Demonstration of payer readiness for value-based care in a fee-for-service environment: Measuring provider performance on sealant delivery.

OBJECTIVES: Previously published sealant measures are not useful when applied to Medicaid claims data in states where dental services are carved out of managed care. A novel sealant measure was developed to assess the degree to which dental providers seal eligible teeth during preventive dental visits (PDVs) in an effort to ascertain if such a measure can be used to valuate provider performance, as condition of potential value-based care model implementation. METHODS: A single-county feasibility study was conducted using Medicaid claims. A study cohort included children aged 8 years and enrolled 12 months during 2018. Prospective analysis was used to determine whether dental sealants were applied by the same dentists during PDVs or up to 9 months thereafter. Eligible teeth included first permanent molars. Teeth previously restored, sealed or missing were excluded. PDV was defined as any encounter with prophylaxis, fluoride treatment, or EPSDT. Claims were compared to public health surveillance for measurement validation. RESULTS: Single-county results showed 11 percent of eligible teeth were sealed. Only 9 percent of dentists applied sealants to at least 40 percent of eligible teeth. Face validation of sealant rate was 23 percent Medicaid versus 36 percent Public Health. The former measures incidence and the latter prevalence with greater heterogeneity that included partially retained sealants. CONCLUSIONS: A sealant measure that assesses provider adherence to sealant standards of care was produced. It has potential application for assessing performance of pediatric preventive services and informing value-based performance expectations.

Differences in dental service utilization by rural children with and without participation in Head Start.

PURPOSE: The purpose of this study was to assess differences in dental and medical care utilization for dental problems between rural Head Start (HS) participants and a nonexposed group. METHODS: A matched retrospective cohort study was conducted using chi-square, Poisson, and logistic regression models. We linked Medicaid claims and HS enrollment data for 7 rural counties in South Carolina to examine oral health service utilization in dental, primary care (PC), and emergency room (ER) settings. The exposed group included 985 HS participants during the 2007/2008 school year and the nonexposed group included 1,969 children enrolled in Medicaid but not HS. RESULTS: HS participants were more than twice as likely to visit dentists for preventive, diagnostic, and restorative care (P<.001). The odds ratio of HS participants relative to the nonexposed group for PC visits for oral health problems was 1.94 (P=.03). No differences between HS participants and the nonexposed group for oral health-related ER visits were observed (P=0.33). CONCLUSIONS: Head Start participants accessed dental care with greater frequency than the nonexposed group. Findings provide evidence that Head Start grantees positively impact dental service utilization for their children. Future research should examine the programmatic features to which the outcomes can be attributed and whether utilization trends continue after Head Start completion.

Rural-urban differences in dental service utilization among an early childhood population enrolled in South Carolina Medicaid.

Our exploratory study examined rural-urban differences in dental care utilization during early childhood among Medicaid-enrolled children aged younger than 4 years in South Carolina. We conducted a secondary data analysis using Medicaid data. Dependent variables included preventive dental visits, use of medical settings (emergency room [ER] and primary care [PC] offices) for dental reasons, receipt of fluoride varnish, and dental home status. The primary independent variable was child's area of residence, rural or urban. The control variables were child's age, gender, race, and special healthcare need status. In adjusted analyses, rural children were found to have significantly higher odds of lacking preventive dental visits, fluoride varnishes, and dental homes as well as using medical settings for dental reasons compared to urban children. This difference, however, was not a simple function of rural residence. Other variables such as race and special healthcare need status interacted with rurality in explaining the differences in the outcomes of interest except visiting medical settings for dental reasons. Children under age of 2 years had higher odds of undesirable outcomes compared to those aged older than 2 years. Significant disparities in dental care utilization were evident among rural, Medicaid-enrolled preschool-aged children in South Carolina. While the state has addressed Medicaid reimbursement and related policies for nearly 10 years, their impact may be disproportionately effective.

South Carolina Partners for Preterm Birth Prevention: a regional perinatal initiative for the reduction of premature birth in a Medicaid population.

OBJECTIVE: The objective of the study was to improve the distribution of preterm deliveries in a Medicaid population through a regional perinatal risk assessment and case management initiative. STUDY DESIGN: An innovative public/private partnership was initiated in the 8 county Lowcountry (LC) perinatal region to reduce preterm birth (PTB) among Medicaid recipient women. Eligible women were identified and underwent telephonic risk assessment, education, and access to a 24 hours, 7 days per week perinatal hotline. Women with predetermined risk factors for PTB were offered patient-centered case management. Medicaid claims and birth certificate data were used to compare obstetric outcomes for 2006 (intervention) and 2004 (control) in both the Lowcountry (LC; program) and Midlands (ML; nonprogram) perinatal regions. RESULTS: There were 6356 Medicaid deliveries in the LC in 2006. Of these, 2111 were referred for telephonic risk assessment; 317 had identifiable PTB risk factors and consented to case management. Compared with 2004, there was a significant improvement in the distribution of preterm birth (P = .05) in the LC region, primarily confined to deliveries less than 28 weeks (1.6% vs 1.1%; P = .029, relative risk [RR] 0.75, 95% confidence interval [CI], 0.51-0.96). There were also reductions in the frequency (6.7% vs 5.8%; RR 0.86, 95% CI, 0.75-0.98; P = .04) and mean duration (25.0 vs 20.6 days; 95% CI, 1.03-7.77; P = .01) of neonatal intensive care unit (NICU) admissions. No changes were identified in the ML region. CONCLUSION: A regional initiative of telephonic risk assessment and case management of Medicaid recipient women significantly reduced deliveries less than 28 weeks and NICU care.