Improving Oral Health: Strategies for Increasing Available Providers

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Improving Oral Health Strategies for
Increasing Available Providers
H. Bryan Tomlinson, II, Director of Health Care
Services Virginia Department of Medical
Assistance Services National Association of
State Medicaid Directors 2007 Fall
Conference Washington, DC November 13, 2007
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Virginia Medicaid/SCHIP Dental Benefits

• Approximately 490,000 eligible children
• Dental benefits for children in Medicaid/SCHIP
  include
• Diagnostic, preventive, restorative/surgical
  procedures and orthodontics
• Dental benefits are not covered for Medicaid
  adults, except for limited oral surgery (e.g.
  extraction of infected teeth complicating a
  medical condition, etc.)

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Access to/Utilization of Dental Services Needed
to Improve

• In FY 2003, 23.4 of eligible children received
  services
• Low participation of all VA licensed dentists
  (620 of 4,786) in the Medicaid/ FAMIS program

Dentist Participation in Medicaid/FAMIS
FY 2003
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DMAS Dental Survey

• Survey was developed to identify the reasons
  providers did not want to participate in the
  Medicaid/FAMIS dental program
• Survey was mailed to all licensed dental
  practitioners in Virginia (over 4500) in 2004
• Over 1000 surveys were completed and returned to
  DMAS. (22 response rate)

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Barriers to Participation

• Reimbursement
• Claim Submission
• Prior authorization
• Timeliness of payment
• Availability of specialists
• Patient behaviors
• Broken appointments
• Non-compliance

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Would you consider participating if fees
increased?
Percentage of those that answered particular
question
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Program Goal

• Improve Access to Quality Dental Care to
  Medicaid/SCHIP Recipients
• Increase Provider Participation
• Increase Pediatric Dental Utilization

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Stakeholder Engagement
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A New Day for Dental! Smiles For Children

• Effective date July 1, 2005
• New program was labeled Smiles For Children
• with a new logo and registered service mark
• All children (Medicaid FAMIS) were enrolled
• in a single program administered by Doral Dental
  USA
• Limited medically necessary services for adults
• Medicaid/SCHIP retains policymaking authority and
  closely monitors contractor activities
• New program is fee-for-service and non-risk

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Fee-for-Service with a Commercial Flare

• Many principles of a managed care product were
  adopted
• Coordination of Care
• Provider Credentialing
• Network Development
• Member Outreach
• Quality Improvement Programs

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Key Program Enhancements

• Old Program
• Multiple Vendors
• Multiple credentialing processes
• Complicated Administration
• Limited local representation on program policy
  decisions
• Enrollee transfer between plans disrupted care

• Smiles For Children
• Single Vendor (Doral)
• Streamlined Credentialing
• Easy, Industry-Standard Administration
• VA Based Peer Review Committee/Dental Advisory
  Committee
• All enrollees in Smiles for Children program

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ResultsIncreased Provider Network
Participating Providers

• 387 new dentists are participating (62 increase)
• Percentage of contracted providers who are
  billing for services has increased from 50 to
  83

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Incentives to Attract Providers

• Increased Reimbursement
• Improved ease of administration
• Conformed to commercial practices
• Reduced broken appointments
• Offered superior provider relations
• Provided flexible levels of participation
• Collaborated with dental community

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..And Increased Access to Care
Percentage of Children Receiving Dental Care
48
46
43
36
35
29
29
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Source CMS 416 Report for Virginia
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Lessons Learned

• Reduce program requirements for providers who
  uphold high standards of care
• Centralize and standardize processes through
  advanced web based services
• Promote best practices
• Acknowledge dental community participation to
  state legislators and public policy groups
• THANK providers

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On-Going Challenges

• Reimbursement
• Prior program experience
• Provider attitude towards Medicaid
  enrollees
• Payor environment
• Recruitment in rural areas

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THANK YOU!!!!!
1-888-912-3456
http//www.dmas.virginia.gov/dental-home.htm
http//www.doralusa.com