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Medicaid Advisory Committee
May 24, 2017 9:00-12:00 Oregon State Library Salem, Oregon
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9:00 Welcome & Introductions
- Adopt minutes
- Approve Committee Calendar
Co Chairs 9:10 Eligibility update BethAnne Darby, OHA 9:20 Why we are here – member story Ross Ryan 9:30 OHP Ombuds update Ellen Pinney, OHA 9:45 Federal policy update & Principles for Oregon’s Medicaid program
- Federal policy update
- Next steps to develop principles for Oregon’s
Medicaid program David Simnitt, Tim Sweeney Co-Chairs 10:15 Break 10:25 Access to oral health: Oral Health Metrics Report
MAC/Oral health workgroup members Bruce Austin, DMD, OHA Amanda Peden, OHA 11:45 Public Comment All 11:55 Closing Co-Chairs
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Welcome & Introductions
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Eligibility Update
BethAnne Darby, External Relations Director, OHA
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Why we are here – OHP member story
Ross Ryan
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Ombuds Update Ellen Pinney, OHA Ombudsperson
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Federal policy update & Principles for Oregon’s Medicaid program
David Simnitt, Director, Office of Health Policy Tim Sweeney, Health Policy Analyst, OHA
http://www.95percentoregon.com/
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Federal policy: Next Steps to develop principles for Oregon’s Medicaid program
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Oregon priorities for federal reforms
- Changes to the ACA and Medicaid should maintain, not reverse, levels of
health care coverage in Oregon and other states.
- Oregon health care transformation is a model for federal Medicaid reform.
Medicaid cost-savings should be achieved by changing health care delivery, not rolling back eligibility, benefits or funding levels. Oregon has shown that it is possible to improve quality for patients while also reducing costs.
- Federal changes to the ACA should stabilize, not disrupt, Oregon’s
insurance market. Insurers need clarity about upcoming changes and timelines.
- Changes to the ACA should preserve the state’s ability to serve and protect
health insurance policyholders.
- Maintain funding to allow innovation and focus on prevention, including core
public health services funded in the ACA and community and home-based services for long-term care.
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Access to oral health: Oral health metrics report
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MAC Oral Health Access Framework: Overview
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Reminder: The ask from OHA to MAC
Develop a framework for defining and assessing access to oral health for OHP members.
1. What are the key factors that influence access to oral health care for OHP members? 2. What key data and information could OHA use to assess access to
- ral health services for OHP members?
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Oral Health Work Group Membership
- 3 CCOs
- 3 DCOs
- 3 Providers (2 dentists, 1 hygienist)
- 2 Consumer advocates
- 3 Tribal representatives
- 2 members of general public
- No consumers applied to the work group – staff undertook separate
consumer engagement effort.
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Recommendations
- Standard Definition of Oral Health Access
that provides a common language and understanding of oral health access in OHP for OHA and the broader stakeholder community.
- Oral Health Access Framework Model that
lays out the key factors and influencers that help
- r hinder oral health access in OHP.
- Oral Health Access Monitoring Measures
Dashboard that provides recommended priority measures to monitor key factors of access for OHP members.
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Oral Health in Oregon’s CCOs
A Metrics Report
May 24, 2017
Bruce Austin, DMD, Dental Director Amanda Peden, Policy Analyst, Office of Health Policy
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Presentation overview
- Oral health and the coordinated care model
- Oral Health in Oregon CCOs
– Background – Framing up the discussion – Key findings – Data deep dive
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https://www.oregon.gov/oha/analytics/Documents/oral-health-ccos.pdf
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Oral health is fundamental to coordinated care model
- A growing body of evidence shows oral health is linked to overall
health:
Heart disease Diabetes Low birth weight Certain cancers Well-being Missed school/work days
- Integration of physical, oral and behavioral health care a key goal of
health system transformation and Oregon CCOs – Oral health in CCO global budget: Jul 2014 – CCO incentive metrics: dental sealants, foster care
- We’ve made progress, but there’s much more work to do…
SLIDE 19 Measures Overview
Provider Distribution Provider: Population Map* & Any Dental Service by County Utilization (Quality of Services) Any preventive service (adults & children)* Any dental services (broken out by preventive, diagnostic, treatment)– adults & children* Topical fluoride varnish Patient Experience Regular dentist Access to emergency care* Care Coordination Follow-up after ED visit for dental reasons* Oral health evaluation for patients with periodontitis* Integration Dental care for adults with diabetes* Oral health assessments in primary care*
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*from MAC oral health access dashboard
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Some caveats
- Much of the data in this report are being produced for the first
time
- Some data used preliminary specifications, courtesy of the
national Dental Quality Alliance (DQA)
- Some measures recommended by the Medicaid Advisory
Committee & Oral Health Workgroup not yet available: – New CAHPS questions: dental provider explanations to patient; customer service experience; oral health providers completing cultural competency training; forthcoming time & distance standard (network adequacy requirements)
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Framing up the discussion
When you are reviewing the data to come, consider…
- 1. What are 1-2 reflections or conclusions when
looking at this data? (i.e. what strikes you the most?)
- 2. Of the measures in the report, which are the most
meaningful and actionable for an ongoing oral health monitoring program? (hint: seeking to target a focused set of no more than 5 measures)
SLIDE 22 Key Findings
Certain counties in Oregon have fewer dentists compared with the number of residents they serve, and only about two of every five dentists (41.5 percent) report seeing Medicaid patients.
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Any preventive service: Children>>
Adult CCO members receive oral health services at lower rates than children. Many members do not receive preventive dental services such as regular cleanings, fluoride treatments, and dental sealants. When stratified by race and ethnicity, members who identify as Hawaiian/Pacific Islander consistently receive services at lower rates than other members.
Receiving any dental service Receiving preventive dental service
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Provider Distribution
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All dentists: FTE dentists per 1,000 Oregonians
Legend 0.0—0.20 0.21—0.50 0-51—0.75 >0.75
Source: Oregon Health Care Workforce Survey (2015/2016 renewal data)
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Percent OHP member receiving any dental service
Source: Administrative (billing) claims (2015)
Legend 11—20% 21—30% 31—40% 41—50% 51—60%
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Medicaid provider capacity
Percent of a dentist’s caseload that are Medicaid patients.
2015/2016 renewal data (statewide)
No Medicaid 58.5% 1-24% Medicaid 19.2% 25-49% Medicaid 7.5% 50-74% Medicaid 5.5% 75-100% Medicaid 9.4%
The percentages above reflect those with known Medicaid acceptance status. 11.5% of all providers report unknown Medicaid caseload.
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Utilization (quality of services)
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Statewide: 2015--18.1% Mid-2016--19.4%
26.0% 9.5% 24.9% 11.5% 0.0% 5.0% 10.0% 15.0% 20.0% 25.0% 30.0%
Any preventive service (adults)
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Statewide: 2015—48.3% Mid-2016—50.1%
54.2% 31.6% 57.5% 32.2% 0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0% 70.0%
Any preventive service (children)
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0.0% 5.0% 10.0% 15.0% 20.0% 25.0% 30.0% 35.0% 40.0%
Any dental service (adults)
Statewide: 2015—33.0% Mid-2016—33.7%
SLIDE 31 Statewide: 2015—53.1% Mid-2016—54.8%
57.2% 39.6% 60.4% 41.5%
0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0% 70.0%
Any dental service (children)
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SLIDE 32 Statewide: 2015—14.5% Mid-2016—16.3%
22.6% 2.0% 23.2% 5.0%
0.0% 5.0% 10.0% 15.0% 20.0% 25.0%
Topical fluoride varnish for children
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Patient Experience
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Statewide: child—79% adult—57%
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Statewide: child—52% adult—44%
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Care Coordination
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Statewide: 2015—36.6% Mid-2016—37.1%
42.4% 22.8% 51.8% 26.1% 0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0%
Follow up after ED visit for non-traumatic dental reasons
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Statewide: 2015—13.7% Mid-2016—14.7%
17.7% 5.3% 18.3% 6.8%
0.0% 2.0% 4.0% 6.0% 8.0% 10.0% 12.0% 14.0% 16.0% 18.0% 20.0%
Oral evaluation with patients with periodontitis
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Integration
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Statewide: 2015—24.2% Mid-2016—24.1%
28.1% 14.1% 26.9% 13.9% 0.0% 5.0% 10.0% 15.0% 20.0% 25.0% 30.0%
Dental care for adults with diabetes
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Percent of children (0-6) who had an oral health assessment in mid-2016. Percent of oral health assessments provided by a medical practitioner (versus a dentist) in mid-2016.
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On the horizon…
- Oral Health in Oregon CCOs stakeholder
“road show”
- Identify meaningful metrics for ongoing
monitoring and action
- Member oral health communications
campaign in development
- Provide resources and technical
assistance to support oral health integration in Oregon CCOs (e.g. Oral Health Integration toolkit)
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Questions?
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Discussion
- 1. What strikes you most about the data you just saw?
- 2. Of the measures in the report, which are the most
meaningful and actionable for an ongoing oral health monitoring program? (hint: seeking to target a focused set of no more than 5 measures)
- 3. How would MAC members like to engage with this work
moving forward?
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Public Comment
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Closing
