1. Medicaid Assistance Program Oversight Council June 13, 2014 Improving the Oral Health of HUSKY Members

2. Carr vs. Wilson-Coker Settlement Agreement –Carve-out of dental services from Medicaid Managed Care in September 2008 –Unified delivery of dental benefits, rates and coverage –Single ASO vendor, BeneCare Dental Plans Pre-Carve Out: –Four MCOs with three dental benefit management subcontractors –349 FFS participating dentists (October 2008) Genesis of the Partnership 2

3. 3 Managed Care Company 1 HUSKY Clients PCPs Dental Vendor1 Pre-Dental Carve Out Managed Care Company 2 HUSKY Clients PCPs Dental Vendor 2 Managed Care Company 3 HUSKY Clients PCPs Dental Vendor 3 Managed Care Company 4 HUSKY Clients PCPs Dental Vendor 2 DSS FFS Clients PCPs FFS Dentists Four Managed Care Companies plus FFS/T19 Different provider networks Different fee schedules Different benefits Different administrative rules Provider and Client confusion!

4. 4 HUSKY Health Clients CTDHPProviders Other ASOs Community Resources Public Health Infrastructure Community Partners Post-Dental Carve Out The Connecticut Dental Health Partnership One provider network One fee schedule One set of benefits One set of administrative rules The CTDHP leverages the State’s ASO configuration through a contract with concrete performance incentives.

5. Carve-out Contracting Premise - Expand access to dental care - Increase awareness of dental benefits among Medicaid client population - Improve oral health literacy and compliance among Medicaid client population - Ensure appropriate dental service delivery - Measure performance and outcomes over time - Reduce dental disease burden - Lower cost of care as dental service needs shift to prevention - Improve overall health Goals Outcomes 5

6. 6 Health Services Division Kate McEvoy, JD, Medicaid Director Integrated Care Unit Bill Halsey, Director Dental/NEMT Dr. Donna Balaski, Manager Dental UnitNon-Emergency TransportationBehavioral HealthMedical Health Medical Health & Special Projects Health Services Division Robert Zavoski, MD, Medical Director Community Health Network of Connecticut, Inc. CTDHP – DSS Oversight Value Options Logisticare Solutions, LLC BeneCare Dental Plans

7. Network development focus on provider education, compliance and support for Dental Home Providers supported by: –Dedicated call center personnel –Dedicated network development manager –Dental Health Care Specialist team Partnering with providers –Integrate qualifications and panel limitations of professional practice into client referral processes –Provide continual feedback through call center interactions, claim review communications and meetings Building Dental Access 7

8. CTDHP Dentist Availability Measures 20092010201120122013 Average Appointment Availability (days) 14.411.2 6.8 Percentage Closed Panels (12/31) 18.7%14.7%13.3%9.7%12.7% Mystery Shopper Compliance 93.3%84.0% 86.0% Building Dental Access, Results 8

9. 9 Contract Standard: one PCD in <=20 miles Results: all Clients have access to one PCD in <= 15 miles at minimum Green = Two Providers in 10 Miles Blue = Two Providers in 15 Miles Yellow = One Provider in 10 Miles Red = One Provider in 15 Miles

10. Dental access and availability issues resolved –Many dentists located near clients –Dental offices actively seeking new clients Primary barriers limiting Client demand for service: –Oral health not seen as important in our society –Only 50-60% utilization by the general population –Much anecdotal evidence in cases: Lack of follow-up Refusing recommended treatment Misunderstanding of benefits 10 Moving Beyond Access and Availability

11. The next focus: Increase client demand to improve utilization –More than just education Created social marketing strategies to elevate the importance of oral health Use ‘trusted people’ to provide information and persuade the clients to seek dental care 11 Moving Beyond Access and Availability

12. Innovative approaches used for: –Informing, increasing awareness –Outreach –Anticipatory guidance Compliance reminders: –Data driven –Discreet messaging for specific client cohorts –Automated phone calls and mail Stratification of outreach methodologies: –Use appropriate tool –Escalate to direct personal interaction if appropriate Comprehensive appointment assistance with education How Do We Increase Client Demand? 12

13. Increased Demand, Utilization Results 13

14. Prior-Authorization/Claim Review implemented Feb 2010 –Ongoing utilization review –Monitor provider service delivery –Provide specific feedback regarding compliance with dental regulations and community standards of dental care Cost containment and cost avoidance are an effect of our focus on quality care: appropriate dental services in the right setting at the right time. Assuring Appropriate Service 14

15. Program Cost Outcomes 15

16. A demonstrable improvement in the client populations’ oral health status. Service Delivery Trends 16

17. Targeted automated reminder calls Targeted informational mailings Expanded outreach through community involvement –Eight Dental Health Care Specialists –Impact ‘Trusted Persons’: Community Agencies, WIC, Head Start, PCP’s, OB/GYN’s, etc. –Expanded Perinatal initiative –ED/ER Initiative –Oral health status data sharing with WIC, DCF, other agencies. Ongoing Outreach Initiatives 17

18. 18 Collaboration with the other ASOs Work closely with all ASOs on individual case management Community Health Network of Connecticut –Oral health status data –Perinatal outreach integration –PCP/PCMH supports Value Options –Integration of BH data into orthodontic case approval Logisticare Solutions –Rapid response integration Hewlett Packard –Dentist provider enrollment and re-enrollment –Prior-Authorization automation –Orthodontic Claim automation

19. ‘Trusted Person’ Strategy 19 Reach our clients through the people they trust –Pediatric PCP medical practices –OB/GYN practices –Key community agencies Personal visits by Dental Health Care Specialists The message: oral health is important –Get regular care in a dental home –Maintain good oral hygiene The ask: –Training meeting with all staff –Add oral health to client visit –Use our ‘prescription pad’ to refer –Distribute our oral health kits

20. ‘Trusted Person’ Strategy 20 Identified 226 pediatric PCP offices - high number of clients, low dental utilization rates Identified all 207 OB/GYN offices in HUSKY Health Identified 4-6 key agencies in each community Materials utilized –Staff information packet (articles, referral information, etc.) –PCP, OB/GYN and generic referral pads –Oral health kits (toothbrush, toothpaste, floss, how-to-brush-and- floss sheet, CTDHP information) Follow-up visits –Deliver more materials, build relationship –Deliver CTDHP bibs to OB/GYNs for postpartum

21. Results  Connecticut was one of only three states to receive the top grade from the Pew Center on the States in both 2010 & 2011, the last years they graded all states on dental health policies  A 2012 study by the Connecticut Department of Public Health showed that, between 2007 and 2010, untreated decay was reduced -50% for Head Start children, -19% for Kindergarten students and -33% for third grade students  The Commonwealth Fund’s 2011 State Scorecard on Child Health System Performance found that Connecticut was in the top ten states overall  In 2013 CMS referenced Connecticut as having the largest increase in the percent of children receiving a preventive dental service in the country 21

22. Excerpt of letter from Cindy Mann, Director, Center for Medicaid and CHIP re: CMS Oral Health Initiative, 4/18/2013 Results 22 Connecticut #1

23. Results 23 CHILDREN’S ACCESS TO DENTAL CARE SEES STRIKING IMPROVEMENT SINCE INCEPTION IN 2008 - Connecticut State Dental Association News Release, 3/14/2012 CHILDREN’S DENTAL SERVICES IN THE HUSKY PROGRAM: Program Improvements Led to Increased Utilization in 2009 and 2010 - CT Voices for Children Report, November 2011 Report shows improvement in children's dental care - WFSB-TV Channel 3, 3/14/2012 State report to show improvement in dental care for poor kids - The Norwich Bulletin, 3/14/2012

24. HRSA PIOHQI Grant Trends Finance Machinery One of three states to be awarded Perinatal & Infant Oral Health Quality Improvement (PIOHQI) grant (others: NY, WV) Expand successful pilot statewide over four years Provide ‘Intensive Community Outreach’ in 14 communities –Build more partners and ‘Trusted Persons’ for perinatal women and their children –Community agencies, WIC, PCP’s, OB/GYN’s, etc. Evaluation of data by CT Voices Share what we learn in a CMS funded State-National Learning Network, mentor other states 24

25. Emergency Department Initiative Identify users of dental services in an ED Automated phone calls, letters to all Targeted outreach by DHCS to those with most serious conditions Presentations to ED Directors Follow up visits to all ED directors, provide training, materials (pads, posters, etc.) Less than 2% of ED visits for dental reasons - CTHA study, 2012-2013 25

26. New initiative which will help measure disease prevalence and severity in children Uses three new dental procedure codes (D0601,D0602,D0603) Codes indicate ‘Low’, ‘Moderate’ and ‘High’ risk Will be used by public health hygienists to complement dental home examinations Uses recognized assessment protocols Launching in the Fall of 2014 Early Childhood Screening Initiative 26

27. Early Childhood Screening Initiative Find children slipping between the cracks Dental hygienists triage children by oral health status and needs Individual follow-up to the highest need children through the use of a reporting tool and claims analysis Target ECE programs, schools, public health settings Based on a pilot by BeneCare in the MCO years 27

28. Contact Us! Please! If you or your staff are contacted by a HUSKY Health client regarding dental services, please have them contact us. 855-CT-DENTAL Mon-Fri, 8AM-5PM www.CTDHP.com 28