MEDICAID ISSUES NEW RESEARCH FOR MEDICAID DENTAL ADVOCACY

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MEDICAID ISSUES: NEW RESEARCH FOR MEDICAID DENTAL ADVOCACY Public Policy Advocates Workshop, September 29,

MEDICAID ISSUES: NEW RESEARCH FOR MEDICAID DENTAL ADVOCACY Public Policy Advocates Workshop, September 29, 2018 Beau Meyer, DDS, MPH Public Policy Advocate—North Carolina Academy of Pediatric Dentistry beau_meyer@unc. edu

WHERE ARE WE? Utilization is changing Contributors Financing mechanisms Fee-for-service budgeting? Capitated budgeting? Reimbursement

WHERE ARE WE? Utilization is changing Contributors Financing mechanisms Fee-for-service budgeting? Capitated budgeting? Reimbursement mechanisms Future of fee-for-service? Managed Care? ACO’s? Value or quality metrics?

SOURCES OF DENTAL COVERAGE

SOURCES OF DENTAL COVERAGE

DENTAL UTILIZATION

DENTAL UTILIZATION

VARIABILITY BY STATE

VARIABILITY BY STATE

LOWER DISEASE RATES

LOWER DISEASE RATES

OVERALL HEALTHCARE FINANCING

OVERALL HEALTHCARE FINANCING

DENTAL EXPENDITURES PERSON

DENTAL EXPENDITURES PERSON

PROVIDER PARTICIPATION

PROVIDER PARTICIPATION

PROVIDER PARTICIPATION VS. UTILIZATION

PROVIDER PARTICIPATION VS. UTILIZATION

MEDICAID REIMBURSEMENT

MEDICAID REIMBURSEMENT

MEDICAID REIMBURSEMENT

MEDICAID REIMBURSEMENT

REIMBURSEMENT VS. UTILIZATION Utilizaiton rate (%) Changes in utilization rate according to reimbursement rate

REIMBURSEMENT VS. UTILIZATION Utilizaiton rate (%) Changes in utilization rate according to reimbursement rate 80 70 60 50 40 30 20 10 0 0 10 20 30 40 50 60 70 80 Medicaid Reimbursement Rate as a percentage of Private Insurance Reimbursement Rates (%) 90

PUTTING IT ALL TOGETHER

PUTTING IT ALL TOGETHER

WHAT ABOUT MANAGED CARE? ADA HPI data (not up to date) Not promising Nearly

WHAT ABOUT MANAGED CARE? ADA HPI data (not up to date) Not promising Nearly 20 states reported contracts 6 experienced lower utilization 5 maintained utilization Remaining increased utilization by small percentage points

WHAT ABOUT MANAGED CARE? Reimbursement to providers might make a difference Some managed care

WHAT ABOUT MANAGED CARE? Reimbursement to providers might make a difference Some managed care contracts are still paying providers fee-for-service Still unclear how quality metrics will impact provider reimbursement Problems with metrics—definitions, limitations Lead article in JADA September 2018 suggests that the claims-based metrics may underestimate care and that clinical/EHR data must be considered Unclear reimbursement applications to dentistry

HOW CAN WE USE THIS? The numbers point us in the right direction Active

HOW CAN WE USE THIS? The numbers point us in the right direction Active engagement in state’s MCO contracting MCO’s can still pay dentists on a fee-for- service basis The dial is moving forward only where fees are in the market-place range We know of no examples where states slashed rates and provider participation increased, patient utilization increased, and children’s oral health improved Personal stories from patients make compelling cases Unfortunately, stories from providers do not

THANK YOU

THANK YOU

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