health information they get from their dentist or doctors’ office, in the media and even in their communities.¹

 

That is a real problem.

Limited health literacy leads people to incorrect conclusions about helpful oral health actions -- like community water fluoridation, eating a healthy diet, brushing and flossing every day, even getting regular preventive dental care visits. Limited oral health literacy is a contributor to the growing number of very young children (age 1-5) with Early Childhood Caries – aggressive dental disease –in need of repair (root canals and crowns) in operating rooms. Health literacy is something we all need to pay more attention to – as consumers, care providers, and public health advocates.

I am pleased to see that oral health literacy is gaining importance as a public health priority. Last year, I had the honor of joining a number of key national oral health leaders at the Institute of Medicine (IOM)’s Roundtable on Health Literacy. Oral health is now included on the IOM Health LiteracyRoundtable through the participation of the California Dental Association. The oral health literacy roundtable explored ways to bring oral health literacy research into oral health practice, and to do this in a way that everyone can understand. As a speaker, I had four key messages:

• The mouth is part of the body
• Cavities and gum disease are the result of a bacterial infection in the mouth
• Dental disease is preventable
• Oral health literacy is everybody’s business

As part of my presentation, I also spoke about my personal experience volunteering at a Mission of Mercy free clinic in rural Virginia. It is impossible to overstate the desperation and gratitude that I saw. I left with a different perspective on our current care delivery system. People are being left behind. People don’t have the information they need to be healthy.  

This experience motivated me to become involved in the establishment of the US National Oral Health Alliance and the DentaQuest Foundation’s multi-year Oral Health 2014 initiative. Both work to improve oral health literacy, and ultimately, the oral health of all.

In June 2012, the U.S. National Oral Health Alliance hosted a national learning event focused on Oral Health Literacy as a Pathway to Health Equity. Participants worked to develop common ground messages about oral health literacy that we can all work to achieve. I share them below because they are simple, yet so important. I hope you will consider using them in your work and your lives.

• Everyone has a stake in oral health literacy.
• Health literacy is based on genuine compassion and care. We all need a sense of empathy to meet people where they are, to listen to, learn from, and respect one another
• Prevention is the starting point for health.
• We need to use simple, clear and consistent educational messages if we are to motivate action to improve their oral health. It is important to be patient-centered and respectful of cultures, languages and customs.

1.     Kutner M, Greenberg E, Jin Y, Paulsen C. The Health Literacy of America’s Adults: Results from the 2003 National Assessment of Adult Literacy (NCES 2006-483). U.S. Department of Education. Washington, DC: National Center for Education Statistics; 2006.

Bacteria in the Mouth are Not Harmless

By John Luther, DDS, Chief Dental Officer, DentaQuest

As a dentist, one of the first things I tell new parents is not to put something that has been in your mouth into your baby’s mouth.

So you can imagine my surprise when I heard about a Swedish study, which found that babies whose parents sucked on their pacifier to cleanse it were less likely to get eczema and asthma, two conditions caused by allergic reactions. 

The study concludes that when parents suck their child's pacifier clean, they transfer some of the harmless bacteria in their mouths to their child which makes those types of allergic reactions less likely. 

Despite this study, there is significant other research that shows that not all bacteria in the mouth are harmless. 

Cavities (caries) are the result of a bacterial infection and young children can “catch” the harmful bacteria that causes cavities. While everybody has bacteria in their mouth, it’s important to try to keep these harmful bacteria from our children’s mouths during their first year or two or they become the dominant bacteria and the child could experience a lifetime of tooth decay.

Babies most often get these bacteria from a family member who has the bacteria in his/her mouth. Cavity-causing bacteria in the adult’s mouth can be transferred easily to a child’s mouth through something as harmless as testing food to be sure it isn’t too hot, sharing a spoon of ice cream, “cleaning” the pacifier that fell on the floor in your mouth, biting off a piece of apple to share with a child, even kissing. If cavity causing bacteria are transferred to the child too early, they can be dominant for life.

Tooth decay is the most common chronic disease of childhood. It is five times more common than asthma. Untreated, tooth decay can have serious, negative effects on a child’s physical and educational development. Mouth pain makes it difficult to eat a healthy diet, to learn to speak properly, and to concentrate in school. Untreated tooth decay in baby teeth can damage a child’s permanent teeth. 

We need to remember there are a lot of studies out there. Occasionally doing something helpful in one area can cause harm in another. Early tooth decay can quickly put kids at a lifelong disadvantage. Taking care to reduce the risk of transmitting cavity-causing bacteria to babies and toddlers will better position them to fight off tooth decay as they grow.

How Data Analytics Creates Value in Dental Care

By: Shaju Puthussery, Chief Analytics Officer

As components of the Affordable Care Act (ACA) go into effect, dental benefit management is keeping pace. Health plans need a dental partner that provides products and services at attractive prices, but also one with experience in commercial and government spaces, as well as on a public exchange. And perhaps most importantly, a dental benefits partner should have the ability to go beyond claims processing into deep data analytics that create cost savings – including the potential for lower premiums – as a result. This new model goes beyond claims adjudication to collaborative engagement with providers and patients. 

In  order to gain cost savings from these partnerships, plan administrators must be able to understand and predict provider and patient behaviors and then put these assessments into action. Data analytics are the key to understanding those behaviors. With the right kind and amount of data, we can build predictive models that ultimately result in better quality of care from providers and better oral health outcomes for patients. That’s a win-win under any circumstances. But add to that the ability to control costs, and you can see why data analytics are a necessity for success in the world of consumer-driven healthcare.

Not every dental benefits organization can leverage data effectively, though. To create effective predictive models, you must start with a wealth of data. DentaQuest, for instance, has access to many years of data from more than 18 million members and thousands of providers. This is where effective modeling begins, as we use external data coupled with claims pattern data and provider utilization data. 

To find out more about how data analytics creates cost savings, sign up for our America Health Insurance Plan (AHIP) webinar, titled “Health Reform Dental Mandate and What It Means to You: The Role of Data Analytics In Value-Based Healthcare.” The webinar is on Wednesday, May 8, 2013 from 2 p.m. to 3 p.m. ET and offers an opportunity to ask our on-staff experts about dental benefits, data analytics, and how to create value in the new healthcare environment. Register today by visiting http://ahip.org/Webinar/DentalMandate/.

With the changes resulting from ACA mandates, health plans are looking for ways to differentiate themselves from competitors. Integrating high-quality dental benefits into their products is an excellent way to do this and an effective strategy to retain and grow membership.