Medicaid Advisory Committee May 24, 2017 9:00-12:00 Oregon State - PowerPoint PPT Presentation

Medicaid Advisory Committee May 24, 2017 9:00-12:00 Oregon State Library Salem, Oregon

9:00 Welcome & Introductions Co Chairs  Adopt minutes  Approve Committee Calendar 9:10 Eligibility update BethAnne Darby, OHA Why we are here – member story 9:20 Ross Ryan 9:30 OHP Ombuds update Ellen Pinney, OHA Federal policy update & Principles for Oregon’s Medicaid 9:45 David Simnitt, Tim program Sweeney  Federal policy update Co-Chairs  Next steps to develop principles for Oregon’s Medicaid program 10:15 Break 10:25 Access to oral health: Oral Health Metrics Report MAC/Oral health • Presentation workgroup members • Discussion Bruce Austin, DMD, OHA Amanda Peden, OHA 11:45 Public Comment All 11:55 Closing Co-Chairs 2

Welcome & Introductions

Eligibility Update BethAnne Darby, External Relations Director, OHA

Why we are here – OHP member story Ross Ryan

Ombuds Update Ellen Pinney, OHA Ombudsperson

Federal policy update & Principles for Oregon’s Medicaid program David Simnitt, Director, Office of Health Policy Tim Sweeney, Health Policy Analyst, OHA http://www.95percentoregon.com/

Federal policy: Next Steps to develop principles for Oregon’s Medicaid program

Oregon priorities for federal reforms • Changes to the ACA and Medicaid should maintain, not reverse, levels of health care coverage in Oregon and other states. • Oregon health care transformation is a model for federal Medicaid reform. Medicaid cost-savings should be achieved by changing health care delivery, not rolling back eligibility, benefits or funding levels. Oregon has shown that it is possible to improve quality for patients while also reducing costs. • Federal changes to the ACA should stabilize, not disrupt, Oregon’s insurance market. Insurers need clarity about upcoming changes and timelines. • Changes to the ACA should preserve the state’s ability to serve and protect health insurance policyholders. • Maintain funding to allow innovation and focus on prevention, including core public health services funded in the ACA and community and home-based services for long-term care. 9 9

Access to oral health: Oral health metrics report

MAC Oral Health Access Framework: Overview

Reminder: The ask from OHA to MAC Develop a framework for defining and assessing access to oral health for OHP members. 1. What are the key factors that influence access to oral health care for OHP members? 2. What key data and information could OHA use to assess access to oral health services for OHP members? 12 12

Oral Health Work Group Membership • 3 CCOs • 3 DCOs • 3 Providers (2 dentists, 1 hygienist) • 2 Consumer advocates • 3 Tribal representatives • 2 members of general public  No consumers applied to the work group – staff undertook separate consumer engagement effort. 13 13

Recommendations • Standard Definition of Oral Health Access that provides a common language and understanding of oral health access in OHP for OHA and the broader stakeholder community. • Oral Health Access Framework Model that lays out the key factors and influencers that help or hinder oral health access in OHP. • Oral Health Access Monitoring Measures Dashboard that provides recommended priority measures to monitor key factors of access for OHP members. 14 14

Oral Health in Oregon’s CCOs A Metrics Report May 24, 2017 Bruce Austin, DMD, Dental Director Amanda Peden, Policy Analyst, Office of Health Policy

Presentation overview • Oral health and the coordinated care model • Oral Health in Oregon CCOs – Background – Framing up the discussion – Key findings – Data deep dive • Q&A and discussion 16 16

https://www.oregon.gov/oha/analytics/Documents/oral-health-ccos.pdf 17

Oral health is fundamental to coordinated care model • A growing body of evidence shows oral health is linked to overall health: Heart disease Diabetes Low birth weight Certain cancers Well-being Missed school/work days • Integration of physical, oral and behavioral health care a key goal of health system transformation and Oregon CCOs – Oral health in CCO global budget: Jul 2014 – CCO incentive metrics: dental sealants, foster care • We’ve made progress, but there’s much more work to do… 18 18

Measures Overview Provider Distribution Provider: Population Map* & Any Dental Service by County Utilization (Quality of Services) Any preventive service (adults & children)* Any dental services (broken out by preventive, diagnostic, treatment) – adults & children* Topical fluoride varnish Patient Experience Regular dentist Access to emergency care* Care Coordination Follow-up after ED visit for dental reasons* Oral health evaluation for patients with periodontitis* Integration Dental care for adults with diabetes* Oral health assessments in primary care* *from MAC oral health access dashboard 19

Some caveats • Much of the data in this report are being produced for the first time • Some data used preliminary specifications, courtesy of the national Dental Quality Alliance (DQA) • Some measures recommended by the Medicaid Advisory Committee & Oral Health Workgroup not yet available: – New CAHPS questions: dental provider explanations to patient; customer service experience; oral health providers completing cultural competency training; forthcoming time & distance standard (network adequacy requirements) 20 20

Framing up the discussion When you are reviewing the data to come, consider… 1. What are 1-2 reflections or conclusions when looking at this data? (i.e. what strikes you the most?) 2. Of the measures in the report, which are the most meaningful and actionable for an ongoing oral health monitoring program? (hint: seeking to target a focused set of no more than 5 measures) 21 21

Key Findings Certain counties in Oregon have fewer dentists compared with the number of residents they serve , and only about two of every five dentists (41.5 percent) report seeing Medicaid patients. Adult CCO members receive oral health services at lower rates than children . Receiving any dental service Many members do not receive preventive dental services such as regular cleanings, Receiving preventive dental service fluoride treatments, and dental sealants. When stratified by race and ethnicity, members who identify as Hawaiian/Pacific Islander consistently receive services at lower rates than other members. 5 Any preventive service: Children>>

Provider Distribution 23 23

All dentists: FTE dentists per 1,000 Oregonians Legend 0.0 — 0.20 0.21 — 0.50 0-51 — 0.75 >0.75 Source: Oregon Health Care Workforce Survey (2015/2016 renewal data) 24 24

Percent OHP member receiving any dental service Legend 11 — 20% 21 — 30% 31 — 40% 41 — 50% 51 — 60% Source: Administrative (billing) claims (2015) 25 25

Medicaid provider capacity Percent of a dentist’s caseload that are Medicaid patients. 2015/2016 renewal data (statewide) No Medicaid 58.5% 1-24% Medicaid 19.2% 25-49% Medicaid 7.5% 50-74% Medicaid 5.5% 75-100% Medicaid 9.4% The percentages above reflect those with known Medicaid acceptance status. 11.5% of all providers report unknown Medicaid caseload. 26 26

Utilization (quality of services) 27 27

Statewide: 2015--18.1% Mid-2016--19.4% Any preventive service (adults) 30.0% 26.0% 24.9% 25.0% 20.0% 15.0% 11.5% 9.5% 10.0% 5.0% 0.0% 28

Statewide: 2015 — 48.3% Mid-2016 — 50.1% Any preventive service (children) 70.0% 57.5% 60.0% 54.2% 50.0% 32.2% 40.0% 31.6% 30.0% 20.0% 10.0% 0.0% 29

Statewide: 2015 — 33.0% Mid-2016 — 33.7% Any dental service (adults) 37.9% 40.0% 37.5% 35.0% 30.0% 27.7% 25.3% 25.0% 20.0% 15.0% 10.0% 5.0% 0.0% 30

Statewide: 2015 — 53.1% Mid-2016 — 54.8% Any dental service (children) 70.0% 60.4% 57.2% 60.0% 50.0% 41.5% 39.6% 40.0% 30.0% 20.0% 10.0% 0.0% 28

Statewide: 2015 — 14.5% Mid-2016 — 16.3% Topical fluoride varnish for children 25.0% 23.2% 22.6% 20.0% 15.0% 10.0% 5.0% 5.0% 2.0% 0.0% 29

Patient Experience 33 33

Statewide: child — 79% adult — 57% 34

Statewide: child — 52% adult — 44% 35

Care Coordination 36 36 36

Statewide: 2015 — 36.6% Mid-2016 — 37.1% Follow up after ED visit for non-traumatic dental reasons 60.0% 51.8% 50.0% 42.4% 40.0% 30.0% 26.1% 22.8% 20.0% 10.0% 0.0% 37

Statewide: 2015 — 13.7% Mid-2016 — 14.7% Oral evaluation with patients with periodontitis 20.0% 18.3% 17.7% 18.0% 16.0% 14.0% 12.0% 10.0% 8.0% 6.8% 5.3% 6.0% 4.0% 2.0% 0.0% 38

Integration 39 39 39

Statewide: 2015 — 24.2% Mid-2016 — 24.1% Dental care for adults with diabetes 30.0% 28.1% 26.9% 25.0% 20.0% 13.9% 14.1% 15.0% 10.0% 5.0% 0.0% 40

Percent of oral health Percent of children (0-6) who assessments provided by a had an oral health assessment medical practitioner (versus a in mid-2016. dentist) in mid-2016. 41 41 41