The Dental Quality Alliance (DQA) Overview and Work of the DQA

http://www. washingtonpost http://www.washingtonpost.com/news/wonkblog/wp/2013/09/19/the-two-most-important-numbers-in-american-health-care/

Health Outcomes Source: County Health Rankings

Pediatrics 2008;121;337-344 Kandyce Larson, Shirley A. Russ, James J Pediatrics 2008;121;337-344 Kandyce Larson, Shirley A. Russ, James J. Crall and Neal Halfon Influence of Multiple Social Risks on Children's Health

December 27, 2016 US Spending on Personal Health Care and Public Health, 1996-2013 Joseph L. Dieleman, PhD1; et al JAMA. 2016;316(24):2627-2646. doi:10.1001/jama.2016.16885

Better Healthcare/ Healthy Population Self-motivated improvement Forced improvement Accountability Transparency

“Quality Innovators Spotlight” Coming Soon! “Quality Innovators Spotlight”

QC? QI? Better Healthcare/ Healthy Population Self-motivated improvement Forced improvement Accountability Transparency QC? QI?

DQA Administrative Claims Based Program and Plan Level Pediatric Measures   Measure Name Measure Domain Evaluating Access and Utilization Utilization of Services Access/Process Preventive Services for Children at Elevated Caries Risk Related Health Care Delivery: Use of Services Treatment Services Evaluating Quality of Care Oral Evaluation Process Topical Fluoride for Children at Elevated Caries Risk Sealants for 6–9 Year-Old Children at Elevated Caries Risk  Sealants for 10–14 Year-Old Children at Elevated Caries Risk  Care Continuity Usual Source of Services Ambulatory Care Sensitive Emergency Department Visits for Dental Caries in Children Outcome Follow-Up after Emergency Department Visit by Children for Dental Caries Evaluating Cost and Efficiency Per Member Per Month Cost of Clinical Services Related Health Care Delivery: Efficiency and Cost To date, DQA has developed a set of 12 pediatric and 2 adult claims administrative program and plan level dental quality measures. The pediatric set targets the goal of addressing Prevention and Disease Management for Dental Caries in Children, with emphasis on utilization, cost, and quality of dental services for children enrolled in public (Medicaid, CHIP) and private (commercial) insurance programs. These measures are specified for reporting at program and plan level.

DQA Administrative Claims Based Program and Plan Level Adult Measures Measure Name Measure Domain Evaluating Access and Utilization Periodontal Evaluation in Adults with Periodontitis Related Health Care Delivery: Use of Services Evaluating Quality of Care Ongoing Care in Adults with Periodontitis Process This slide depicts the two adult measures developed by the DQA.

2015: Medicaid Use of DQA Measures

Projects under consideration Emergency department visits for dental related reasons (adults) Follow up to the emergency department visits (adults) Oral evaluation in Adults Diagnosed with Diabetes Caries Risk Documentation in children DQA has several measures under consideration for testing in 2017- amongst these are the ones related to ED visits and oral evaluation in diabetics amongst adults and caries risk documentation amongst children.

  Measured Entity Reported By Population Data source DQA Standard Program/ Plan All enrollees Payer Administrative Database (Claims/Eligibility) All enrollees with a dental exam D1 Practice All enrollees receiving exams from a specific practice D2 All receiving exams from the practice Practice management billing data D3 All patients receiving exams from the practice All patient record data including history, findings and diagnoses

The Strategy That Will Fix Health Care. by Michael E The Strategy That Will Fix Health Care. by Michael E. Porter and Thomas H. Lee, MD

“In measuring quality of care, providers tend to focus on only what they directly control or easily measured clinical indicators. However, measuring the full set of outcomes that matter to patients by condition is essential in meeting their needs.” – M. Porter

What is Quality? What is oral health? Better vs best

Global Budgets? P4P Health? P4P Healthcare? The Strategy That Will Fix Health Care. by Michael E. Porter and Thomas H. Lee, MD

The Future: “Did we make the population healthy” Patient reported oral health outcomes/ QOL Population health state Patient experience Patient engagement Clinical care indicators Functional Status Disease Status Risk Status Better vs best

http://ada.org/dqa

A measure is a tool to improve Great job with sick Are you good keeping healthy Compete for payment Compete for reputation

E. M. Rogers in 1962 http://sphweb. bumc. bu

It’s time to spread the message!

THANK YOU! “Best is an endpoint. Better is a Quest” -- Northwestern Memorial Hospital Better versus best

Oral Health Status 42% 30% 24% 33% 27% 25% 37% 24% 18% 35% 21% 17% 30% 16% 26% 15% 17% ADA Health Policy Institute. Oral Health and Well-Being in the United States