INCREASING ACCESS TO HEALTH CARE FOR THE UNINSURED AND UNDERSERVED

Oral Health

Although we tend to recognize that a healthy mouth is important, many regard a visit to the dentist as a commodity, not a necessity. However, the Surgeon General’s report of 2000 states that tooth decay is 5-8 times more common in children than asthma.
In addition, despite our knowledge of the risks associated with poor oral health, we continue to encounter many barriers to access oral healthcare, particularly for the uninsured and underserved. Community Voices Miami’s challenge for oral health is to bring community members to the table to implement the objectives from the Miami Action Plan for Access to Healthcare (MAP).

Objective Four, under Goal Two of the MAP, is to increase proportion of uninsured or underinsured consumers with access to oral health services.
Community Voices Miami: Working to Improve Oral Health Outcomes

Phase 1: Strategic Planning for Oral Health

Facilitated with additional funding from the Health Foundation of South Florida in 2004, Community Voices Miami convened providers and community stakeholders to develop a community-driven, strategic plan for increasing access to oral healthcare.
The Strategic Plan for Improving Oral Health for the Uninsured and Underserved in Miami-Dade County is now a living document which is updated as new resources, programs and policies are established for oral health.

As part of the planning process, a study of dental providers in Miami-Dade was completed. A national review of best practices to improve oral health access was also conducted. These are both part of the report released in March of 2005 titled Oral Healthcare Access in Miami-Dade County, March 2005

Phase 2: Analysis of the Medicaid Pre-Paid Dental Pilot

With funding from the Health Foundation, Community Voices Miami produced two reports regarding the Medicaid Pilot in order to provide AHCA, legislators and stakeholders with the best available evidence of the Pilot’s performance in comparison with the pre-existing state-managed dental Medicaid program for children. This was a compliment to the University of Florida's evaluation, which focused "to design and implement an evaluation model to examine providers' and families' satisfaction with the Medicaid prepaid dental health program in Miami-Dade County."

The policy brief, Understanding the Impacts of Florida’s Medicaid Pre-Paid Dental Pilot
provides background and outlines the findings from the data analysis we commissioned from the School of Dentistry at Columbia University.

The full report from Columbia University, Miami-Dade County Prepaid Dental Health Plan Demonstration: Less Value for State Dollars reports on value, the benefit to the state in terms of quality of care for Medicaid dollars expended.

Using data from the UF report and additional information obtained from the Agency for Health Care Administration (AHCA), our analysis tried to answer to questions:

• How was access to dental care affected by the Medicaid Pre-Paid Dental Pilot in Miami-Dade?

• How was the value of Florida’s Medicaid dollars affected in terms of quality of care for Medicaid dollars spent?

Outcome

Overall, Florida paid about the same for the Pilot but utilization of services decreased so the value of the State's dollar decreased.  Nearly all measures of quality declined so the State paid the same for less care and less quality.

This is likely the result of a capitated managed care system with low reimbursement rates, which is a combination that has been shown in other states not to work. This was a pilot, a demonstration program, which was to be evaluated so that the state could determine whether to continue it, make changes to it or put it aside and look to build a different program.

Solutions

Some options that hold strong promise and have been initiated in other states include:
Targeting primary preventive care to very young children and their families in order to limit overall disease burden
- Paying dental providers at “market rates” by contracting with commercial dental plans or managed care vendors
- Expanding engagement of the dental community through outreach and expanded case management
- Stimulating expansion of preventive efforts by primary medical providers.
- With recent changes in federal law and regulations, the time is ripe for further experimentation that will lead to improved health of Florida’s children at less cost to the State

What Does The Medicaid Pre-Paid Dental Pilot In Miami-Dade Have To Do With Medicaid Reform In Florida?

• The key to determining the success of a program - Did consumer access to services improve and did the state get the most for our dollars? - is in the data collected and the quality of that data
• We now know that collecting provider claim forms is an issue with capitated managed care programs and that impacts how we evaluate these programs
• Contracts with HMOs and other healthcare providers need to include very specific direction about what data is collected and how, including data by provider, per user, per service.

Our goal is for people in Florida to have access to the highest quality care possible. We will continue to work with elected officials, policymakers, providers, consumers and others to share information, ideas and evaluated best practices for improving access to care.

Oral Health Resources:

State Oral Health Improvement Plan for Disadvantaged Floridians
The Goal of the Florida SOHIP is to advance general health and well being by increasing critical partnerships, coordination and collaboration in efforts to reduce oral health disparities. To be effective, the SOHIP needs participation in its development by a broad base of individuals, health care providers, communities, and policymakers, representing multiple oral health interests at all levels of society.

Association of State and Territorial Dental Directors
ASTDD provides leadership to advocate a governmental oral health presence in each state and territory, to formulate and promote sound oral health policy, to increase awareness of oral health issues, and to assist in the development of initiatives for prevention and control of oral diseases.

Children’s Dental Health Project
The Children's Dental Health Project advances policies that improve children's access to oral health. The Children's Dental Health Project forges research-driven policies and innovative solutions by engaging a broad base of partners committed to children and oral health.

Oral Health Resources from the Center for Disease Control
National Center for Chronic Disease Prevention and Health Promotion - Oral Health Resources.

Florida Oral Health Profile
The Center for Disease Control's National Oral Health Surveillance System; Florida's profile

National Maternal and Child Oral Health Resource Center
Helping states and communities address public oral health issues.

American Dental Association Topics and Resources
Use the A to Z list of oral health topics and quickly find the information you're looking for. Links to related topics or other pertinent sites provide you with additional information. The History of Dentistry timeline features milestones in oral health.

American Dental Hygienist's Association
General oral health information and tips.

State issues and oral health from the Center for Policy Alternatives
While oral health care has traditionally been split off from the rest of health care, from an individual's point of view, there is no difference. Just as a child cannot concentrate or learn in school if they have an upset stomach, they cannot learn if they have a tooth infection. And yet many states have not made the needed investment to make sure that children and adults have access to quality, affordable oral health care.

National Survey of Children’s Health
The Data Resource Center for Child and Adolescent Health is supported by through cooperative agreement from the Maternal and Child Health Bureau (MCHB), Health Resources and Services Administration, U.S. Department of Health and Human Resources, with the Early Intervention Research Institute, Utah State University.

Surveillance for Dental Caries, Dental Sealants, Tooth Retention, Edentulism, and Enamel Fluorosis --- United States, 1988--1994 and 1999--2002
Since 1996, a consortium formed by CDC and the National Institute of Dental and Craniofacial Research (NIDCR) has developed and implemented a plan to use the National Health and Nutrition Examination Survey (NHANES) to obtain epidemiologic estimates of dental conditions and preventive efforts. NHANES provides data for oral health surveillance at the national level. The specific objectives are to 1) assess the prevalence of major oral diseases and conditions, including dental caries, periodontal diseases, dental trauma, and enamel fluorosis; 2) assess efforts to prevent disease and disability, including prevalence of dental sealants and use/status of dentures; 3) monitor the oral health status of minority and underserved populations; and 4) provide estimates to evaluate the national health objectives for 2000 and 2010 related to oral health.

Watch Your Mouth Campaign
Making oral health a priority in Washington State.

Connecticut Oral Health Initiative
The Connecticut Oral Health Initiative (COHI) began as a committee of the Connecticut State Dental Association in 1993, charged with addressing the Healthy People 2000 goals on oral health. A strategic planning process completed in 2000 led to the decision to focus on advocacy in order to address the oral health crisis effecting low income families in the state.

Collins center
Collins Center For Public Policy • 150 SE 2 Avenue, Suite 709 • Miami, FL 33131 •
• Tel: 305.377.4484 • Fax: 305.377.4485 • www.collinscenter.org
Community Voices