1. DentaQuest© Prevention Focused Patient Care in the Dental Practice Robert Compton, DDS Executive Director DentaQuest Institute October 2013

2. DentaQuest© One of the largest dental benefits administrators in the United States DentaQuest Benefits Company  Serve nearly 20 million members in both government and commercial business sectors nationwide  Subcontract with over 70 health plans in 19 states  Contract with ten state agencies DentaQuest Foundation www.DentaQuestFoundation.org DentaQuest Institute www.DentaQuestInstitute.org 2 Disclosure About DentaQuest

3. DentaQuest© www.DentaQuestInstitute.org 3

4. DentaQuest© Untreated Decay in 5 to 19 year olds Income/Poverty LevelRace & Ethnicity CDC: Selected Oral Health Indicators in the United States, 2005-2008, May 2012 4 Health Disparities

5. DentaQuest© 5 “The occurrence of caries in the permanent dentition is clustered: A quarter of the children and adolescents ages 5 to 17 with at least one permanent tooth accounted for about 80% of the caries experienced in permanent teeth. Differences in caries experience were found among race and race-ethnicity subpopulations” 5 Kaste LM, et al. Coronal caries in the primary and permanent dentition of children and adolescents 1-17 years of age: United States, 1988-1991. J Dent Res. 1996 Feb; 75 Spec No:631-41 25% of Children Have 80% of Caries

6. DentaQuest© A human health condition or disease that is persistent or otherwise long-lasting in its effects. The term chronic is usually applied when the course of the disease lasts for more than three months. [1] [1] A growing body of evidence supports that prevention is effective in reducing the effect of chronic conditions; in particular, early detection results in less severe outcomes. [2] Chronic Disease is a long-lasting condition that can be controlled but not cured. [3] 1.World Health Organization 2.Kenkel DS “Prevention” “Handbook Of Health Economics” 3.The Center for Managing Chronic Disease http://cmcd.sph.umich.edu/what-is-chronic-disease.htmlhttp://cmcd.sph.umich.edu/what-is-chronic-disease.html 6 Chronic Disease

7. DentaQuest© 7 Determinants of Health Adapted from: McGinnis JM, Williams-Russo P, Knickman JR. The case for more active policy attention to health promotion. Health Aff (Millwood) 2002;21(2):78-93

8. DentaQuest© Chronic Care Model Delivery System Design Self- Management Support Community Health System http://www.improvingchroniccare.org Informed Active Patient Prepared Proactive Practice Team Productive Interactions Decision Support Clinical Information Systems Improved Outcomes

9. DentaQuest© 9 Restorative Costs by Tooth Type

10. DentaQuest© 10 Restorative Costs by Age Preventistry SM Sealant Program Preventistry SM Fluoride Program ECC Disease Management Disease Management

11. DentaQuest© Evidence-based clinical recommendations for the use of pit-and-fissure sealants. A report of the American Dental Association Council on Scientific Affairs. JADA, Vol. 139. March 2008 11 ADA Sealant Recommendation

12. DentaQuest© Evidence from ADA Dental Sealant Recommendation Reduction of caries incidence in children and adolescents after placement of resin-based sealants ranges from  86 percent at one year  78.6 percent at two years  58.6 percent at four years. Sealants are effective in reducing occlusal caries incidence in permanent first molars of children by  76.3 percent at four years, when reapplied as needed.  Caries reduction was 65 percent at nine years with no reapplication during the last five years Evidence-based clinical recommendations for the use of pit-and-fissure sealants. A report of the American Dental Association Council on Scientific Affairs. JADA, Vol. 139. March 2008 12 Effectiveness of Sealants

13. DentaQuest© 13 Most Restorations Could Have Been Prevented First Permanent Molars

14. DentaQuest© Healthy People 2010Healthy People 2020 Age8146 to 913 to 15 Baseline23%15%25.5%19.9% Target50% 28.1%21.9% MethodBetter than the best10% Improvement 14 National Goals for Dental Sealants

15. DentaQuest© 15 Medicaid 6-9 Y.O. Receiving Sealants in 2011

16. DentaQuest© Organize patient and population data to facilitate efficient and effective care Provide timely reminders for providers and patients Identify relevant subpopulations for proactive care Facilitate individual patient care planning Share information with patients and providers to coordinate care Monitor performance of practice team and care system Chronic Care Model: Clinical Information Systems http://www.improvingchroniccare.org/index.php?p=The_Chronic_Care_Model&s=2

17. DentaQuest© 17 Monitor Performance of Practice Team

18. DentaQuest© 18 Identify Relevant Subpopulation for Proactive Care Provide Timely Reminders for Providers & Patients

19. DentaQuest© 19 Monitor Performance of Care Team

20. DentaQuest© Professional applied topical fluoride: Evidence-based clinical recommendations. ADA Council on Scientific Affairs. JADA 2006;137;1151- 1159 20 Fluoride Recommendation

21. DentaQuest© Many patients presenting with recurrent gingivitis without additional attachment loss after definitive periodontal therapy may be adequately maintained with PM performed semiannually. In general, data suggest that most patients with a previous history of periodontitis should obtain PM at least four times per year, since that interval will result in a decreased likelihood of progressive disease, compared to patients receiving PM on a less frequent basis Periodontal Maintenance (2003) J Periodontol 2003;74:1395-1401 21 Frequency for Periodontal Maintenance

22. DentaQuest© First goal is to increase the percentage of perio patients receiving at least 2 maintenances per year 22 Perio Patients Receiving Perio Maintenance

23. DentaQuest© 23 Identify Relevant Subpopulation for Proactive Care Provide Timely Reminders for Providers & Patients

24. DentaQuest© 24 Health System: Provide Incentives Based on Quality

25. DentaQuest© 25 Results for Populations

26. DentaQuest© Names of Providers on X Axis 26 Fluoride Results for Network Providers

27. DentaQuest© Names of Providers on X Axis 27 Perio Results for Network Providers

28. DentaQuest© The highest bonuses are in $7,000 - $8,000 range Around 60% of dentist achieve the fluoride goal Around 75% of dentists achieve the perio goal Around 85% of dentists receive a financial bonus Improved quality of care Improved our Program Quality Score Reimbursed for quality not just quantity (P4P) 28 Overall Results for Network Providers

29. DentaQuest© 29 ECC Disease Management Early Childhood Caries and Severe ECC

30. DentaQuest© The disease of ECC is the presence of 1 or more decayed (noncavitated or cavitated lesions), missing (due to caries), or filled tooth surfaces in any primary tooth in a child under the age of 6. In children younger than 3 years of age, any sign of smooth- surface caries is indicative of severe early childhood caries (S- ECC). From ages 3 through 5, 1 or more cavitated, missing (due to caries), or filled smooth surfaces in primary maxillary anterior teeth or a decayed, missing, or filled score of ≥4 (age 3), ≥5 (age 4), or ≥6 (age 5) surfaces also constitutes S-ECC. 30 AAPD Early Childhood Caries

31. DentaQuest© Empower and prepare patients to manage their health and health care Emphasize the patient’s central role in managing their health Use effective self-management support strategies that include assessment, goal-setting, action planning, problem-solving and follow-up Organize internal and community resources to provide ongoing self-management support to patients Chronic Care Model: Self Management Support http://www.improvingchroniccare.org/index.php?p=The_Chronic_Care_Model&s=2

32. DentaQuest© 32 INITIAL OR RECALL APPT Medical history Caries Risk Assessment (CRA) Exam/X-rays Behavioral assessment INITIAL OR RECALL APPT Medical history Caries Risk Assessment (CRA) Exam/X-rays Behavioral assessment VISIT 1 Self-management goals (diet, oral hygiene, home fluoride) Fluoride varnish Indicated clinical care VISIT 1 Self-management goals (diet, oral hygiene, home fluoride) Fluoride varnish Indicated clinical care D ISEASE M ANAGEMENT V ISIT Caries Risk Assessment Clinical/X-ray exam Fluoride varnish Re-define or re-emphasize self-management goals Behavioral assessment D ISEASE M ANAGEMENT V ISIT Caries Risk Assessment Clinical/X-ray exam Fluoride varnish Re-define or re-emphasize self-management goals Behavioral assessment R ESTORATIVE ITR V ISIT ( S ) Provide restorative care as indicated Provide ITR as indicated Schedule OR time if indicated R ESTORATIVE ITR V ISIT ( S ) Provide restorative care as indicated Provide ITR as indicated Schedule OR time if indicated C HILDREN AT H IGH R ISK Schedule next Disease Management visit in 1 month C HILDREN AT H IGH R ISK Schedule next Disease Management visit in 1 month C HILDREN AT M EDIUM R ISK Schedule next Disease Management visit in 3 months C HILDREN AT M EDIUM R ISK Schedule next Disease Management visit in 3 months C HILDREN AT L OW R ISK Schedule next Disease Management visit in 6 month C HILDREN AT L OW R ISK Schedule next Disease Management visit in 6 month 32 Risk-Based Disease Management Protocols

33. DentaQuest© 33

34. DentaQuest© 34 ECC disease management approach based on premise that a patient’s caries risk status is not static, but can be managed and improved over time. 34 Patient’s Caries Risk Status is Not Static

35. DentaQuest© 35 Improved Outcomes and Patient Experience

36. DentaQuest© 36 www.dentaquestinstitute.org

37. DentaQuest© Contact information Robert Compton, DDS Executive Director DentaQuest Institute October 2013 Rob.Compton@dentaquestinstitute.org