Impacts of innovation in dental care delivery and payment in Medicaid managed care for children and adolescents

Douglas A Conrad,Yuxian Du,Joana Cunha-Cruz,Peter Milgrom,R Mike Shirtcliff,Sharity Ludwig

doi:10.1186/s12913-021-06549-3

Abstract

BackgroundWe evaluated a 14-county quality improvement program of care delivery and payment of a dental care organization for child and adolescent managed care Medicaid beneficiaries after 2 years of implementation.MethodsCounties were randomly assigned to either the intervention (PREDICT) or control group. Using Medicaid administrative data, difference-in-difference regression models were used to estimate PREDICT intervention effects (formally, “average marginal effects”) on dental care utilization and costs to Medicaid, controlling for patient and county characteristics.ResultsAverage marginal effects of PREDICT on expected use and expected cost of services per patient (child or adolescent) per quarter were small and insignificant for most service categories. There were statistically significant effects of PREDICT (p < .05), though still small, for certain types of service:Expected number of diagnostic services per patient-quarter increased by .009 units;Expected number of sealants per patient-quarter increased by .003 units, and expected cost by $0.06;Total expected cost per patient-quarter for all services increased by $0.64.These consistent positive effects of PREDICT on diagnostic and certain preventive services (i.e., sealants) were not accompanied by increases in more costly service types (i.e., restorations) or extractions.ConclusionThe major hypothesis that primary dental care (selected preventive services and diagnostic services in general) would increase significantly over time in PREDICT counties relative to controls was supported. There were small but statistically significant, increases in differential use of diagnostic services and sealants. Total cost per beneficiary rose modestly, but restorative and dental costs did not. The findings suggest favorable developments within PREDICT counties in enhanced preventive and diagnostic procedures, while holding the line on expensive restorative and extraction procedures.

Highlights

We evaluated a 14-county quality improvement program of care delivery and payment of a dental care organization for child and adolescent managed care Medicaid beneficiaries after 2 years of implementation
In which many Medicaid recipients are served by dental care organizations (DCOs), have created an opportunity to test hub and spoke models [4]
Programs in schools and community facilities provide basic care delivered by expanded practice dental hygienists (EPDHs) or therapists and refer complex care to hubs staffed by general dentists and specialists

Summary

Introduction

We evaluated a 14-county quality improvement program of care delivery and payment of a dental care organization for child and adolescent managed care Medicaid beneficiaries after 2 years of implementation. (1) Expected number of diagnostic services per patient-quarter increased by .009 units; (2) Expected number of sealants per patient-quarter increased by .003 units, and expected cost by $0.06; (3) Total expected cost per patient-quarter for all services increased by $0.64 These consistent positive effects of PREDICT on diagnostic and certain preventive services (i.e., sealants) were not accompanied by increases in more costly service types (i.e., restorations) or extractions. Overview Access to dental care has improved for children from low-income families in the United States in recent decades [1] These changes have occurred because of Medicaid expansion, growth of Federally Qualified Health Centers, and development of private and not-for-profit dental care organizations [2]. In which many Medicaid recipients are served by dental care organizations (DCOs), have created an opportunity to test hub and spoke models [4]. Hub and spoke models potentially could implement these evolving care protocols efficiently [4, 5]

Methods

Results

Discussion

Conclusion