1. Planning for oral health services: Utilization and cost of dental care for people living with HIV/AIDS Carol Tobias, BUSPH APHA 2012

2. Presenter Disclosures (1)The following personal financial relationships with commercial interests relevant to this presentation existed during the past 12 months: Carol Tobias No relationship to disclose

3. The SPNS Oral Health Initiative (2006-2011) 15 programs funded to expand access to HIV oral health care 8 rural programs, 7 urban programs Service models – 4 mobile vans – 7 co-located medical and dental services – 1 program in a dental hygiene school – 3 Satellite clinics

4. SPNS Sites

5. Eligibility Criteria At least 18 years of age HIV positive Out of oral health care for prior 12 months, except for emergency care to relieve pain or infection

6. Services Provided Over the course of the study: Patients made over 15,000 clinic visits They received over 37,000 services 917 (42%) completed a Phase 1 treatment plan *Phase 1 Treatment Plan = Prevent and treat active disease

7. The ones that got away… 375 (17%) patients had only one visit

8. Category Types of Dental Services Explanation % Receiving Service Diagnostic careExams, x-rays, etc.98% Preventive careCleanings, fluoride, patient ed.63% Restorative careRestorations, fillings50% Periodontal careNon-surgical and surgical care42% Oral surgeryExtractions, simple and surgical29% Removable Prosthodontics Partial and complete dentures, repairs21% Endodontic servicesRoot canals, pulpal procedures11% Fixed ProsthodonticsBridges3%

9. What does it cost to provide this care? It depends on ……. The services covered The price paid for a service, or the cost How many patients are new to dental care vs. already engaged What other resources are available? ( Medicaid, private insurance, foundation funds)

10. Pricing Methods Used utilization data from the SPNS initiative Grouped sites according to services provided (basic, intermediate, comprehensive) Used 3 different fee schedules (FL Medicaid, Delta Dental, ADA usual and customary) Applied fee schedules to services provided during the first 12 months of care (at different levels of coverage) Did the same thing for the second 12 months of care

11. Definitions Level of Care # of sitesCovered Services Basic Care 14Diagnostic services, preventive services, restorations excluding crowns, periodontal care excluding surgery, adjunctive services Intermediate Care 12Basic care PLUS periodontal surgery, oral surgery, removable prosthodontics Comprehen- sive care 8Intermediate care PLUS crowns, endodontics, and fixed prosthodontics.

12. Average Cost/Person in First 12 months of Treatment Low cost = Miami/Dade County fee schedule; Medium cost = Delta Dental; High cost = ADA usual & customary

13. Average Cost/Person for First 12 Months of Treatment Service% of Pts receiving serviceAnnual cost (medium) Diagnostic Care98%$153 Preventive Care63%$60 Restorative Care ( exc. crowns) 59%$205 Crowns6%$112 Periodontal Care42%$106 Endodontic Care11%$107 Oral Surgery29%$134 Removable Prosthetics21%$291 Fixed Prosthetics21%$88 AdjunctiveNA$18 TOTAL$1271

14. Change in Costs – Year 2* *Using the medium cost schedule

15. Difference in cost – Years 1 and 2* * Using intermediate level of care and medium cost schedule

16. Things to think about Who are your dental providers – CHCs, university clinics, private practices, HIV clinics? What will they accept for payment rates? What is the trade off between depth of coverage and numbers served? Other payers? Geographic considerations

17. Other Results To access the Public Health Reports journal supplement on Innovations in Oral Health Care for People Living with HIV/AIDS, go to: http://www.publichealthreports.o rg/issuecontents.cfm?Volume=12 7&Issue=8