Making ends meet while caring for patients with Medicaid and Children's Health Insurance Plan (CHIP) coverage can be challenging for the average dental practice. Many private practices are unable to accept Medicaid patients because the reimbursement rate still lags far behind private insurance. Also, the Medicaid credentialing and claims process is so burdensome that it would require extra dedicated staff just to manage the administrative aspects. On top of these challenges, it's difficult, if not impossible, for small practices seeing a limited number of Medicaid patients to absorb the losses from missed appointments, which tend to occur at a much higher rate for Medicaid patients than for commercial patients.
Fortunately, dental support organizations (DSOs) are uniquely positioned to help dentists expand access to care among Medicaid patient populations. By providing dental practices with nonclinical support services in areas such as marketing, purchasing, operations, accounting, and payroll, DSOs enable dentists to focus solely on patient care, all while leveraging technology and economies of scale to expand access, improve quality, and promote cost-effective solutions to reduce oral health disparities among Medicaid beneficiaries.
Here are five approaches that DSOs take to make Medicaid work for dentistry:
In any health-care profession, the doctor-patient relationship is at the core of a good practice. Dental care is no different. The DSO practice support model allows dentists to devote their full attention to patient care, which includes prevention education and relationship building. This focus on the patient is especially important when caring for traditionally underserved patient populations, including Medicaid beneficiaries, who often have complex care needs. Clinical leaders ensure that dentists have complete clinical autonomy and can make treatment decisions that are in the best interest of their patients.
Quality of care
The quality assurance and compliance programs developed by today's leading DSOs are unrivaled in the dental industry and are helping affiliated dentists lead the way in strengthening Medicaid program integrity. DSO-affiliated providers such as Kool Smiles use advanced electronic health records (EHR) systems in all dental offices to support their robust clinical auditing and quality assurance systems. These systems are monitored by dental clinical leaders to help ensure the consistent delivery of patient care that meets professional standards and ensures patient satisfaction. These programs also help dentists deliver the high-quality care that both taxpayers and Medicaid patients expect and deserve.
Economies of scale
By harnessing economies of scale, DSOs are able to streamline the claims process, achieve lower equipment and supply costs, and leverage information technology platforms to better absorb low Medicaid reimbursement rates. This helps dentists treat Medicaid patients while still operating profitably and efficiently, all while providing more conservative care than other dentists treating a comparable patient population.
Improved outcomes, lower cost
By significantly expanding access to dental care and education, DSOs are helping states improve dental health outcomes and lower Medicaid program costs. For example, here at Kool Smiles, approximately 80% to 90% of our patients are Medicaid or CHIP enrollees. By creating millions of dental homes for children and families who previously lacked access to dental care, Kool Smiles has played a significant role in improving Medicaid and CHIP dental use in key states. Data from the Centers for Medicare & Medicaid Services (CMS) show that in states where Kool Smiles has a large presence, improvement in Medicaid dental access is higher at the state level than the national average (figures 1-3). A recent Dobson DaVanzo study of Kool Smiles patient data in several states revealed that, as a result of our focus on preventive dental health care, Kool Smiles providers performed 15% fewer services overall and had a Medicaid expenditure 33% lower than non-Kool Smiles Medicaid patients.2 These cost-effective strategies amount to Medicaid savings that could fund dental services for up to 1.9 million more children who currently do not receive care.
Data from the Centers for Medicare & Medicaid Services (CMS)1 show that in states where Kool Smiles has a large presence, improvement in Medicaid dental access among children eligible for the early and periodic screening, diagnostic and treatment (EPSDT) benefit is higher at the state level than the national average.
By leveraging new information technology platforms, DSOs can help affiliated practices operate efficiently and at lower costs. For example, Kool Smiles uses a centralized, cloud-based practice management platform to provide dentists with real-time access to patient records, ensure consistent quality standards, and streamline claims processing so staff have more time to spend with patients. DSOs are also pioneering the use of electronic data interchange systems to better manage Medicaid's complicated billing process, further reducing the administrative burden on staff. Technology allows DSOs to better communicate with their patients, which reduces the frequency of missed appointments. Furthermore, by grouping practices under one organization, dental offices around the country, both large and small, can benefit from shared technology resources.
DSOs are revolutionizing the way dental care is delivered while improving quality and expanding access to millions of Americans. In the coming years we can expect to see this trend toward modernizing dental care continue as more dental practices, managed care organizations, and state Medicaid programs come to realize that, if done right, Medicaid can work for dentistry.
1. Medicaid Dental Programs in Seven States Could Save $550 Million Annually or Provide Care for 1.9 Million More Children Through Adoption of Kool Smiles Practice Model. Benevis Practice Services website. benevis.com/study/. Accessed February 14, 2017.
2. DaVanzo J, El-Gamil A, Manolov M, Chen D, Dobson A. Comparison of Kool Smiles Utilization and Medicaid Expenditures Across States using Government-Provided Data. Benevis Practice Services website. http://benevis.com/wp-content/uploads/2016/02/Dobson-DaVanzo-Final-Report-for-Benevis-Presentation-1-31-1611.pdf. February 1, 2016. Accessed February 14, 2017.
Dale Mayfield, DMD, is chief dental officer at Kool Smiles. Kool Smiles is affiliated with Benevis, an Atlanta-based DSO.