Quality Oral Health Care in Medicaid Through Health IT

FINAL REPORT Quality Oral Health Care in Medicaid Through Health IT PRESENTED BY: NORC at the University of Chicago 4350 East West Highway 8th Floor PRESENTED TO: Bethesda, MD 20814 Agency for Healthcare Research (301) 634-9300 SEPTEMBER 2011 and Quality (301) 634-9301 Final Report Quality Oral Health Care in Medicaid Through Health IT Prepared for: Agency for Healthcare Research and Quality U.S. Department of Health and Human Services 540 Gaither Road Rockville, MD 20850 www.ahrq.gov Prepared by: NORC at the University of Chicago Authors: Cheryl Austein Casnoff, M.P.H. Lisa Rosenberger, M.P.H. Nancy Kwon, M.P.H. Hilary Scherer AHRQ Publication No. 11-0085-EF September 2011 This document is in the public domain and may be used and reprinted with permission except those copyrighted materials that are clearly noted in the document. Further reproduction of those copyrighted materials is prohibited without the specific permission of copyright holders. Suggested Citation: Casnoff CA, Rosenberger L, Kwon N, Scherer H. Quality Oral Health Care in Medicaid Through Health IT: Final Report. (Prepared by NORC at the University of Chicago.) AHRQ Publication No. 11-0085-EF. Rockville, MD: Agency for Healthcare Research and Quality. September 2011. None of the investigators has any affiliations or financial involvement that conflicts with the material presented in this report. The findings and conclusions in this document are those of the authors who are responsible for its contents; the findings and the conclusions do not necessarily represent the views of AHRQ. No statement in this article should be construed as an official position of the Agency for Healthcare Research and Quality or of the U.S. Department of Health and Human Services. FINAL REPORT | ii Contents Introduction ..................................................................................................................... 1 Background ..................................................................................................................... 2 Opportunities and Barriers for Health IT to Increase Access to Quality Oral Health Care for Medicaid and CHIP Enrollees .................................................................................... 4 Health IT Adoption ..................................................................................................................... 4 Barriers to Health IT Adoption by Dentists .......................................................................... 4 Opportunities to Increase Health IT Adoption by Dentists .................................................. 6 Meaningful Use .......................................................................................................................... 8 Barriers to Dentists Meeting the Medicaid Meaningful Use Incentive Payments Requirements ...................................................................................................................... 8 Opportunities to Enable Dentists to Meet the Meaningful Use Requirements ................... 9 Access to Care for Medicaid and CHIP ................................................................................... 10 Strategies to Use the Functionalities of Health IT to Increase Access to Oral Health Care for Medicaid and CHIP Enrollees ...................................................................................... 11 Conclusions ................................................................................................................... 14 References .................................................................................................................... 15 Appendix A: Quality Oral Health Care in Medicaid Through Health IT Background Report ........................................................................................................................ A-15 Appendix B: Expert Panel Meeting List ...................................................................... A-23 FINAL REPORT | iii Introduction NORC at the University of Chicago, with our partner the Children’s Dental Health Project (CDHP), is pleased to present this Final Report on whether and how health information technology (health IT) and the Medicaid EHR incentive program can be used as tools to improve access to quality oral health care for children enrolled in Medicaid and the Children’s Health Insurance Program (CHIP), to the Agency for Healthcare Research and Quality (AHRQ) in the U.S. Department of Health and Human Services (HHS). The discussion and recommendations presented in this report were developed through an extensive review of the literature and expert consultation. A Background Report (Appendix A) synthesized the current literature and provided a foundational context for this project. A list of the individuals who participated in the Expert Panel for this study is included in Appendix B. Through the literature review and expert consultation, this report aims to address and present recommendations regarding: 1. Whether or not the Medicaid electronic health record (EHR) incentive payments could serve as an incentive for dentists to serve additional Medicaid and CHIP enrollees; and 2. Ways in which the functionalities of health IT can increase access to quality oral health care for Medicaid and CHIP enrollees by making this population more attractive to dentists. The report also considers ways in which the functionalities of health IT can increase access to oral health care for Medicaid and CHIP enrollees by helping this population find oral health providers and increasing their understanding of the importance of quality oral health care. Although there is limited literature on this topic to date, the goal of this report is to explore various ways in which health IT offers the potential to increase access to oral health care among these vulnerable populations. The report concludes by discussing a number of areas for additional research. FINAL REPORT | 1 Background Disparities in access to quality dental care between privately and publicly insured children is a long standing problem. A 1996 study reported that approximately 80 percent of childhood dental disease was found in only 25 percent of children, particularly among minorities and/or those who come from low income families.1 More specifically, another study that looked at primary and permanent teeth by age in specific populations found that for 2-5 year olds, 75 percent of dental cavities were found in 8.1 percent of the population and for patients 6 years and older, 75 percent of dental caries were found in 33.0 percent of the population.2 A 2008 Government Accountability Office (GAO) report cited that 33 percent of children enrolled in Medicaid had untreated tooth decay, almost double the rate for privately insured children at 17 percent and comparable to the rate for uninsured children at 35 percent.3 Additionally, although the proportion of dental visits among children newly enrolled in CHIP increased from 1996- 2004, disparities in dental visits continue to be evidenced by age, family income, race/ethnicity, and caregiver education.4 It has also been well documented that the lack of essential dental care can lead to a variety of problems, including contiguous ear, sinus, neck, and intracranial infections as well as distant inflammatory complications that impact diabetes management, heart disease, pregnancy, and other serious conditions. Lack of care can also impact children’s everyday lives by affecting their speech and growth, and impacting their social development and educational opportunities.5,6 For dentists, lack of engagement in public insurance programs represents lost opportunities to serve a population that is covered for dental services and can greatly benefit from quality oral health care. Disparities in care have been discussed time and again, without significant progress in closing gaps for low income and publically insured children. Two thirds of children insured by public programs do not receive any dental care in a year’s time.7 The largest barrier to access to care for these children is the lack of acceptance of public insurance by providers.8 Lack of acceptance of Medicaid and CHIP has been extensively studied in the literature; the most common reasons given by dentists for not accepting Medicaid and CHIP are low payment rates, cumbersome administration, and missed appointments by beneficiaries. 9–13 New Federal incentives created by the American Recovery and Reinvestment Act of 2009 (ARRA) and its Health Information Technology for Economic and Clinical Health Act (HITECH) provisions are designed to engage dentists and other health care providers in adopting and using health IT for electronic data capture and health information exchange (HIE) in meaningful ways that can improve access to and quality of essential health services. These systems hold promise to expand and improve quality and access to care, enhance reporting and accountability, engage patients in their own wellness, create virtual networks of providers, and expand dentists’ roles in linking with primary health care and in the use of treatment guidelines and protocols. Furthermore, ARRA provides an opportunity for dentists to adopt and meaningfully use health IT/HIE with financial support from the Centers for Medicare & Medicaid Services (CMS). Although almost no dental services are covered by Medicare, dental services are covered comprehensively for children enrolled in Medicaid and CHIP and inconsistently across States for adults in Medicaid. Dentists are

Load more