FLORIDA S STATE ORAL HEALTH
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1 FLORIDA S FLORIDA S STATE ORAL HEALTH STATE ORAL HEALTH ACTION PLAN ACTION PLAN Division of Medicaid Erica Floyd-Thomas July
2 Presentation Objectives FLORIDA S What is the Oral Health Initiative? STATE ORAL HEALTH Provide an overview of Florida s State Oral Health Action Plan (SOHAP) Discuss interventions that are currently being implemented ACTION PLAN Takeaways from the Oral Health Initiative Future next steps 2
3 Oral Health Initiative FLORIDA S In 2010, the Centers for Medicaid and Medicare Services (CMS) launched the Children's Oral Health Initiative and set goals for improvement by the end of FFY STATE ORAL HEALTH Goal #1 Increase by 10 percentage points the proportion of ACTION PLAN Medicaid and CHIP children ages 1 to 20 (enrolled for at least 90 days) who receive a preventive dental service. Goal #2 Increase by 10 percentage points the proportion of Medicaid and CHIP children ages 6 to 9 (enrolled for at least 90 days) who receive a dental sealant on a permanent molar tooth. 3
4 Oral Health Initiative (cont.) CMS selected a total of five states in the fall of 2014 to participate in a learning collaborative to provide state Medicaid agencies with technical assistance to design, develop and implement a State Oral Health Action Plan (SOHAP) FLORIDA S STATE ORAL HEALTH District of Columbia, Kansas, Michigan, Utah and Florida ACTION PLAN Initial collaborative period October 27, May 15, 2015, which was later extended one additional year (May 2016). 4
5 Oral Health Initiative (cont.) FLORIDA S STATE ORAL HEALTH ACTION PLAN 5
6 Overview of the SOHAP FLORIDA S Describes and assesses the Florida Medicaid dental delivery system Addresses STATE structure, current ORAL workforce HEALTH participation, dental reimbursement rates, opportunities, and resources (which will improve dental service utilization and identify key barriers to preventive service utilization) ACTION PLAN Identifies key drivers of change and interventions needed to meet the CMS goals Utilizing a driver diagram & the Plan-Do-Study-Act (PDSA) cycle 6
7 Overview of the SOHAP (cont.) Determines the resources needed to implement the interventions What barriers will we encounter? Potential solutions? What technical assistance will be needed from CMS to overcome these barriers? 7
8 Overview of the SOHAP (cont.) 8
9 Interventions (in process) Use single, streamlined query for CMS-416 data collection Develop/adopt and distribute materials (working primarily through health plans) to educate parents on the importance of oral health 9
10 Interventions (Streamlined CMS-416 Query) How the need to improve data was identified: Discussions held regularly with the Centers for Medicare and Medicaid Services on Florida Medicaid s approach to collecting and reporting data and they suggested several areas to explore. We reviewed the CMS 416 report and several lines of data stood out as requiring additional review. 10
11 Interventions (Streamlined CMS-416 Query) Established an internal workgroup that included staff responsible for data, systems, policy, and managed care contracts. Significantly modified the methodology of compiling the data used to develop the CMS 416 report. Created a process to ensure that data utilized to define the eligible population was mutually exclusive. 11
12 Interventions (Streamlined CMS-416 Query) We closely examined the data used to compile the CMS 416 report and found opportunities for improvement Health access settings had to list only one or two procedure codes on their claim, even though more procedures could be completed in one encounter. Data on services rendered to Medicaid recipients that is not being reported or is under-reported: Most school-based dental programs and dental schools Grant-funded programs Dentists providing free care 12
13 Interventions (Streamlined CMS-416 Query) The internal workgroup conducted a line-by-line review of the coding used for the CMS 416 query Included staff responsible for data, systems, policy, and managed care contracts Achieved agreement on the areas where updates were required Developed and programmed a single, refined query Updated our billing system to allow for more detailed information on claims from health access settings Identified areas where data are unreported or under-reported for future targeted interventions 13
14 Interventions (Consumer Engagement) Performance Improvement Project (PIP) Check-Ins with health plans The sharing of ideas across health plans Discovered which plans (are/are not) utilizing the PDSA process Introduction of quality improvement tools Discussion of the importance of rapid cycle improvement Learned that health plans are doing much more than what is actually documented Health plans are monitoring data more frequently (monthly and weekly) Establishment of stakeholder connections between the Agency and the health plans 14
15 Interventions (Consumer Engagement) As part of the Agency s oral health social media campaign, a new logo has been developed The logo s message is one that is attempting to incorporate the overall health of the recipient 15
16 Takeaway from the OHI 35% 30% 25% 20% 15% 10% 5% Percent of Children Ages 1-20 Enrolled in Florida Medicaid for at Least 90 Continuous Days Receiving A Preventive Dental Service: FFY FFY 2015 * 0% FFY2011 FFY 2012 FFY 2013 FFY 2014 FFY 2015 * Florida s FFY 2015 goal is based on the state s FFY 2012 CMS-416 data. 16
17 Takeaway from the OHI 17
18 Next Steps The Agency seeks to partner with Head Start and Early Head Start centers to have federally qualified health centers and county health departments provide: Oral health assessments Screenings Fluoride varnish Education Referrals to dental homes 18
19 Questions? Contact Information: Thank you for your time! Erica Floyd-Thomas Agency for Health Care Administration Medicaid Policy Bob Reifinger Agency for Health Care Administration Medicaid Policy 19
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