1 DENTAL ADVISORY COMMITTEE DENTAL ADVISORY COMMITTEE November 15, 2013 Richmond, Virginia

2 SFC PEDIATRIC DENTAL UTILIZATION and ADULT SERVICES

3 Increase Pediatric Dental Utilization  53%  53% of children ages 0-20 utilized dental services in SFY 2012:  53% previous year  24% when program started  60%  60% of children ages 3-20 utilized dental services in SFY 2012:  61% previous year  29% when program started Notes: * SFY 2012* and Represents new CMS guidelines – unduplicated individuals who have been continuously enrolled for 90 days versus previous enrollment of 1 day. Source: Centers for Medicare and Medicaid Services EPSDT 41 Report produced on SFY reporting timeframe. Figures are based on claims received through September, 23, 2013 (3 months lag time).

4 Annual Dental Exam Comparing SFC to HEDIS 2013  Measures the percentage of members 2-21 years of age who had at least one (1) dental visit during the measurement year.  Data shows that 62.26% of the members had at least one dental visit; well above the HEDIS National Medicaid average of 49.07%.  Percentage of members with at least one dental visit was above the 75th percentile of the HEDIS national data.

5 SFC PROVIDER NETWORK

6 Increase Provider Participation  As of September 30, 2013, 1801 dentists are participating in the SFC program:  This represents approximately 28% of the 6,529 Virginia licensed dentists.  The number of providers enrolled in the program has tripled since July 1, % are accepting new patients  More than 85% are accepting new patients. 80%  For SFY 13, approximately 80% of network providers are submitting claims as compared to less than half prior to SFC.

7 NETWORK RECRUITMENT

8 Provider Recruitment Activities  Attended the National Dental Association meeting (July 26, 2013)  Attended and displayed at the VDA annual meeting (September 20-22, 2013)  Approved letter from VDA to be sent to all attendees of the VDA Annual meeting that are not participating providers (247 providers)  Awaiting VDA President signature  Recruitment presentation presented to Virginia Association of Free and Chartable Clinics (20 clinic sites) with minimum of 35 providers (October 22, 2013)  Attending the Virginia Academy of General Dentistry meeting (November 8, 2013)  Attended and displayed at the Virginia Oral Health Summit (Nov 8, 2013)

9 Adult Dental Services  10.49%  10.49% of SFC adults ages 21 and over utilized dental services in SFY  Assistance with the treatment of adults is still needed.  Recent activities to expand the number of dentists treating adults include:  Kool Smiles in Christiansburg and Danville is treating some adults for non-complicated extractions  Franklin Dental Clinic is now treating adults  Atlantic Dental Care (New Church -Eastern Shore) is treating Adult members  20 of the Virginia Association of Free and Charitable clinics are considering treating adults  Rescue Mission of Roanoke is considering treating adults

10 NEW PROGRAM INITIATIVES: Preventistry SM Sealant Program

11 Overview of Early Sealant Placement Results  The results show an increase in sealant placement for ages 6, 7, and 12.  We see a slight decrease in sealant placement rates for age 13 even though these children are included in the Preventistry program.  In priors periods, we saw an increase in sealant rates for those 12 and 13 so many of the children age 13 may have already had their second molars sealed.  There is also an increase in sealant placement for children who are ages 8 since many are on the list because they were 7 at the beginning of the period.  There is a decrease in sealant placement (often significant) in other age groups that aren’t identified by the Preventistry program.

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13 NEW PROGRAM INITIATIVES:

14 Early Dental Home Pilot Area  The Pilot was launched July 1, 2013 and will run for at least 12 months.  Targeted Pilot Area – Greater Richmond Area:  Richmond City  Henrico  Hanover  Chesterfield  Periodic assessments will be conducted to determine when and how to expand the initiative.  Program goals :  To increase oral health and overall health outcomes  To increase caries risk assessments and dental referrals by medical providers  To increase access to care, EPSDT related visits and utilization of preventive services

15 Baseline Data and Goals  Goal for the Greater Richmond pilot areas is to increase utilization in each area by 3%.

16 Member Assignments Letters were mailed to each head of household to inform the parent/guardian of their child’s assigned Dental Home.

17 Next Steps Early Dental Home Next Steps  Continue to assign new members as enrolled in the SFC program  Implement Healthy Smiles Wellness Program:  After their first and second birthdays, DentaQuest mails a birthday card to the member’s home.  Implement Value add member incentive(s):  Member oral health backpack after first visit  For participating providers in the Early Dental Home pilot area, expand Preventistry report to include:  Sealants  Topical Fluoride  Preventive 6 month check-ups  Quarterly monitoring of utilization (overall, preventative and fluoride) results

18 NEW PROGRAM INITIATIVES: Broken Appointment Tracking & Outreach

19 Broken Appointment Analysis  From July 1, 2011 – September 30, 2013:  463 of 1801 (26%) of SFC providers reported a broken appointment.  760,133 appointments were scheduled  24,856 broken appointments were reported  Based on data for this period, 3.27 broken appointments per 100 appointments were reported.  An estimated 1,262,507 broken appointments were unreported for the period. Phone call outreach implemented 11/2011 Postcard outreach implemented April 2012

20 Broken Appointment Analysis (cont.)  24% of members reported are breaking more than 1 appointment. 76% of members broke only 1 appointment.  65% of members that broke an appointment did visit a dentist following their broken appointment.

21 MEMBER OUTREACH

22 Sussex High School Pilot Program  Program Objectives:  Develop and implement a pilot project with a group of teens to increase dental services for this population  Encourage teens to consider occupations in the dental field  Who:  1st year: target 10th grade students at Sussex High (approximately 90 students)  2nd year: target all Sussex High School grade levels  What:  Teen Outreach: Teen Oral Health PowerPoint Presentation Teen Questionnaire Evaluation Incentive for visit once return dental visit form Of those that return dental appt form, enter into drawing for electric toothbrush Keep toothbrushes and oral health supplies in the clinic to use as needed Find a dentist for next year’s career day Question and Answer cards-PE teacher will give extra credit for those with good questions

23 Sussex High School Pilot Program (cont.)  What (cont.):  Parent/Guardian Outreach: Letters/handouts in report cards Information on website and around school In future, attend a back to school night  When:  Program was implemented on October 14, 2013  Evaluation:  Identify the number of students that go to the dentist up to six months following the presentation by using the Dental Visit Form and checking claims history

24 Collaboration with Health Plans  DentaQuest is working with each of the health plans to ensure awareness of oral health services available to Smiles For Children members.  Collaborative efforts include:  MCO distribution of DentaQuest fluoride varnish pads to pediatricians and family practice practitioners  Newsletter articles  Attendance at health plan provider meetings (i.e. Anthem provider forum)  Distribution of DentaQuest pregnancy kits to pregnant women is scheduled to begin in Jan 2014

25 Postcard Reminder Activity June 2012 Mailing  DentaQuest identified all members, ages 1-20 (age 1 on or after 6/1/11), in the 30 counties with the lowest utilization rates.  These members had no date of service between June 1, 2011 and March 1,  33,781  33,781 postcards were mailed to these members.  Of the members receiving postcards, 6,700 (20%) received services within 6 months following the postcard reminder. January 2013 Mailing  DentaQuest identified all members, ages 1-20 (age 1 on or after 1/1/2013), in the 54 counties with the lowest utilization rates.  These members had no date of service between March 1, 2012 and September 1,  84,821 postcards were mailed to these members.  Of the members receiving postcards, 22,367 (26%) received services within 6 months following the postcard reminder.

26 Meetings and Events  DentaQuest partners with more than 30 organizations throughout the Commonwealth. Some of these partners include:  Home visitors  Head Start Association and the Health Advisory Committee  Virginia Association of Early Childhood Education  Virginia Rural Health Association  Virginia Oral Health Coalition  Virginia Association of School Nurses  National Association of Social Workers-Virginia Chapter  Participation in community outreach events include:  RVA Streets Alive  Newport News Children’s Fest  New River Valley Children’s Health and Safety Day  Give Kids a Smile Day  Mission of Mercy Events

27 PROVIDER OPERATIONS

28 Provider Operations Updates  Direct Deposit81.7%  Direct Deposit - As of October 30, 2013, 81.7% of all SFC payees are enrolled in direct deposit.  Provider Verification Project 575 (45%)  Provider Verification Project – Since June 2013, DentaQuest has been conducting a Provider Verification Project. As of September 30, 2013, 575 (45%) of the verification forms have been received.  # for Credentialing Calls  # for Credentialing Calls – Effective 12/2/2013, providers will have direct access to Staff knowledgeable about credentialing/recredentialing process.  App Central  App Central – During 4 th Quarter 2013, DentaQuest will begin pilot testing a “smart” application that will allow Providers to electronically complete credentialing applications. Upon completion of the pilot test, the new feature will be rolled out across all DentaQuest markets.  Provider Web Portal  Provider Web Portal – The DentaQuest Provider Portal now features 2 new message types:  Appeals  DDS Peer to Peer Call Request

29 Provider Education Winter 2013 Provider Training Seminars: As part of our ongoing provider education efforts, DentaQuest is offering training to all providers via a Webinar:  Monday, Dec. 2, 2013 at 12:00-1:30 pm  Tuesday, Dec. 3, 2013 at 12:00-1:30 pm  Wednesday, Dec. 11, 2013 at 12:00 –1:30 pm  Thursday, Dec 12, 2013 at 12:00–1:30pm Training topics include:  IVR Self Service Functions,  Authorizations for OR cases,  Changes to Office Reference Manual,  Enhancements to the Provider Web Portal,  Broken Appointment Tracking,  Sealant Program,  Dental Home Program and more

30 New! Free Online CEU Credits  DentaQuest Institute recently launched a free online dental learning center, allowing dental professionals to earn certified education units for completing learning modules.  Modules include self-paced curriculum on prevention and disease management of caries, from birth to maturity.  Go to to open the online learning center.  Click the Register button to sign up and create your user name and password.  Upon registration you will have access to all the learning resources available.  Watch our Leader Profile videos from oral health leaders who are practicing prevention and disease management.  Browse the Resource Library to view webinars, access valuable web links, and read white papers

31 THANK YOU!