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Oral Health Disparities in Publicly Insured Children

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Oral Health Disparities in Publicly Insured Children

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    1. Oral Health Disparities in Publicly Insured Children Dental Advisory Committee April 11th, 2008 Tegwyn H. Brickhouse DDS PhD Department of Pediatric Dentistry VCU School of Dentistry

    2. Grant NIH Career Transition Award (K22) From the National Institutes of Dental and Craniofacial Research Supports young investigators in their early career Experience guides them to become a independent scientist Future grants

    3. Oral Health Disparities Dental caries is the most common chronic disease of childhood, affecting 58% of all children. Untreated dental caries has been identified as the most prevalent unmet health need in US children.

    4. Health Coverage for Children Employer/Private Insurance 60% 47 million children Medicaid/SCHIP 28% 22 million children Uninsured 12% Over 9.4 million

    5. Background Publicly Financed Health Plans Providing Dental Services Medicaid A joint federal-state-county program established in 1965 to provide health insurance to low-income populations State Children’s Health Insurance Program (SCHIP) A joint federal-state program established in 1997 to provide coverage to low-income uninsured children who are not eligible for Medicaid.

    6. Grant Objectives Examine the structure of public dental insurance programs and patterns of Enrollment in publicly insured children. Examine the Process of dental care (utilization, mix of services) and dental health status Outcomes (tooth loss, caries-related treatments). Compare dental treatment with of general anesthesia versus the conventional dental delivery system for preschool-aged children Implement a project that examines outcomes for case management of infant oral health in a medical setting.

    7. Effects of Public Insurance on Access to Dental Services Cohort of Publicly Insured Children Enrollment and Claims data from 2002-2005 Children 0-18 years of age Two State Programs (Virginia and North Carolina) Similar size Similar population distribution Similar geography

    8. Analytical File Construction Claim summaries of utilization Provider-Level summaries Individual Child-level files linked enrollment and claims across time periods.

    9. Analytical File Creation Child-Level File

    10. Enrollment Patterns of Publicly Insured Children Measures that characterize enrollment in public programs Length of Enrollment (duration) Heterogeneous populations Patterns of Enrollment (continuity) yearly and age determinations gaps

    11. Impacts of Enrollment Impact on eligibility for dental services Age and aid categories of eligibility determination Enrollees are approximately 10% SCHIP, 90% Medicaid 75% of children were enrolled with one MCO provider 20% enrolled with 2 MCO’s 5% enrolled with 3+ Impact on provider acceptance Real-time eligibility determination (on-line, swipe methods)

    12. Enrollment Over the 3 year period, children were enrolled a mean number of 436 days, median of 365 days. The mean age of enrolled children is 5 years. 12.5% had no gaps in enrollment 50% has one gap in enrollment 37.5% had 2+ gaps in enrollment Few studies have examined the relationship of enrollment patterns and utilization.

    13. Outcomes Dental Visits Utilization of dental services measured by at least one paid claim. Annual Dental Visit (NCQA standards) Performance Measures of Dental Services Which children utilize services/benefit most Age Geography Income

    14. Outcomes Performance Measures of Dental Services Preventive services Restorative services Tooth Loss (receipt of one or more extraction services) Dental Home 2 visits to same practice/same year

    15. North Carolina Claims Data

    16. Medicaid versus Separate SCHIP Program

    17. Mix of Services for all Children

    18. Mix of Services for Children Accessing Dental Care

    20. Virginia Claims Data 62% of dental claims were MCO 38% of dental claims were FFS Mean age for children with claims was 9 years of age.

    21. Mix of Services 32% Diagnostic Services 40% Preventive Services 18% Restorative Services 5% Extraction Services 1.5 % Orthodontic Services

    22. Infant Oral Health Project Preventive oral health services consist of knee to knee oral screening and risk assessment Fluoride varnish oral health education for caregivers referral to a pediatric dental clinic.

    23. Infant Assessment 19% of children had signs of dental caries 12.5% having white-spot lesions 75% were categorized as ‘high’ risk and referred for a dental visit 80% of children received a fluoride varnish treatment

    26. High-Risk Children 6-months post-enrollment, 9% of children had made a dental visit to VCU. Children with visible plaque were more likely to have decay at baseline. 400+ Children enrolled in the VCU Bright Smiles Program Examine the prevalence of dental claims for enrolled children versus a random sample of Medicaid children 0-3 years of age.

    27. Future Studies Provider Measures Participation in programs Level of activity Types of Services Response to program changes Program structure Fee increases

    28. State Program Reform Single Vendor Carve Out Pre-Post Design

    29. Questions? Many Thanks to DMAS Sandra Brown James Starkey Lisa Bilik Pat Finnerty

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