1. How Are Accountable Care Organizations Approaching Dental Care Services? Thank you for joining! You will be on hold until the call begins at 11 a.m. Central time Please remember to mute your phone unless you are speaking If you are not currently connected by phone, dial 1.866.740.1260 If prompted, enter meeting number: 4407745

2. © 2016 American Dental Association. All Rights Reserved. 2 Today CHAIR Marko Vujicic, PhD, Chief Economist & Vice President, HPI PRESENTER Carrie H. Colla, PhD, Assistant Professor, The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth COMMENTATORS Eli Schwarz, DDS, MPH, PhD, Professor & Chair, Department of Community Dentistry, School of Dentistry, Oregon Health & Science University Tom Merrill, ACO Research Manager, Leavitt Partners

3. © 2016 American Dental Association. All Rights Reserved. 3

4. How Are Accountable Care Organizations Approaching Dental Care Services? Carrie H. Colla, Ph.D. Assistant Professor The Dartmouth Institute for Health Policy and Clinical Practice Geisel School of Medicine at Dartmouth

5. Accountable Care Organizations Groups of doctors, hospitals, and other health care providers held accountable for the total cost and quality of care for a defined patient population | 5 Can provide or manage the continuum of care for patients as a real or virtually integrated delivery system Are of sufficient size to support comprehensive performance measurement and expenditure projections Are capable of internally distributing shared savings and prospectively planning budgets and resource needs

6. | 6 Accountable Care Organizations Year

7. Accountable Care Organizations | 7 Source: Leavitt Partners

8. Our Research Questions Where are ACOs forming? What strategies are ACOs using? How do ACOs perform? Do they save? Which settings/ groups? What do ACOs look like? Methods: National Survey of ACOs, qualitative research, Medicare and commercial claims analysis, spatial analysis | 8 Which types of ACOs, with which capabilities perform best in which groups?

9. The National Survey of ACOs Objective: Accelerate learning about characteristics associated with ACO development and success Respondents: Organizations with ACO contracts holding group responsible for total cost of care and overall quality for defined population Methodology: Cross sectional survey Wave 1: N = 173 (October 2012 to May 2013) – 82/173 Completed follow-up survey in 2015 Wave 2: N = 96 (September 2013 to March 2014) Wave 3: N = 128 (November 2014 to April 2015) Response rate 64% across waves | 9

10. What Do ACOs Look Like? Total Medicare 74% Total Private 57% Medicaid 4% Medicaid + Private 7% Medicare+ Medicaid 3% Medicare + Private 26% Medicare + Medicaid + Private 10% Total Medicaid 24% Private 15% Medicare 36% | 10

11. Dental Care within ACOs | 11 Objectives To measure the extent of dental care inclusion in ACOs To understand the motivations for including or excluding dental care To describe the types of dental services provided To describe the patient populations served Methodology and Analysis: NSACO questions about: (1) contractual responsibility for dental services, (2) organizational characteristics, (3) motivations for inclusion/exclusion Two-tailed t-testing and chi-square analysis to determine significance Unit of analysis varies between the ACO and individual ACO contracts

12. Dental Care within ACOs | 12

13. Under which types of contracts are ACOs responsible for dental services? | 13

14. ACO Characteristics by Dental Responsibility Status | 14

15. ACO Characteristics by Dental Service Responsibility Status | 15

16. ACO Motivations for Dental Inclusion and Exclusion | 16

17. Dental Services and Delivery Models Used by ACOs | 17 Diagnostic/ Preventative Basic Restorative Emergency/ Urgent Major Restorative Note: Figures include ACOs that include or plan to include services in their largest overall contract and/or Medicaid contract

18. Summary + Policy Implications | 18 The majority of ACO contracts do not include accountability for dental services and do not plan to in the future Medicaid ACO contracts are three times more likely than commercial contracts to include dental care More comprehensive, safety-net providers are more likely to be accountable for dental care Most commonly reported barrier to accountability for dental care is the lack of integrated information technology Very few ACOs offer dental services and planned offering is also low ACO integration of behavioral health serves as a model for the future of integrating dental care

19. | 19 Acknowledgements Research team Carrie H. Colla Greg Kennedy Courtney Stachowski Souma Kundu Benjamin Harris Marko Vujicic Funders American Dental Association The Commonwealth Fund

20. Eli Schwarz Professor & Chair Department of Community Dentistry, School of Dentistry, Oregon Health & Science University

21. Tom Merrill ACO Research Manager Leavitt Partners

22. © 2016 American Dental Association. All Rights Reserved. 22 Thank You! For more information on the Health Policy Institute please visit: ADA.org/hpi To inquire about speaking engagements or custom data analytics please contact: hpi@ada.org