Analysis of Indiana Dental Medicaid Claims to Validate Actual - PowerPoint PPT Presentation

Analysis of Indiana Dental Medicaid Claims to Validate Actual Dentist Participation in the State’s Safety Net Presenting Author: Hannah Maxey, PhD, MPH, RDH Contributing Authors: Connor Norwood, Sierra Vaughn, Yumin Wang, John Williams

Presentation Objectives • Describe challenges associated with measuring dental service capacity in Medicaid programs • Present innovative method for measuring participation • Discuss limitation, policy implications and future direction BOWEN CENTER FOR HEALTH WORKFORCE RESEARCH & POLICY

Medicaid and Dentists: What we know. . . • Numerous state Medicaid programs report experiencing challenges in recruiting a sufficient number of dental providers • Being enrolled as a Medicaid provider does not equal active participation • Most studies focused assessing characteristics of dentists associated with participation in Medicaid use self-reported measures BOWEN CENTER FOR HEALTH WORKFORCE RESEARCH & POLICY

Measuring dentists’ participation in Medicaid • Recent article: – Evaluating levels of dentist participation in Medicaid. Warder, Clayton J. et al. The Journal of the American Dental Association , Volume 148 , Issue 1 , 26 - 32.e2 • What: Assessment of secondary data sources examining dentist participation in Medicaid – ASTDD Survey – ADA Compendium – InsureKidsNow.org – ADA 2015 – Medicaid/Medicare Services Dental Association • Findings: “No consistent, comparable, on - going source of data” • Implications: “ Ongoing method to measure meaningful participation needed ” BOWEN CENTER FOR HEALTH WORKFORCE RESEARCH & POLICY

The current study • Primary Objective: – Analyze Medicaid claims for dentists enrolled in Indiana Medicaid to determine whether certain characteristics are associated with: • Medicaid Participation (clinical engagement) • Level of participation in Medicaid • Secondary Objectives: – Develop method to measure “level of participation” – Assess validity of self-reported Medicaid participation BOWEN CENTER FOR HEALTH WORKFORCE RESEARCH & POLICY

Methods: Study Data • Sources – Indiana Professional Licensing Agency • Indiana dental license file • Licensure survey data (collected during renewal period December 2015-April 2016) – Indiana Office of Medicaid Planning and Policy • Enrolled dental providers (National Provider Identifier and Indiana State License Number) during state fiscal year 2015 (July 1, 2015- June 30, 2016) • Dental claim count (FFS, CHIP, SCHIP, MCO) associated with Indiana License Number of rendering provider for state fiscal year 2015 • Merging – Indiana license number BOWEN CENTER FOR HEALTH WORKFORCE RESEARCH & POLICY

Methods: Study Population BOWEN CENTER FOR HEALTH WORKFORCE RESEARCH & POLICY

Methods: Study Population v. All Enrolled Table 1: Total Indiana Medicaid enrolled dentists versus licensure survey sample Total Enrolled Survey Sample Total Dentists 1564 1023 Mean Age 48.9 48.2 Mean Claims Count 701.4 656.4 Total Active Dentists 1125 (0.72) 759 (0.74) Claims Category 439 (0.28) 264 (0.26) Inactive Provider 206 (0.13) 133 (0.13) Less than 30 Mintues Per Week as a Provider 97 (0.06) 67 (0.07) 30 Minutes to 1 hour per week as a Medicaid Provider 141 (0.09) 96 (0.09) 1 - 2 hours per week as a Medicaid Provider 151 (0.10) 105 (0.10) 2 - 4 hours per week as a Medicaid Provider 202 (0.13) 147 (0.14) 4 - 8 hours per week as a Medicaid Provider 328 (0.21) 211 (0.21) 8 or more hours per week as a Medicaid Provider BOWEN CENTER FOR HEALTH WORKFORCE RESEARCH & POLICY

Methods: Variables and Analyses • Outcome measures – Medicaid Participation • Binary measure – ‘Active’ = 1 or more claim(s) during the fiscal year – ‘Inactive’ = 0 claims during the fiscal year – Level of Medicaid Participation • Ordinal measure – Described in subsequent slides • Independent measures – Demographic characteristics (age, race, gender) – Practice characteristics (geography, full-/part-time, Medicaid participation) • Analytic Methods – Chi-square tests – Logistic Regression (binary outcome) – Partial Proportional Odds (ordinal outcome)* BOWEN CENTER FOR HEALTH WORKFORCE RESEARCH & POLICY

Methods: Level of Medicaid Participation BOWEN CENTER FOR HEALTH WORKFORCE RESEARCH & POLICY

Methods: Categorized Levels of Participation Outcome Measures Table 2. Categorization and Conversion of Medicaid Claims Medicaid Claim Number Estimated Hours per Week Providing Total Dentists Category of Claims Dental Care to Medicaid Recipients* 1 0 Inactive 264 1 – 49 2 Less than 30 Mintues Per Week 133 50 – 99 3 30 Minutes to 1 hour per week as a Medicaid Provider 67 100 – 199 4 1 - 2 hours per week as a Medicaid Provider 96 200 – 399 5 2 - 4 hours per week as a Medicaid Provider 105 400 – 799 6 4 - 8 hours per week as a Medicaid Provider 147 ≥ 800 claims 7 8 or more hours per week as a Medicaid Provider 211 * Conversion based on criteria defined by the Health Resources and Services Administration BOWEN CENTER FOR HEALTH WORKFORCE RESEARCH & POLICY

Table 3: Demographic and Practice Characteristics of Indiana Medicaid Enrolled Dentists by Participation Status (N=1,023) Results: Descriptive Active Not Active N Row% N Row% P-Value Total Dentists 759 74.19 264 0.26 Age Category • Significant differences < 35 132 0.13 69 0.07 0.008 35 to 55 373 0.36 113 0.11 >55 254 0.25 82 0.08 identified Job Status 517 0.51 170 0.17 0.2674 Full Part 242 0.24 94 0.09 – Age Gender Female 224 0.22 91 0.09 0.1329 Male 535 0.52 173 0.17 – Dental Specialty Dental Specialty General practice 613 0.60 207 0.20 Dental Public health 18 0.02 3 0.00 <0.0001 – Practice Setting Pediatric 74 0.07 14 0.01 Other Type 3 0.00 14 0.01 51 0.05 26 0.03 Oral surgery Race 0.3346 White 652 0.64 233 0.23 Other Race 107 0.10 31 0.03 Rural/Urban Rural 134 0.13 40 0.04 0.3511 Urban 625 0.61 224 0.22 Primary Practice Setting Solo Practice 409 0.40 113 0.11 Partnership Practice 110 0.11 34 0.03 0.0023 Other Type/Setting 55 0.05 30 0.03 Group Practice 185 0.18 87 0.09 BOWEN CENTER FOR HEALTH WORKFORCE RESEARCH & POLICY

Results: Partial Proportional Odds Table 4. Adjusted odds ratios (AOR) and 95% CI from generalized ordered logistic regression models of clinical engagment in Medicaid (hours/week) by dentists' demographic and practice characteristics AOR and 95% CI Clinical Engagement in Medicaid (hours/week) a If the odds ratio is proportional, a single AOR is shown in the center column. If the odds are non-proportional three AORs are shown, one for each of the three contrasts Variables 0 vs. > 0 <.5 vs. .5+ < 1 vs. .1+ < 2 vs. 2+ < 4 vs. 4+ < 8 vs. 8+ Primary Practice Setting (Other Practice Setting) Solo Practice 1.40 (0.90, 2.17) Partnership Practice 1.14 (0.70, 1.87) Group Practice 1.13 (0.71, 1.79) Dental Practice Type (other type) 29.77 (7.46, 118.81) * Dental Public health 13.42 (4.24, 42.44)* General practice 9.62 (2.90, 31.92)* Oral and maxillofacial surgery 55.32 (16.52, 185.30)* Pediatric 1.24 (0.98, 1.57) Gender (Female) 0.69 (0.51, 0.94)** Race (Non-white) 1.38 (1.11, 1.72)* Full-Time Job Status (part-time) Age Category (≥ 55 years old) 35-54 years old 1.1(0.80,1.51) 1.37(1.03,1.82)* 1.58(1.20,2.09)*** 2.00(1.50,2.64)*** 1.93(1.44,2.6)*** 2.03(1.43,2.88)*** 0.61(0.42,0.89)* 0.87(0.55,1.10) 0.96(0.67,1.35) 1.33(0.93,1.89) 1.83(127,2.64)** 1.66(1.67,2.57)* Less than 35 years old Source: Authors' analysis of state Medicaid claims count data, 2015 ***: p<.001; ** p<0.01; * p<0.05. BOWEN CENTER FOR HEALTH WORKFORCE RESEARCH & POLICY

Results: Participation across age groups BOWEN CENTER FOR HEALTH WORKFORCE RESEARCH & POLICY

Discussion • Using the ordinal measure representing “time based contribution” results are consistent with literature • Non- white dentists and those that practice “full - time” are greater contributors to Medicaid • Medicaid productivity peak in the 35-55 age group is consistent with general productivity trends BOWEN CENTER FOR HEALTH WORKFORCE RESEARCH & POLICY

Limitations • Outcome dependent upon the assumption that HRSA criteria (4,000 claims =1 FTE) is valid • Survey sample may or may not represent all enrolled • Additional unmeasured factors may contribute to dentists participation • Dentists may provide care to Medicaid recipients and not submit claims • Claims data may not be reliable BOWEN CENTER FOR HEALTH WORKFORCE RESEARCH & POLICY

Policy Implications/Future Directions • A standardized method of measuring dentist participation in Medicaid is needed • Claims data may be useful in measuring participation • Future research will focus on analyzing claims data from other states BOWEN CENTER FOR HEALTH WORKFORCE RESEARCH & POLICY